Luis F. Velez

The impact of education and literacy levels on cancer screening among older Latin American and Caribbean adults.

BACKGROUND There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries. METHODS To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years. RESULTS In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men. CONCLUSIONS Older adults with low educational or literacy levels should be targeted for screening programs in these populations.

Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities

BACKGROUND The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance. METHODS A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status. RESULTS Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance. CONCLUSIONS In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.

Efectos de las intervenciones diseñadas para prevenir las muertes de motociclistas en Cali, Colombia (1993-2001)

OBJETIVO: Este estudio se ideo para describir el efecto de las intervenciones dirigidas a disminuir las muertes de los motociclistas. MATERIAL Y METODOS: Se analizaron las variaciones en la mortalidad de motociclistas en Cali, al momento de aplicarse las intervenciones, y el significado estadistico de dichos cambios, entre 1993 y 2001. RESULTADOS: La tasa de muerte de motociclistas por cada 100 000 habitantes se redujo de 9.7 en 1995 a 3.6 en 2001. La mayor reduccion se observo despues de la introduccion del uso del casco protector en 1996 (12.3%). Otras medidas como la obligatoriedad del casco para los pasajeros, el uso del chaleco reflectivo, la prohibicion de usar motocicletas en dias de diciembre y la exigencia de cursos para infractores redujeron en su conjunto aun mas la mortalidad, mientras que el debilitamiento de la vigilancia la incremento. CONCLUSIONES: La implantacion y ejecucion de medidas combinadas de prevencion resultan mas efectivas que las medidas individuales o desarticuladas.

Tobacco Control Policy Advocacy Attitudes and Self-Efficacy Among Ethnically Diverse High School Students

This study applied self-efficacy theory to assess empowerment to advocate on behalf of tobacco control policies. The Youth Tobacco Survey with added policy advocacy self-efficacy, attitudes, and outcome expectations scales was given to 9,177 high school students in Texas. Asians showed the lowest prevalence of experimentation and current smoking, followed by African Americans. Anglo-Europeans had higher rates of current smoking. Latino male students had the highest experimentation and current smoking rates. Policy advocacy self-efficacy was higher among African Americans. Latinos scored lowest. Asians had the highest level of approval for tobacco control policies. African Americans had the highest scores in policy advocacy outcome expectations, followed by Asians and Latinos. Anglo-Europeans scored lowest. Students who had never tried smoking had the highest scores in all three scales, with a decreasing trend as the frequency of smoking increased. Associations with smoking status remained significant when controlling by gender and ethnicity