Nasar U. Ahmed

Factors Explaining Racial/Ethnic Disparities in Rates of Physician Recommendation for Colorectal Cancer Screening

OBJECTIVES Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation. METHODS Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates. RESULTS Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income for Blacks. After accounting for the effects of usual source of care, insurance coverage, and education, the disparity reduced and became statistically insignificant. CONCLUSIONS Socioeconomic status and access to health care may explain major racial/ethnic disparities in CRC screening recommendation rates.

Breast cancer knowledge and barriers to mammography in a low-income managed care population.

Background. Low-income women experience multiple barriers to screening mammography. This study explored cancer knowledge as a point of intervention to reduce overall barriers. Methods. A survey of breast cancer knowledge and barriers was obtained from 173 low-income female residents of Middle Tennessee, ≥40 years, enrolled in the state managed care organization and nonadherent to mammography. Multiple regression models examined the effect of breast cancer knowledge on mammography screening barriers. Results. Comprehensive breast cancer knowledge, not mere screening awareness, was the strongest contributor towards lower barrier scores. Conclusions. Strategies to overcome mammography barriers should include comprehensive breast cancer education.

Bayesian Method for Modeling Male Breast Cancer Survival Data

BACKGROUND With recent progress in health science administration, a huge amount of data has been collected from thousands of subjects. Statistical and computational techniques are very necessary to understand such data and to make valid scientific conclusions. The purpose of this paper was to develop a statistical probability model and to predict future survival times for male breast cancer patients who were diagnosed in the USA during 1973-2009. MATERIALS AND METHODS A random sample of 500 male patients was selected from the Surveillance Epidemiology and End Results (SEER) database. The survival times for the male patients were used to derive the statistical probability model. To measure the goodness of fit tests, the model building criterions: Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), and Deviance Information Criteria (DIC) were employed. A novel Bayesian method was used to derive the posterior density function for the parameters and the predictive inference for future survival times from the exponentiated Weibull model, assuming that the observed breast cancer survival data follow such type of model. The Markov chain Monte Carlo method was used to determine the inference for the parameters. RESULTS The summary results of certain demographic and socio-economic variables are reported. It was found that the exponentiated Weibull model fits the male survival data. Statistical inferences of the posterior parameters are presented. Mean predictive survival times, 95% predictive intervals, predictive skewness and kurtosis were obtained. CONCLUSIONS The findings will hopefully be useful in treatment planning, healthcare resource allocation, and may motivate future research on breast cancer related survival issues.

Are Women With Functional Limitations at High Risk of Underutilization of Mammography Screening

OBJECTIVES Women with functional limitations face obstacles in adhering to established mammography guidelines owing to personal factors and barriers within the health care system. Whereas some studies have focused on either physical or cognitive limitations that correlate with lower rates of cancer screening, this study examined multiple functional limitations (physical, psychological, and sociability) and mammography screening. METHODS Data from the 2000 National Health Interview Survey were analyzed for 9,505 women aged > or =40 years. We hypothesized that women with functional limitations (physical, psychological, and/or sociability) are less likely to receive screening mammography. Access variables (insurance coverage and usual source of health care) and utilization variables (physician contact and receipt of clinical breast examination) were included. Using multiple logistic regression (MLR), we estimated the relative contribution of functional limitations on mammography use after accounting for sociodemographic characteristics and confounding variables. RESULTS An estimated 34.6% of women had physical limitations, 16.1% sociability limitations, and 8.1% psychological limitations. After controlling for all other variables, MLR analysis indicated that women with moderate or severe sociability limitations were less likely than their unimpaired counterparts to utilize mammography (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.81). Interestingly, women with severe physical limitations were more likely than physically able women to utilize mammography screening (OR, 1.28; 95% CI, 1.07-1.53). Women with no insurance, no usual care, and no doctors visit within the past year were substantially less likely to use mammography screening. CONCLUSIONS Sociability limitations, lack of access to health care, and limited regular checkups played significant roles in underutilization of screening mammography.

How the health care system can improve mammography-screening rates for underserved women: a closer look at the health care delivery system.

The way care is delivered has dramatic impact on the patient-provider interaction and the outcomes experienced by the patient. This article explores a deceptively simple but very powerful method for evaluating and improving care delivery. Mammography is a routine screening procedure. However, many factors can influence how frequently women seek and obtain mammograms. Twenty-five low-income women identified empowering factors and barriers they experienced when trying to obtain a mammogram.

The Effectiveness of Red Light Cameras in the United States—A Literature Review

Objective: To examine the available scientific evidence based on peer-reviewed publications concerning the effectiveness of red light cameras (RLCs) within the U.S. traffic system. Methods: Relevant literature published prior to December 2012 was retrieved from the PubMed, Medline, and Engineering Index databases using free-text term queries. Jurisdictions with either a fixed number of RLCs studied or area wide programs within the United States were included. RLC studies with additional interventions were excluded. Nine RLC studies were extracted and grouped into 3 categories based on outcome measures: violations, crashes, and injuries/fatalities. Results: All 9 studies reviewed showed significant reductions in the frequency/rate of violations, crashes, and injuries at intersections after RLC implementation. RLC interventions appear to decrease violations, crashes, and injuries at intersections. Conclusions: Despite limited peer-reviewed publications available in the literature, it appears that RLCs decrease violations, crashes, and injuries at intersections. Some studies, however, contained methodological shortcomings. Therefore, the apparent effectiveness should be confirmed with stronger methodological approaches. Although spillover effects appeared to be evident, many of the jurisdictions examined were small in area. Thus, it is unknown whether spillover resulting from RLCs would have similar effects in large metropolitan areas. To determine the full public health impact of RLC programs, crashes, injuries, and fatalities should be considered as primary outcomes of interest. To accomplish this requires a clear definition of which types of crashes will be included for RLC studies. Lastly, it is unknown whether RLCs would be effective in reducing crashes resulting from distracted or alcohol-impaired drivers. Future studies should examine the effects of RLCs by exclusively analyzing these crash types.

Prevalence of Smokeless Tobacco among Low Socioeconomic Populations: A Cross-Sectional Analysis

Background Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations. Aims To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh. Methods A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users. Results Almost fifty percent of the respondents initiated SLT usage at the age of 15–24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01) about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0.01). Regarding the knowledge about the health consequences of the practice of SLT, one participant in the FGD session commented that “although the mouth is the gateway to health, we infected our mouth by using Zarda and Gul”. Again, informants opined that peer, family, curiosity and hospitality, culture are influencing factors for SLT initiation. Conclusion counselling on tobacco, including SLT, health hazards have to be emphasized through mass media and it is essential for development of relevant policies and communication messages to make people aware of serious health consequences of SLT usages.

The Impact of Red Light Cameras on Crashes Within Miami–Dade County, Florida

Objective: To determine the safety effect of red light camera (RLC) programs, this study attempted to estimate its impact on collisions within Miami–Dade County, Florida Methods: A before–after evaluation using a comparison group along with traffic control correction was employed. Twenty signalized intersections with RLCs that began enforcement on January 1, 2011, were matched to 2 comparison sites located at least 2 miles from camera sites to minimize spillover effect. An empirical Bayes analysis was used to account for potential regression to the mean effects. An index of effectiveness along with 95% confidence intervals were calculated based on the comparison between the estimated and actual number of crashes in the after period. Results: During the first year, RLC sites experienced a marginal decrease in right angle/turn collisions (−3%), a significant increase in rear-end collisions (+40%), and significant decreases in all injury (−19%) and RLR-related injury collisions (−24%). An increase in right angle/turning (+14%) and rear-end (+51%) collisions at the RLC sites was observed after 2 years despite camera enforcement. A significant reduction in RLR-related injury crashes (−17%), however, was still observed after 2 years. A nonsignificant decline in all injury collisions (−12%) was also noted. Conclusions: RLCs showed a benefit in reducing RLR-related injury collisions at camera sites after enforcement commenced, yet its tradeoff was a large increase in rear-end collisions. There was inconclusive evidence whether RLCs affected right angle/turning and all injury collisions. Statutory changes in crash reporting during the second year of camera enforcement affected the incidence of right angle and rear-end collisions; nevertheless, a “novelty effect” could not be ruled out. Future research should consider events such as low frequencies of severe injury/fatal collisions and changes in crash reporting requirements when conducting RLC analyses.

State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers

Background. The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County. Method. In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day. Results. Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation. Conclusion. CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood.

A Review: Associations Between Attention-deficit/hyperactivity Disorder, Physical Activity, Medication Use, Eating Behaviors and Obesity in Children and Adolescents

ABSTRACT In the past few years we have become increasingly aware of strong associations between obesity and ADHD. Both conditions are major public health issues, affecting children, adolescents and adults alike. Objective: This review seeks to (1) examine prior research on the association between ADHD and obesity in children and adolescents; (2) discuss mechanisms and consequent behavioral attributes to gain understanding of the path association between ADHD and obesity, (3) review studies examining the role of physical activity, medication, eating behavior and gender on the relationship between ADHD and obesity in children and adolescents. Method: PubMed, CINAHL and PsycINFO databases were used to search for studies whose subjects were children and adolescents, ages 0–17years and whose publication years were from 2000 to 2016. After screening 31 studies were included in the review. Results: The literature suggests that there is a significant association between ADHD and obesity. Further, the inattentive and impulsive behaviors that characterize ADHD could contribute to dis‐regulated eating behaviors and a lack of motivation to engage in physical activity. In addition, it is proposed that medication, gender and physical activity play a role in mediating and moderating the relationship between ADHD and obesity. HIGHLIGHTSEvidence for understanding the association between ADHD and obesity.The impact physical activity, medication, eating behavior and gender have on the relationship between ADHD and obesity.Includes the latest research in the field assessing the relationship between ADHD and obesity in children and adolescents.Rationale for offering preventive strategies for obesity for those diagnosed with ADHD.