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As the number of cancer survivors in the United States increases, quantifying the risks and burden of second primary cancers (SPCs) among cancer survivors will help develop long-term prevention and surveillance strategies. We describe the risk of developing a SPC among survivors of 10 cancer sites with the highest survival rates in the United States. Adult patients diagnosed with an index smoking-related (urinary bladder, kidney and renal pelvis, uterine cervix, oral cavity and pharynx, and colon and rectum) and index non-smoking-related (prostate, thyroid, breast, corpus and uterus, and non-Hodgkin lymphoma) cancers were identified from Surveillance, Epidemiology, and End Results (2000–2015). SPC risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). A cohort of 2,903,241 patients was identified and 259,685 (8.9%) developed SPC (7.6% of women and 10.3% of men). All index cancer sites (except prostate) were associated with a significant increase in SPC risk for women and men. Patients diagnosed with smoking-related index cancers (SIR range 1.20–2.16 for women and 1.12–1.91 for men) had a higher increased risk of SPC than patients with non-smoking-related index cancers (SIR range 1.08–1.39 for women and 1.23–1.38 for men) relative to the general population. We found that 1-in-11 cancer survivors developed a SPC. Given the increasing number of cancer survivors and the importance of SPC as a cause of cancer death, there is a need for increased screening for and prevention of SPC.

BACKGROUND AND OBJECTIVES Despite increasing drug use in rural communities, potentially life-saving harm reduction interventions, such as needle exchange programs (NEPs), remain underutilized. Religion is an integral component of the rural culture that has been shown to influence health, yet no studies to date have explored rural faith leaders' perceptions of harm reduction strategies. METHODS An online cross-sectional survey was conducted among rural faith leaders (n = 133) in the rural Illinois Delta Region. RESULTS While most of the respondents felt that drug abuse was an issue in their communities, support was mixed regarding whether they were in favor of NEPs with the majority of respondents having never heard of an NEP before this survey. While the majority believed that NEPs would help decrease bloodborne disease transmission, it was also perceived that NEPs would increase drug use. Significant differences in perceptions based on race, marital status, and political party also exist. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Congruent with previous harm reduction literature, many rural faith leaders have varied perceptions of NEPs. Rural faith leaders could benefit from education about NEPs, including the possible positive and negative impacts they can have on the community. Future studies should explore contextual differences among rural faith leaders. To date, no studies have examined faith-based organizations' perceptions of NEPs. The findings have the potential to increase the current body of knowledge and provide data to support recommendations for engaging faith-based organizations in behavioral health service delivery.

To examined human papillomavirus (HPV) vaccination rates and identified factors that are associated with HPV vaccination among Native Hawaiian and Pacific Islander (NHPI) young adults aged 18-34.Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey were analyzed. The outcome variables were HPV vaccination initiation (receipt of ≥1 dose) and completion (receipt of ≥3 doses). Multivariable logistic regressions were used to identify socio-demographic, healthcare access and utilization factors that were associated with HPV vaccination.A total of 663 adults were included in the study. The overall HPV vaccination initiation and completion rates were 17.6% and 7.9%, respectively. Most of the respondents who had initiated and completed the vaccine were women, of multiple race, un-married, had some college or associate degree, insured, and had a usual place of getting care. In the weighted multivariable models, men were less likely to initiate (AOR = 0.21, 95% CI = 0.12, 0.34) and complete (AOR = 0.16, 95% CI = 0.07, 0.34) the HPV vaccination compared with women.The low HPV vaccination coverage found in this study signals the need for more evidence-based, culturally relevant immunization and cancer prevention interventions for NHPIs. Failure to improve HPV vaccination rates may increase the burden of HPV associated preventable cancers among NHPIs and broaden disparities.

INTRODUCTION: This study explores how human papillomavirus vaccination initiation and completion among men and women aged 18–34 years varies by geographic region. METHODS: Data from the 2015–2017 Behavioral Risk Factor Surveillance System were analyzed. Geographic regions for the selected states were defined as South, Northeast, and Midwest/West. Human papillomavirus vaccination initiation was defined as receipt of ≥1 dose and completion as receipt of ≥3 doses. Weighted, multivariable logistic regression models estimated the association between geographic region and vaccine uptake, adjusting for sociodemographic, health, and healthcare factors. Analyses were performed in November 2019. RESULTS: A total of 18,078 adults were included in the study, 80% of whom resided in the South. The overall vaccination initiation rate was 23.4% and the completion rate was 11.0%. Initiation was higher among those who resided in the Northeast (38.6%), followed by Midwest/West (23.8%), and lowest for those in the South (21.8%) (p

Out-of-pocket costs may significantly dampen patients’ willingness to adopt preventive procedures. This is especially true for colonoscopies, which typically involved relatively high cost-sharing requirements prior to the Affordable Care Act (ACA) implementation in 2011. We aim to examine the effects of income-related disparities in colonoscopy use in the years prior to and immediately after the implementation of the ACA. Further, we quantify the contributions of different factors in explaining the disparities in the use of colonoscopies among elderly population with health insurance coverage. Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk Factor Surveillance System data were utilized. To examine income-related disparities in the use of CRC, individuals aged 65–75 were included, and the concentration index (CI) was calculated before and after the implementation of ACA. To identify and quantify the contribution of different factors, a decomposition analysis of CI was conducted. CIs decreased from 0.1935 in pre-ACA years to 0.1813 in the post-ACA years among the elderly, indicating that the disparities in the use of colonoscopy was relatively low and the disparities index declined after the implementation of ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational level, higher level of income and educational attainment were major contributors to the observed disparities in colonoscopy use. Our findings indicate that the ACA’s removal of financial barriers may have contributed toward the reduction in disparities of colonoscopy use. More direct interventions, e.g., improved knowledge, better access and lower indirect cost will be helpful in improving screening among low-income and low-educational attainment households.

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA&rsquo, s directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. Methods: Data from the 2008&ndash, 2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the change in colonoscopy use before and after the introduction of the ACA, adjusting for patient characteristics and availability of health care providers in the geographic region. Results: Of 349,899 eligible elderly insured in the age group 65 to 75 years, 236,275 (67.2%) had received a colonoscopy in the previous ten years. The receipt of colonoscopies increased from 63.5% in pre-ACA years to 69.2% in the post-ACA years (p &lt, 0.001). Compared with the pre-ACA period, the odds ratio of colonoscopy uptake in post-ACA years was 1.15 (95% CI = 1.08&ndash, 1.22). Conclusions: A statistically significant increase in colonoscopy use was observed in the post-ACA years. However, achieving the target coverage rate of 80% will require additional interventions to encourage higher levels of screenings.

Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24–0.73 and aOR = 0.79; 95% = 0.72–0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80–0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41–0.94) than heterosexuals, and there were no differences for breast screening. We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.

ObjectiveDespite its established benefits, palliative care (PC) is not well known among patients and family/caregivers. From a nationally representative survey, we sought to assess the following associated with PC: knowledge, knowledge sources, and beliefs.MethodsData were drawn from the Health Information National Trends Study (HINTS 5 Cycle 2), a cross-sectional, survey of non-institutionalized adults aged 18+ years in the USA. Data were weighted and assessed by proportional comparison and multivariable logistic regression.ResultsA total of 3504 respondents were identified, and approximately 29% knew about PC. In the adjusted model, less PC knowledge was associated with: lower age (those aged Significance of resultsPC knowledge was generally low (1-in-3 respondents knew of PC), with significant differences according to age, gender, education, and internet use. These data provide a baseline from which PC education policies and interventions may be measured.

e24064 Background: The number of cancer survivors in the United States (U.S.) is projected to exceed 20 million by 2024. More and more U.S. states are legalizing marijuana use for both recreational and medicinal purposes. This study estimated the prevalence of marijuana use by state among adult cancer survivors. Methods: U.S nationally representative, cross-sectional data from the 2018-2019 Behavioral Risk Factor Surveillance System Survey (BRFSS) Marijuana Use module were used. A total of 13,174 cancer survivors in 17 states was included. Analyses were weighted to account for BRFSS’s complex survey design with results generalizable to 5.7 million cancer survivors. The outcome variable was marijuana use in the past 30 days. Weighted prevalence estimates were computed. Weighted, multivariable logistic regression model estimated the association between state and marijuana use, adjusting for sociodemographic, health, and healthcare factors. Analyses were performed in January 2021. Results: The prevalence of past-month marijuana use among adult cancer survivors in these states was 9.2%. States varied widely in terms of the prevalence of marijuana use. Marijuana use was higher among those who resided in Guam (15.9%), followed by New Hampshire (13.1%), and lowest for those in Puerto Rico (3.3%) ( p< 0.0001). In the adjusted models, compared with the adult cancer survivors residing in California, those living in Maryland, Minnesota, North Dakota, Ohio, South Carolina, Tennessee, Utah, West Virginia, and Wyoming were significantly less likely to use marijuana. Conclusions: Nearly 9% of adult cancer survivors used marijuana, and those who resided in Guam, New Hampshire, Florida, and California are at higher risk for marijuana use. Given the increasing number of cancer survivors and the proliferation of marijuana legalization, identifying high-risk cancer survivors for marijuana use and informing physicians and patients about safe uses and doses and the potential adverse effects of marijuana use is critical.

12088 Background: Cancer survivors experiencing adverse effects from their cancer and treatment report decreased symptom burden with marijuana use. An increasing number of U.S. states have legalized marijuana use for both medical and recreational purposes. This study aimed to assess the prevalence of current marijuana use and to identify the factors associated with its use among US adults with cancer living in 17 U.S. states and territories. Methods: Data from the 2018-2019 Behavioral Risk Factor Surveillance System Marijuana Use module were analyzed. In 2018, 13 states (California, Florida, Idaho, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Ohio, South Carolina, Tennessee, West Virginia, and Wyoming) and 2 territories (Guam and Puerto Rico) participated in the optional marijuana use module. In 2019, 12 states (California, Idaho, Illinois, Maryland, Minnesota, New Hampshire, North Dakota, South Carolina, Tennessee, Utah, West Virginia, and Wyoming) and 1 territory (Guam) participated in the optional marijuana use module. The analytic sample included 13,174 adults with cancer. The analysis was weighted to account for BRFSS’s complex survey design. The primary outcome was current marijuana use (in the past 30-days). Multivariable logistic regression was used to identify demographic, socioeconomic, clinical, and behavioral factors associated with marijuana use among US adults with cancer. Results: Overall, 9.2% of adult cancer survivors (n = 13,174; weighted 5.7 million; 37.9% men) reported marijuana recently current use, 51.3% of whom used it for medical reasons only, with 65.2% reporting smoking as the main method of administration. Adult cancer survivors were significantly more like to use marijuana if they were younger (odds ratio [OR] for 55-64 versus 18-44 years old: 0.60; 95% CI: 0.38-0.93; P < 0.01); male (OR for female versus male: 0.65; 95% CI: 0.48-0.87; P < 0.01); non-Hispanic Black race/ethnicity (OR: 2.00; 95% CI: 1.21-3.33; P < 0.01); having depression (OR: 1.58; 95% CI: 1.17-2.14; P < 0.01) and current (OR: 3.23; 95% CI: 2.20-4.74; P < 0.01) or former tobacco smoker (OR: 2.40; 95% CI: 1.70-3.38; P < 0.01) and binge drinker (OR: 2.25; 95% CI: 1.53-3.29; P < 0.01). Conclusions: Among a large cohort of US adults with cancer, marijuana use was commonly reported and certain subgroups were at higher risk for marijuana use. Health professionals should identify the risk factors for elevated marijuana use, especially as more states legalize medical and recreational marijuana use despite uncertain health risks.

Purpose: County-level health departments (HD) have lead roles in COVID-19 response, with actions guided by 15 federal capabilities We sought to assess Illinois HD perception of preparation and ability to accomplish these, and how perceptions might vary by population size and rurality Methods: We attempted contact with all 96 certified HD (4/6-24/2020) and administered a survey asking 4 identical questions regarding each capability: 1) adequacy of past preparation (pastPreparation);2) current ability to accomplish (currAbility);3) sufficiency of current resources (Resources);and 4) sufficiency of local cooperation and support (Cooperation;all Likert 1-5) Rurality was assessed with Rural-Urban Continuum Codes (levels 1-9;stratified as metropolitan [1-3] and nonmetropolitan [4-9]);and population data obtained from the Census Bureau T-test, chi-square and regression analyses were conducted with SAS Results: We received 34 surveys representing 40/100 counties with HDs (11 metropolitan and 23 nonmetropolitan) Respondents/non-respondents did not differ by population or rurality Ave-currAbility (currAbility averaged across all 15 capabilities) was positively associated with population (+3 57E-6;p=0 027), and nonmetropolitan counties reported significantly lower ave-Cooperation (3 37 [95% CI 3 16-3 57] vs 3 93 [3 47-4 38]) For individual capabilities, nonmetropolitan HDs reported significantly lesser Resources for capabilities #2-Community Recovery, #3-Emergency Operation Coordination, and #5-Fatality Management;and lesser Cooperation for #2, #8 and #9-Medical Countermeasure and Material Dispensing, #10-Medical Surge, and #15-Volunteer Management Conclusions: Though metropolitan areas experience greater numbers of COVID-19 cases, many rural communities experience comparably high infection rates Though statewide HD response is critical, many nonmetropolitan HDs report comparatively lesser ability to meet this challenge

OBJECTIVES: Obesogenic environments (OE) to induce the fat accumulation are also risk factors of related chronic diseases. In previous studies, the metabolic rate for energy consumption such as BMR and RMR were significantly correlated with obesity prevalence. Our purpose was to find the scientific evidences of the connection among energy consumption (BMR or RMR), genomics related to BMR or RMR, and obesity prevalence in children and adults. METHODS: Using Affymetrix® Genome-Wide Human SNP 6.0 Array, genes related with BMR/RMR and BMI were screened in children (n = 512) from the cohort study, and adult subjects (N = 77) from the cross-sectional study. The correlation or association between SNPs of those genes and obesity prevalence or OE was estimated by Cochran-Armitage trend test and logistic regression. The data for family history, anthropometrics, blood biochemistry, dietary intakes and other OE were used in this study. RESULTS: Hsp40/C6 gene was highly associated with both of obesity (BMI) and (BMR/RMR) in children. However, Hsp40/C6 gene was not significantly confirmed in adults, and all significant genes derived from adults were not screened in children. We found that several OE and genes affect obesity prevalence in children or adults are different. We focused on the mutant types of five SNPs in Hsp40/C6 gene derived from children were associated with obesity by reducing energy consumption. CONCLUSIONS: We discovered the different genes related to energy consumption in obese children and adults. The mutation of Hsp40/C6 may change energy consumption and eventually induce obesity. These findings will contribute to find the mechanism of Hsp40/C6 gene on the fat accumulation in future. FUNDING SOURCES: This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIP) (2019R1A2C1008434).

Introduction: Although a few studies have examined screening uptake among sexual minority, almost none have examined it in the specific context of rural populations. Therefore, the objective was to assess how cancer screening utilization might vary by residence (rural versus urban) and sexual orientation. Methods: Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) were utilized. Study outcomes included recommended recent breast, cervical, and colorectal cancer (CRC) screening receipt. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes. Analyses were conducted in 2018. Results: Rates for all three screenings were lowest in rural areas and among sexual minority populations (cervical cancer among lesbians, rural at 64.8%; breast cancer among lesbians, rural at 66.8%; and CRC among bisexual, rural men at 52.4%). For CRC screening, both rural gay and heterosexual rural males were less likely to receive screening (aOR=0.45; 95%=0.24-0.73 and aOR=0.79; 95%=0.72-0.87, respectively) while only rural heterosexual females were less likely (aOR=0.87; 95%=0.80-0.94). For cervical cancer screening, heterosexuals were less likely to be screened (aOR=0.83; 95%=0.72-0.94), and there were no differences for breast cancer. Conclusions: We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual orientation. Further work is needed to identify factors influencing these disparities and how they might be addressed. Citation Format: Min Jee Lee, Wiley Jenkins, Eric Adjei Boakye. Cancer screening disparities among rural sexual minority individuals: Implication for prevention and policy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C119.

Background: Approximately 43,000 human papillomavirus (HPV)-associated cancers and 350,000 genital warts are diagnosed annually in the United States. The HPV vaccine can prevent HPV-associated cancers and genital warts. The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years of age, and catch-up vaccination up to 45 years recently. Despite the availability, safety, and efficacy of HPV vaccines, uptake has been suboptimal compared to other routine vaccinations in adolescents, and even worse for adults in the catch-up group. As little is known about geographic variation in HPV vaccine uptake among adults, we explored how HPV vaccine initiation and completion rates among 18–34 year olds (both men and women) varies by geographic region. Methods: We analyzed data from 16 states (Alabama, Arkansas, Connecticut, Georgia, Hawaii, Massachusetts, Mississippi, Missouri, New Hampshire, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and West Virginia) which conducted the adult HPV module survey during 2015–2017 Behavioral Risk Factor Surveillance System. Two variables were used to define geographic region: census region (South, Northeast and Midwest/west) and residential area (urban and rural). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of three doses. Weighted, multivariable binary logistic regression models were used to assess the association between geographic region and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare utilization factors. Results: A total of 18,078 adults were included in the study, of whom 80% resided in the South. The overall HPV initiation and completion rates were 23.4% and 11.0%, respectively. Vaccine initiation was higher among those who resided in the Northeast (38.6%) followed by Midwest/west (23.8%) and lowest for those in the South (21.8%). But initiation rates was similar between those who reside in urban (24.1%) and rural (21.0%) areas. Completion rates followed the same trend as initiation for both census region and residential area. In the adjusted models, compared to adults residing in the South, those living in the Northeast were more likely to initiate (adjusted odds ratio: 2.14; 95 % CI: 1.81–2.53) and complete (1.80; 1.47–2.20) the HPV vaccine. There were no significant differences observed for initiation or completion by residential area. Conclusions: Both the South and the Northeast have low HPV vaccination initiation and completion rates compare to the Healthy People 2020 goal of 80%, but vaccine uptake were significantly lower in the South region. No difference in HPV vaccine uptake was observed between the rural and urban areas. This demonstrates the need to develop and implement interventions programs to reduce geographical disparities in HPV vaccine uptake and ultimately to improve HPV vaccine uptake, especially in the South region. Citation Format: Eric Adjei Boakye, Maggie Wang, Wiley D Jenkins, Nosayaba Osazuwa-Peters, Oluwole Babatunde, Min Jee Lee, Minjin Kim. Geographic variation in human papillomavirus (HPV) vaccination initiation and completion among adults in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C084.

Cancer survivors avoid necessary medications due to costs.To estimate the prevalence of cost-related medication non-adherence (CRN) by age and insurance status over a number of years in a national sample of U.S. cancer survivors.Using the 1999-2012 National Health Interview Survey, we examined the prevalence and correlates of self-reported CRN, that is, patient-reported inability to afford prescribed medications within the past 12 months, resulting in nonadherence among cancer survivors. Descriptive statistics and multivariate logistic regression models were used to identify time trends in CRN among cancer survivors.In a nationally representative sample of 20,517 cancer survivors from 1999 to 2012, 1,788 (8.7%) survivors reported CRN, representing approximately 436,498 individuals nationally. CRN increased significantly from 11.8% (1999-2005) to 16.9% (2006-2012) among younger cancer survivors (P0.001). Among young cancer survivors (aged 45-64 years), the uninsurance rate was higher for those reporting CRN in the years 2006-2012 (48.5%) than in the earlier period (42.5%; P = 0.043). Among older cancer survivors, insurance coverage through Medicare only was lower for individuals reporting CRN in the years 2006-2012 (5.8%) than in the earlier period (7.8%; P = 0.0210). In adjusted models, younger cancer survivors without health insurance were more likely to report CRN than those with supplemental private insurance with Medicare, and older cancer survivors with Medicare only were more likely to report CRN than those with supplemental private insurance with Medicare.Increasing trends in CRN were evident among younger cancer survivors.No external funding was received for this work. The authors have no conflicts of interest to report. Study concept and design were contributed by Lee, along with Khan and Salloum. Lee collected the data, and data interpretation was performed by Lee, Khan, and Salloum. The manuscript was written primarily by Lee, with assistance from Khan and Salloum, and revised by Lee, Khan, and Salloum.

Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by race and ethnicity and examines factors associated with CRN among cancer survivors. Using the 2006–2013 National Health Interview Survey, we examine self-reported CRN among cancer survivors compared with cancer-free controls. Descriptive statistics and multiple logistic regression models were used to identify factors associated with CRN among cancer survivors. In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN. Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites. Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations.

It has been reported that cancer survivors are delaying or avoiding necessary care due to costs. Medication non-adherence is one of the important aspects of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by gender and factors associated with CRN among cancer survivors. Using 2006–2013 National Health Interview Survey (NHIS), we examined self-reported CRN among cancer survivors by gender. Descriptive statistics and multiple logistic regression models were used to examine gender differences in CRN. In a nationally representative sample of 15,159 cancer survivors, 7.4 % of male and 12.5 % of female reported CRN. Overall, the prevalence of CRN was found to be the highest for uninsured group and the lowest for Medicare, but gender differences persist for all insurance types, including Medicare. After controlling for relevant covariates, female cancer survivors were 27 % more likely (odds ratio (OR) = 1.27, confidence intervals (CI), 1.06–1.53) than male to report CRN. With higher number of comorbidities and activity limitations, CRN rates tend to increase for both male and female cancer survivors. Significant gender differences in CRN were found among cancer survivors after controlling for differences in sociodemographic, health status, and insurance coverage. Given the rapid increase in prescription drug costs, it is important to monitor closely the CRN in high-risk subgroups.

Objectives: The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD). Methods: We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007–2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR < 60 mL/min/1.73 m 2 , and 1304 of the 45 208 individuals included in the KNHANES were found to have CKD by this definition. The outcome variable was whether individual subjects adhered to the CKD prevention and management guidelines recommended by the Korea Centers for Disease Control and Prevention. The guidelines suggest that individuals maintain a normal weight, abstain from alcohol consumption and smoking, manage diabetes and hypertension, and engage in regular exercise in order to prevent and manage CKD. Results: This study found that individuals with CKD were more likely to be obese and have hypertension or diabetes than individuals without CKD. In particular, male and less-educated CKD patients were less likely to adhere to the guidelines. Conclusions: Although the prevalence of CKD, as indicated by the KNHANES data, decreased from 2007 to 2013, the prevalence of most risk factors associated with CKD fluctuated over the same time period. Since a variety of demographic and socioeconomic fac tors are related to the successful implementation of guidelines for preventing and managing CKD, individually tailored prevention activities should be developed.

1586 Background: The number of cancer survivors in the United States is projected to exceed 20 million by 2024. Survivors are at risk of developing a second primary neoplasm (SPN) – a leading cause of survivor death. We described the risk of developing a SPN among survivors of common cancers (smoking-related vs non-smoking-related) in the United States. Methods: We identified patients aged ≥18 years who were diagnosed with a primary cancer from the 10 sites with highest survival rates and stratified as smoking-related (urinary bladder, kidney & renal pelvis, uterine cervix, oral cavity & pharynx, and colon & rectum) and non-smoking related (prostate, thyroid, breast, corpus & uterus, and non-Hodgkin lymphoma) from Surveillance, Epidemiology, and End Results (2000-2015). SPN was defined as the first subsequent primary cancer occurring ≥2 months after first cancer diagnosis. Excess SPN risk was quantified using standardized incidence ratios (SIRs) stratified by sex. Results: A cohort of 2,908,349 patients (50.1% female) was identified and 260,267 (9.0%) developed SPN (7.6% of females and 10.3% of males). All index cancer sites were associated with a significant increase in SPN risk for females and males (except prostate cancer). Index smoking-related cancers (SIR range 1.20 – 2.17 for females and 1.12 – 1.91 for males) had higher increased risk of SPN than non-smoking-related cancers (SIR range 1.08 – 1.39 for females and 0.55 – 1.38 for males) relative to the general population. Conclusions: Nearly 10% of cancer survivors developed an SPN, and those with smoking-related cancers had higher risk. Given the increasing number of cancer survivors and importance of SPN as a cause of cancer death, these findings can improve secondary prevention and surveillance guidelines. [Table: see text]

In 2011, the Korean government designated hospitals with certain structural characteristics as specialty hospitals. This study compared the inpatient charges and length of stay of patients with joint diseases treated at these specialty hospitals with those of patients treated at small general hospitals. In addition, the study investigated whether the designation of certain hospitals as specialty hospitals had an effect on inpatient charges and length of stay. Multi-level models were used to perform regression analyses on inpatient claims data (N=268,809) for 2010-2012 because of the hierarchical structure of the data. The inpatient charge at specialty hospitals was 19% greater than that at small general hospitals, but the length of stay was 21% shorter. After adjusting for patient and hospital level confounders, specialty hospitals had a higher inpatient charge (34.6%) and a reduced length of stay (31.7%). However, the effect of specialty hospital designation on inpatient charge (2.7% higher) and length of stay (2.3% longer) was relatively smaller. Among the patient characteristics, female gender, age, and severity of illness were positively associated with inpatient charge and length of stay. In terms of location, hospitals in metropolitan area had higher inpatient charges (5.5%), but much shorter length of stay (-14%). Several structural factors, such as occupancy rate, bed size, number of outpatients and nurses were positively associated with both inpatient charges and length of stay. However, number of specialists was positively associated with inpatient charges, but negatively associated with length of stay. In sum, this study found that specialty hospitals treating joint diseases tend to incur higher charges but produce shorter length of stay, compared to their counterparts. Specialty hospitals' overcharging behaviors, although shorter length of stay, suggest that policy makers could introduce bundled payments for the joint procedures. To promote a successful specialty hospital system, a broader discussion and investigation that includes quality measures as well as real cost of care should be initiated.

PURPOSE This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. MATERIALS AND METHODS We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153,518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. RESULTS Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)≥25, compared to BMI

The Food and Drug Administration approved testing for prostate cancer screening in 1994. Today over four decades have passed since the Prostate-Specific Antigen (PSA) was first discovered. Yet enormous uncertainty governs the effectiveness of PSA testing as well as the appropriate strategy to best detect early prostate cancer. Many groups including the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American Urological Association (AUA) and the US Preventative Services Task Force (USPSTF), have issued a series of clinical guidelines for prostate cancer screening with inconsistent recommendations. Research shows that prostate cancer screening with PSA resulting in a false-positive screen occurs among 80 percent of men, while 20 percent of men have false-negative results. Recently changes to existing recommendations were suggested by the USPSTF due to concerns of negative effects of PSA testing on patient outcomes. While the evidence underlying prostate cancer screening recommendations is continuously in flux, it is important to understand implications of the debate for clinicians and men. In this paper we examine ensuing ethical considerations of PSA screening for prostate cancer.

Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years ( N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans.

Background Various risk factors of intimate partner violence (IPV) have been found to vary by gender. South Korea has one of the highest prevalences of IPV in the world; however, little is known about potential risk factors of IPV and whether gender influences this relationship. Methods Using data from the 2006 Korea Welfare Panel Study, 8,877 married participants (4,545 men and 4,332 women) aged ≥30 years were included. Reported IPV was categorized as verbal or physical IPV and the association between IPV and related factors was assessed by multivariate logistic regression analysis. Results Women were significantly more likely than men were to report IPV victimization (verbal 28.2% vs. 24.4%; physical 6.9% vs. 3.4%). Wor odds of physical perpetration than women satisfied with their family. Moreover, alcohol intake was significantly associated with IPV perpetration and victimization in both genders. Conclusion Significant gender-specific differences were found among factors related to perpetrating violence and being a victim of violence among adults in heterosexual relationships in South Korea.

This study investigated the relationship between level of stress in middle and high school students aged 12–18 and risk of atopic dermatitis. Data from the Sixth Korea Youth Risk Behavior Web-based Survey (KYRBWS-VI), a cross-sectional study among 74,980 students in 800 middle schools and high schools with a response rate of 97.7%, were analyzed. Ordinal logistic regression analyses were conducted to determine the relationship between stress and atopic dermatitis with severity. A total of 5,550 boys and 6,964 girls reported having been diagnosed with atopic dermatitis. Younger students were more likely to have atopic dermatitis. Interestingly, the educational level of parents was found to be associated with having atopic dermatitis and having more severe condition. In particular, girls with mothers with at least college education had a 41% higher risk of having atopic dermatitis and severe atopic condition (odds ratio (OR)) = 1.41, 95% CI, 1.22–1.63; P

Allergic rhinitis (AR) is the most common chronic disorder in the pediatric population. Although several studies have investigated the correlation between AR and sleep-related issues, the association between the duration and time of sleep and AR has not been analyzed in long-term national data. This study investigated the relationship between sleep time and duration and AR risk in middle- and high-school students (adolescents aged 12-18). We analyzed national data from the Korea Youth Risk Behavior Web-based Survey by the Korea Centers for Disease Control and Prevention from 2007-2012. The sample size was 274,480, with an average response rate of 96.2%. Multivariate logistic regression analyses were conducted to determine the relationship between sleep and AR risk. Furthermore, to determine the best-fitted model among independent variables such as sleep duration, sleep time, and the combination of sleep duration and sleep time, we used Akaike Information Criteria (AIC) to compare models. A total of 43,337 boys and 41,665 girls reported a diagnosis of AR at baseline. The odds ratio increased with age and with higher education and economic status of the parents. Further, students in mid-sized and large cities had stronger relationships to AR than those in small cities. In both genders, AR was associated with depression and suicidal ideation. In the analysis of sleep duration and sleep time, the odds ratio increased in both genders when sleep duration was

Korean National Health Insurance (NHI) was established during only 12 yr from its inception (1977-1989), providing universal medical coverage to the entire nation and making a huge contribution to medical security. However, the program now faces many challenges in terms of sustainability. The low birth rates, aging population, low economic growth, and escalating demands for welfare, as well as unification issues, all add pressure to the sustainability of NHI. The old paradigm of low contribution - low benefits coverage - low NHI's fee schedule needs to be replaced by a new paradigm of proper contribution - adequate benefit coverage - fair NHI's fee schedule. This new paradigm will require reform of NHI's operating system, funding, and spending.