Lisa T. Wigfall

HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data.

OBJECTIVE AND BACKGROUND Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. METHODS Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. RESULTS More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship. CONCLUSIONS Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.

Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis

OBJECTIVE Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States. METHODS County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs. We compared breast cancer MIRs based on the density and availability of FQHC delivery sites with or without mammography services both in the county and in the neighboring counties. RESULTS The relationship between breast cancer MIRs and access to mammography services at FQHCs differed by race and county of residence. Breast cancer MIRs were lower in counties with mammography facilities or FQHC delivery sites than in counties without a mammography facility or FQHC delivery site. This trend was stronger in urban counties (p=0.01) and among whites (p=0.008). Counties with a high density of mammography facilities had lower breast cancer MIRs than other counties, specifically in urban counties (p=0.01) and among whites (p=0.01). Breast cancer MIR for blacks was the lowest in counties having mammography facilities; and was highest in counties without a mammography facility within the county or the neighboring counties (p=0.03). CONCLUSIONS Mammography services provided at FQHCs may have a positive impact on breast cancer MIRs. Expansion of services provided at the FQHCs and placement of FQHCs in additional underserved areas might help to reduce cancer disparities in the United States.

HIV testing among Deep South residents 50 to 64 years old with cardiovascular disease and/or diabetes.

PURPOSE To describe HIV testing among Deep South residents aged 50 to 64 years old with cardiovascular disease (CVD) and/or diabetes. METHODS Deep South residents from Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina who completed the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey were sampled. Associations between chronic health conditions (CVD, diabetes) and human immunodeficiency virus (HIV) testing were examined. RESULTS Fewer than one-third (30.8%) of the sample (n = 1017) reported that they had been tested for HIV. Of the weighted sample of adults tested for HIV, the mean age--56.63 +/- 0.20 SE (95% confidence interval [CI], 56.24-57.03)--was significantly lower than that of those who had never been tested for HIV--57.60 +/- 0.12 SE (95% CI, 57.37-57.84; p < .0001). Although not statistically significant, HIV testing was slightly higher among men (53.3%) (p = .9432). Persons with CVD or diabetes were 22% less likely to report that they had been tested for HIV, compared to those with both CVD and diabetes (adjusted odds ratio [AOR], 0.776; 95% CI, 0.611-0.985). CONCLUSIONS Chronic conditions (CVD, diabetes) among HIV-infected persons can be adversely affected by antiretroviral regimens. All adults 50 to 64 years old should be routinely offered an HIV test if their HIV serostatus is unknown, regardless of perceived risk for HIV/AIDS. Our findings suggest that linking HIV testing with routine checkups for persons with CVD and/or diabetes is a potentially missed opportunity for earlier diagnosis of HIV infection, especially among older adults who are at a greater risk of being diagnosed with AIDS within 1 year of an initial HIV-positive diagnosis.

HPV High Risk and Protective Behaviors: The Effects of Religious Affiliation

The majority of Americans identify themselves as belonging to some religious group. There is a mixed body of literature on whether or not religious affiliation has an influence on engaging in risky behaviors among young adults attending college. This study examined associations between religious affiliation, risky sexual practices, substance use, and family structure among a sample of predominantly white college females attending a southeastern university. Given the high risk of acquiring genital human papillomavirus infection as a result of high risk sexual practices, gaining a better understanding of how religious affiliation can be used to promote healthy sexual behaviors is warranted.

Development of the Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project Coordinating Center: Challenges and Opportunities Within a University/Community Partnership

The Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project was designed to be a partnership between the Institute for Partnerships to Eliminate Health Disparities at the University of South Carolina and the Fort Jackson United States Army Base located in Columbia, South Carolina. SHPERHD Project researchers are studying problems related to obesity and weight management, musculoskeletal injuries and infection, and mental health issues during recruitment, basic training, and post-deployment. In order to successfully develop targeted interventions to prevent and lower the incidence of injury, promote healthy nutrition, and decrease mental health issues, at the same time also reducing disparity gaps, the SHPERHD Project comprises a professional, technical, and administrative staff with specific competence in the operation of a Coordinating Center to handle the wide variety of areas related to military studies. This article discusses the procedures and processes that were implemented in the development of the SHPERHD Project Coordinating Center.

Patient-provider communication with HIV-positive women about abnormal Pap test results

ABSTRACT In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

Cancer Information Seeking and Cancer-Related Health Outcomes: A Scoping Review of the Health Information National Trends Survey Literature.

Cancer is a leading cause of death among adults in the United States. Only 54% of U.S. adults reported seeking cancer information in 2014. Cancer information seeking has been positively associated with cancer-related health outcomes such as screening adherence. We conducted a scoping review of studies that used data from the Health Information National Trends Survey (HINTS) in order to examine cancer information seeking in depth and the relationship between cancer information seeking and cancer-related health outcomes. We searched five databases and the HINTS website. The search yielded a total of 274 article titles. After review of 114 de-duplicated titles, 66 abstracts, and 50 articles, 22 studies met inclusion criteria. Cancer information seeking was the outcome in only four studies. The other 18 studies focused on a cancer-related health outcome. Cancer beliefs, health knowledge, and information seeking experience were positive predictors of cancer information seeking. Cancer-related awareness, knowledge, beliefs, preventive behaviors, and screening adherence were higher among cancer information seekers. Results from this review can inform other research study designs and primary data collection focused on specific cancer sites or aimed at populations not represented or underrepresented in the HINTS data (e.g., minority populations, those with lower socioeconomic status).

HIV Testing Among Deep South Residents With Serious Psychological Distress

OBJECTIVE To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. METHODS Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersens behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. RESULTS Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60%). Predisposing factors (age, race/ethnicity, and urbanization) were confounders of HIV testing among both males and females with serious psychological distress. Enabling factors (income, health care access) were only confounders of HIV testing among males with serious psychological distress. CONCLUSION Future HIV prevention and management efforts should consider the potential role of concurrent serious psychological distress in impacting an individuals daily life and health activities such as self-care, caring for family, and maintaining employment.

Reasons for not adhering to cervical cancer screening guidelines and HPV knowledge among HIV indeterminate midlife women (50-64 years old) whose last Pap test was >6 years ago

Reasons for not adhering to cervical cancer screening guidelines and HPV knowledge among HIV indeterminate midlife women (50-64 years old) whose last Pap test was >6 years ago Lisa T Wigfall, Heather M Brandt, Donna L Richter, Wayne A Duffus, Saundra H Glover From 12 International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) Bethesda, MD, USA. 26-27 April, 2010

Psychological Distress and Health Insurance Coverage among Formerly Incarcerated Young Adults in the United States

The United States incarcerates more people per capita than any other nation. Studies have consistently demonstrated higher prevalence of serious mental illness among the incarcerated. Although health care may be available to individuals while incarcerated, research is needed to understand the context of health care coverage and mental health after incarceration. The purpose of this study is to estimate the point prevalence of psychological distress (PD) among young adults with incarceration experience, while comparing the prevalence to that of young adults in the general population. Additionally, this study characterizes the relationship between incarceration experience and PD, while also examining this association given an individuals health insurance coverage status among young adults. Lastly, we examine if other individual, contextual, and behavioral factors influences the relationship between incarceration experience and PD, in addition to their health insurance coverage status. This study utilizes data from the 2008 panel of the National Longitudinal Survey of Youth 97, a population based survey dataset from the U.S. Department of Labor. Andersens Behavioral Model of Health Services Use provided the conceptual framework for the study. The Mental Health Index 5 (MHI-5) was used to determine PD or normal mental health. Chi-square testing and multivariate logistic regression were performed to examine incarceration experience in association to PD. The sample with incarceration experience reported almost double the proportion of PD (21%) compared to those without an incarceration experience (11%). Young adults who have been incarcerated reported greater odds of PD than those with no incarceration experience (COR 2.18; 95% CI, 1.68–2.83) and the association was diminished in the presence of health insurance status and model covariates. Future health prevention and health management efforts should consider the impact of health insurance coverage status, health behaviors, and life satisfaction on mental health status among young adults with incarceration experience.