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Purpose: To examine whether sociodemographic characteristics, access to care, risk behavior factors, and chronic health conditions were associated with colorectal cancer (CRC) screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. Methods: We analyzed the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data on 9780 eligible cancer survivors. Descriptive statistics and multivariable logistic regression models were applied to assess the association between guideline-concordant CRC screening and the mentioned characteristics. Results: Overall, 81.9%, 65%, 88%,78.1%, and 80.1% of breast, cervical, prostate, skin, and lung cancer survivors received CRC screening, respectively (p-value < 0.001). In multivariable analysis, breast, cervical, and skin cancer survivors aged 60 years or older were associated with higher odds of receiving CRC screening. Respondents that had their recency of routine checkup two or more years before had lower odds of having CRC screening among cervical (OR = 0.06; 95% CI, 0.02–0.22), prostate (OR = 0.26; 95% CI, 0.14–0.49), and skin cancer (OR = 0.50; 95% CI, 0.36–0.70) survivors. The presence of chronic diseases was also associated with guideline-concordant CRC screening among breast, prostate, and skin cancer survivors. Conclusions: Our findings provide important evidence on potential factors that are associated with guideline-concordant CRC screening utilization across different cancer survivors, which include older age, recency of routine checkup, and multiple chronic diseases. Moreover, variation in CRC screening utilization across cancer survivors may highlight missed opportunities for secondary cancer prevention. Implications for Cancer Survivors: Establishing clear CRC screening guidelines and including patient-provider communication on recommendation in cancer survivorship care may increase adherence to CRC screening. [ABSTRACT FROM AUTHOR]

Objectives: Periodontitis is a non-communicable disease (NCD) that may be linked to other NCDs through shared risk factors. Accordingly, we analyzed the relationship between periodontitis and behavioral and metabolic risks common to NCDs in Brazilian adults over three decades. Methods: Indicators of periodontitis, behavioral risks (smoking, alcohol use, sugar-sweetened beverages (SSB), and physical activity), and metabolic risks (overweight/obesity, dyslipidemia, hyperglycemia, and hypertension) in Brazilian adults (25–49 y-old) between 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Data were adjusted for Gini index. Fixed-effects and Prais-Winsten regressions were performed (p < 0.05). Results: The prevalence of periodontitis has increased among Brazilians since 2005. High-SSB diet, alcohol use, and metabolic risks increased between 1990–2019, whereas smoking decreased. In crude models, periodontitis prevalence increased with alcohol use (2545.1; 95%CI: 2307.9–2782.3), high-SSB diet (365.5; 95%CI: 322.5–408.4), low physical activity (1784.4; 95%CI: 763.7–2805.0), overweight/obesity (172.3; 95%CI: 156.3–188.4), dyslipidemia (734.5; 95%CI: 624.7–844.2), and hyperglycemia (1774.3; 95%CI: 1555.9–1992.7). After adjustment for the Gini index, periodontitis prevalence raised with a high-SBB diet (1416.0; 95%CI: 1120.2–1711.8), overweight/obesity (629.9; 95%CI: 573.1–686.8), dyslipidemia (2035.8; 95%CI: 1728.1–2343.5), and hyperglycemia (8918.1; 95%CI: 7979.8–9856.3). Conclusions: Periodontitis has increased in Brazil since 2005, despite the smoking reduction. Sugar-sweetened beverage was the behavioral risk that mostly accompanied the periodontal trend. Clinical relevance: Our results support upstream strategies targeting commercial, social, political, and structural determinants to tackle NCDs and reduce oral health inequities. [ABSTRACT FROM AUTHOR]

Introduction: Concerns over the escalating burden of non-communicable diseases call for the redressal of behavioral risk factors like increased body mass index. Most studies have failed to quantify the contribution of socio-demographic characteristics in a linear trend. The present study aims to estimate the current prevalence of overweight and obesity in Indian adults and the contribution of different socio-demographic factors to the increasing prevalence. Methods: We carried out a secondary data analysis of two National Family Health Survey (NFHS) rounds. The final sample includes 558,122 women and 84,477 men from round 4, and 574,099 women and 74,761 men were included from round 5, using a multi-stage stratified random sampling approach. Overweight/obesity was our primary dependent variable. Weighted bivariate analysis was used to ascertain the prevalence, and the adjusted odds ratios were computed to ascertain the potential predictors. The contribution of different factors towards rising burden over two time points was estimated using multivariate decomposition analysis for non-linear response models. Results: Overall weighted prevalence of overweight and obesity in males and females per NFHS-5 was 44.02% and 41.16%, respectively, compared to 37.71% and 36.14% in NFHS-4. Decomposition analyses depict that the proportion of obesity increased by 6.37% and 5.10% points among men and women, respectively, over the two rounds. Compositional differences of participants (endowment) attributed to 16.54 and 49.90% differences, and the difference in coefficient or effect accounted for 83.46 and 50.10%, respectively, of the increase in the prevalence. The most significant factors contributing to increased prevalence were age, improving socio-economic status, smoking, unclean cooking fuel, and diabetes. Conclusions: The incremental rise in such a short period, mainly attributed to the effect of socio-demographic variables, is concerning. Policy interventions should prioritize health advocacy programs and aggressively target behavioral modifications while preparing the health systems to manage the people living with obesity. [ABSTRACT FROM AUTHOR]

Background: The lack of adequate data on the oral health status among the Egyptians is a challenging barrier for the assessment and improvement of oral health needs. Objectives: The aim of this study was to collect data on oral health status among a sample of Egyptian rural population and to assess the possible role of the socio-demographic, socio-economic, and behavioral risk factors on the status of the present dentition (the pattern of tooth loss and edentulism). Materials and methods: Data was collected from 530 patients with age ranged from 20 to 70 years using a modified World Health Organization (WHO) questionnaire. The questionnaire included information about oral health status, socio-demographic (age and sex), socio-economic (educational levels and income), and behavioral factors (smoking and oral hygiene measures). A complete intra- and extraoral examination and free dental health care services were provided by a team of qualified dental specialists from National Research Centre (NRC). Data was analyzed using chi-square and Spearman's correlation tests, and the significance level was validated at p < 0.05. Results: Females comprised 79% while males were 21% of the surveyed rural sample. Concerning socio-economic aspects including the level of education and income, it was found that 50% of the individuals completed their secondary educational levels, followed by illiterates 35.5% and preparatory levels, while college graduates were minority 4.7%. On the other hand, only 27.5% of rural had income while 72.5% of them had no income. Assessment of behavioral risk factors (oral hygiene procedures and smoking) showed that only 34.3% of the individuals claimed to brush their teeth and only a minority were male smokers (13.8%). The results demonstrated poor oral health status and increased incidence of partial edentulism (45%), where Kennedy class III was the most common type (34.6%). Conclusions: Lack of oral hygiene measures specifically tooth brushing is the most significant behavioral risk factor for the poor oral health status and tooth loss in this survey. Sociodemographic and socio-economic factors are influential risk factors for tooth loss. Cigarette smoking was not a main behavioral risk factor that impacts the oral health status in the present survey [ABSTRACT FROM AUTHOR]

Purpose This study investigated the relationship between the individual’s self-assessed health status (SAHS) and health-risk factors (smoking, alcohol consumption and obesity), in 16 European countries. The associations were studied for the individual and for the country measures—and in particular, for the unexplored aspect of interaction between individual and country levels of the three risk factors. Method Data for 47,114 adults, who participated in the Survey of Health Aging and Retirement Europe (SHARE), were analyzed using Multilevel Regression Analysis. The individual data were com plemented by OECD data that provided country-specific risk measures: percentage of daily smokers, annual per-capita consumption of alcohol (liters), and percentage of obese individuals. Results We found that the individual ’ s SAHS is negatively associated with smoking and with weight-risk factors and is positively associated with her/his alcohol consumption. The most pronounced associations relate to the weight variables, albeit they are attenuated in countries with higher percentages of obese individuals. Significant differences across countries were evidenced in the association between SAHS and smoking and between SAHS and alcohol consumption. Conclusion Individual health levels are associated with individual risk factors and also with the behaviors in the country. Significant interactions might indicate that psychological factors are at work. [ABSTRACT FROM AUTHOR]

Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent. [ABSTRACT FROM AUTHOR]

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Hispanics are more likely to be diagnosed with breast cancer at a younger age, with more advanced stage at diagnosis, hormone receptor-negative tumors, and worse prognosis than non-Hispanic whites (NHW). Little is known regarding the association between behavioral risk factors and breast tumor characteristics and whether these associations vary by race/ethnicity. We evaluated the association between several behavioral risk factors and tumor phenotype in a population-based study of Hispanics and NHWs. Participants are cases (846 Hispanic and 1,625 NHW women) diagnosed with breast cancer between 1999 and 2004 in Arizona, Colorado, New Mexico, or Utah. The association between breast cancer characteristics and obesity, physical activity, smoking, alcohol intake, and reproductive factors was examined. Logistic regression was used to compute the ethnic-specific odds ratios for the association between these risk factors and estrogen receptor (ER) status, tumor size, and histologic grade. Hispanics had more ER-negative tumors (28 vs. 20%), tumors >2 cm (39 vs. 27%), and poorly differentiated tumors (84 vs. 77%) than NHW. Among premenopausal women, obesity was associated with more ER-negative cancers among NHW [OR = 2.47 (95% CI: 1.08, 5.67)] but less ER-negative cancers among Hispanics [OR = 0.29 (0.13, 0.66)]. Obesity was associated with larger tumors among NHW [OR = 1.58 (1.09, 2.29)], but not among Hispanics. Never using mammography was associated with larger tumors in both ethnic groups. Moderate alcohol drinking and moderate and vigorous physical activity were weakly associated with smaller tumors in both ethnic groups. Our findings suggest that the association of obesity and other behavioral risk factors with breast cancer characteristics differ by ethnicity. We observed a divergent pattern between Hispanic and NHW cases in the association between obesity and ER status and tumor size. These observations suggest that a complex set of metabolic and hormonal factors related to estrogen and insulin pathways influence tumor characteristics. [ABSTRACT FROM AUTHOR]

Many falls occur among older adults with no traditional risk factors. We examined potential independent effects of lifestyle on fall risk. Not smoking and going outdoors frequently or infrequently were independently associated with more falls, indicating lifestyle-related behavioral and environmental risk factors are important causes of falls in older women. Physical and lifestyle risk factors for falls and population attributable risks (PAR) were examined. We conducted a 4-year prospective study of 8,378 community-dwelling women (mean age = 71 years, SD = 3) enrolled in the Study of Osteoporotic Fractures. Data on number of falls were self-reported every 4 months. Fall rates were calculated (# falls/woman-years). Poisson regression was used to estimate relative risks (RR). Physical risk factors ( p ≤ 0.05 for all) included tall height (RR = 0.89 per 5 in.), dizziness (RR = 1.16), fear of falling (RR = 1.20), self-reported health decline (RR = 1.19), difficulty with Instrumental Activities of Daily Living (IADLs) (RR = 1.12, per item), fast usual-paced walking speed (RR = 1.18, per 2 SD), and use of antidepressants (RR = 1.20), benzodiazepines (RR = 1.11), or anticonvulsants (RR = 1.62). Protective physical factors ( p ≤ 0.05 for all) included good visual acuity (RR = 0.87, per 2 SD) and good balance (RR = 0.85 vs. poor). Lifestyle predicted fewer falls including current smoking (RR = 0.76), going outdoors at least twice weekly but not more than once a day (RR = 0.89 and vs. twice daily). High physical activity was associated with more falls but only among IADL impaired women. Five potentially modifiable physical risk factors had PAR ≥ 5%. Fall interventions addressing modifiable physical risk factors with PAR ≥ 5% while considering environmental/behavioral risk factors are indicated. [ABSTRACT FROM AUTHOR]

Little is known about sex work in Tashkent, Uzbekistan, despite rapid increases in HIV infection. Consistent client condom use and prior HIV testing are described among 448 female sex workers (FSW) completing a self-administered questionnaire, health provider interview, and HIV testing between April 2003 and March 2004. Participants were recruited through outreach workers using modified snowball sampling. Consistent client condom use was more likely for FSW who were married, knew condoms prevent HIV, and from countries in south Central Asia. Prior HIV testing was less likely for FSW younger than 21 years, who shared drugs with clients, initiated sex work at 18 years or less and had engaged in sex work less than 2 years. Low rates of condom use, particularly by those with risky drug behaviors, indicate that targeted risk-reduction interventions are urgently needed. [ABSTRACT FROM AUTHOR]