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To identify patterns of Internet use among childhood and young adult cancer survivors who smoke.Baseline assessment data were collected from 2005 to 2008 for the Partnership for Health-2 (PFH-2) study, a web-based smoking cessation intervention for childhood and young adult cancer survivors. Participants were surveyed about their Internet access and use. Sociodemographic, clinical, and psychosocial data also were collected.Internet access and use was widespread among PFH-2 participants. However, older, less-educated, and female survivors reported less frequent Internet use, even when they had access to the Internet at home and/or at work. These associations were significant in multivariable analyses.Although the digital divide is narrowing, Internet use and engagement remains socially patterned. web-based prevention interventions are a promising method of reaching this geographically dispersed, high-risk population, but certain subgroups-particularly older and lower socioeconomic status survivors-might be missed by this approach.

OBJECTIVES: To examine adherence rates for multiple cancer screening tests, which will inform prevention efforts in community health centers (CHCs). METHODS: We report on the prevalence of screening for multiple cancers (cervical, breast, colorectal) among 43,000 patients who are predominantly Hispanic, in four CHC sites that share an integrated electronic medical record. RESULTS: Among the 20,057 patients eligible for at least one test, 43% of the population was current on all screening targets; 15,887 additional screening tests were needed among 11,526 individuals. CONCLUSIONS: Expanding use of health information technology in community health centers provides an opportunity to create an electronic infrastructure for addressing multiple screening needs from a patient-centered perspective.

The primary aim of this paper was to explore whether provider's understanding of patient's social context is associated with screening uptake, independent of provider's recommendation. Baseline data were collected in 2004-2005 from a cluster randomized control trial in 12 low-income housing sites. Participants included 695 low-income, multiethnic adults aged 50 years and over who were primarily insured (97%). Provider's recommendation was significantly associated with current adherence to colorectal cancer (CRC) screening. Provider's understanding of patient's social context, as operationalized by how well participants felt that their provider knew (a) their responsibilities at work, home, or school; (b) their worries about health; and (c) them as a person and their values and beliefs, was also significantly associated with current adherence to screening, independent of provider's recommendation. Participants who reported that their provider knew them well on two or three items were significantly more likely to be current with CRC screening compared to those who reported their provider knew them well on only one or none of the items (odds ratio = 1.56; 95% confidence interval = 1.06, 2.29). Our findings indicate that provider's understanding of patient's social context, independent of provider's recommendation for CRC screening, contributed to adherence to CRC screening in this low-income, multiethnic population.

To characterize the smoking-related services available to childhood cancer survivors and describe organizational characteristics that were related to institutions’ capacity to provide smoking services. Institutions affiliated with the Children’s Oncology Group were surveyed from 2003 to 2004. Of the 132 responding institutions, 85% assessed the smoking status of their cancer survivors intermittingly, but only 3% assessed smoking status at every visit, as recommended by the PHS guidelines. A minority of sites offered either smoking prevention (39%) or cessation (25%) services; 58% of sites had a mechanism in place to refer survivors for cessation services. In multivariate analyses, the most parsimonious model predicting capacity for smoking service delivery included barriers, respondents’ attitudes, complexity, and institutional stability. These data highlight an important need to improve the availability of smoking services for childhood cancer survivors. Additionally, these findings will inform the development of future interventions that are sensitive to barriers and facilitators to providing prevention services.

To assess the impact of the aging population on the occurrence of fragility fractures, we examined hospital discharges for hip fracture among U.S. women and men aged 45 years and older from 1993 through to 2003. The number of hospitalizations declined by 5%, and age-adjusted rates fell by over 20% for both women and men during this period.Although the aging of the population should mean an increasing burden of fragility fractures, several recently published reports suggest regional declines in the incidence of hip fracture. We investigated trends in hospital discharges and utilization for hip fractures across the USA from 1993 to 2003.Hospital discharges from the Nationwide Inpatient Sample from 1993 through to 2003 were analyzed for numbers of primary diagnosis of hip fracture and associated average length of stay (LOS) and charges among women and men aged 45 years and older. Age-specific rates were constructed using national census data.Over the 11-year study period the number of hospitalizations for hip fractures decreased by 5%, from 296,000 to 281,000. The numbers of discharges declined by 16,600 (7.4%) for women and increased by 1900 (2.6%) among men. However, age-adjusted rates for both women and men fell by about 20%. Average hospital LOS was reduced by about 35% for both sexes, resulting in decreases in days of care of 42 and 33% for women and men, respectively. At the same time, average inflation-adjusted charges for each hospitalization grew by 35% for women and 38% for men, and increasing proportions of patients were discharged to continuing institutional care. During the study interval the total number of prescriptions per year for bisphosphonate anti-resorptive agents grew from under 0.5 to 30 million.Despite the increasing size of the older segment of the U.S. population, hospitalizations for hip fractures are not increasing. With declining lengths of stay there has been a reduced demand on hospital resources, although with average charges per hospitalization rising and more patients being discharged to other institutions for continuing care the economic consequences of hip fracture continue to increase.

Ongoing market trends are increasing the risks that working families will be uninsured or suffer lapses in health insurance coverage, with consequent threats to access to health care. Despite strong economic growth, employer-provided health insurance coverage has continued to erode throughout the past decade. Although a record number of women and men are working, slow wage growth for lower-wage workers, a shift in work toward industries less likely to provide and pay for health benefits for families, and a shift toward temporary and parttime jobs have combined to undermine employment as a base for health insurance coverage for working families. 1'2 As a result, the nation has seen a steady increase in the number and proportion of working-age Americans without insurance throughout the 1990s: from March 1989 to March 1997, the number of uninsured increased from 33 to 42 million, a jump from 15.2% to 17.6% of the under-65 population. 3 Recent projections suggest that the number of uninsured will reach 47 million in 8 years, with one American in five uninsured. 4 The rise in the number of uninsured comes at a time when access to health care is likely to be ever more difficult to obtain for those who cannot pay. In a search to contain health costs, public and private purchasers of health insurance have turned to managed-care plans with an endorsement of intense efforts to negotiate deep discounts and reduce payments for care for the insured. Enrollment of insured beneficiaries in managed-care plans has proceeded so rapidly that 8 in 10 workers employed by medium and large employers were enrolled in some form of managed care by 1997, compared with 56% in 1992 and 29% in