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Objective: Rural areas experience significant disparities in cancer incidence and mortality and are also disproportionately impacted by the drug use epidemic. People who use drugs (PWUDs) frequently experience healthcare-associated stigma sufficient to cause avoidance of all non-urgent care. Research associated with cancer risk and screening utilization among rural PWUDs is nearly nonexistent. Methods: We searched PubMed for articles describing rural healthcare access and cancer disparities, and drug use and healthcare-associated stigma. Results: Rural populations frequently experience increased rates of circumstances and behaviors associated with increased cancer risk, morbidity, and mortality, but also lesser access to and use of healthcare. Rural areas have been disproportionately impacted by many types of drug use, and the stigma PWUDs frequently encounter leads to deferred care and poorer health outcomes. The limited data suggest that PWUDs experience at least equal cancer risk as their non-PWUD peers but obtain screening less often. Whereas interventions to increase medical care engagement among PWUDs have succeeded, none has explored cancer risk and screening. Conclusions: Although there are mechanisms to increase cancer screening in rural areas, and methods to increase healthcare engagement for PWUDs, research should combine these evidence-based practices to explore implementation in this population with distinct risk profiles.

Chronic hypernutrition promotes lipid accumulation in the body and excessive lipid accumulation leads to obesity. An increase in the number and size of adipocytes, a characteristic of obesity is closely associated with adipose dysfunction. Recent in vitro and in vivo studies have shown that probiotics may prevent this dysfunction by regulating lipid metabolism. However, the mechanisms of action of probiotics in obesity are not fully understood and their usage for treating obesity remains limited.Bifidobacterium animalis subsp. lactis IDCC 4301 was selected for its anti-obesity potential after evaluating inhibitory activity of pancreatic lipase and cholesterol reducing activity. Next, we investigated the roles of B. lactis IDCC 4301 on lipid metabolism in 3T3-L1 preadipocytes and high-fat diet (HFD)-fed mice. B. lactis IDCC 4301 inhibited cell differentiation and lipid accumulation by suppressing the expression of adipogenic enzymes in 3T3-L1 cells. Moreover, the administration of B. lactis IDCC 4301 resulted in decreased body and adipose tissue weight, improvement in serum lipid levels, and downregulated adipogenic mRNA expression in HFD-fed mice. Additionally, metabolomic analysis suggested that 2-ketobutyrate should be a possible target compound against obesity.B. lactis IDCC 4301 might be used as an alternative treatment for obesity. This article is protected by copyright. All rights reserved.

Melanogenesis is responsible for skin pigmentation and the enzymatic browning of foods. Tyrosinases play a major role in melanin synthesis, and many attempts have been made to identify new natural tyrosinase inhibitors, but few have sought to do in microbes. Postbiotics are bioactive compounds produced by the metabolism of probiotics and have been reported to be safe and effective. In this study, we evaluated the tyrosinase inhibitory effects of culture supernatants of probiotics and discovered novel bacterial metabolites that can be used as a potent tyrosinase inhibitor based on metabolomics. Cultures of

Identification of probiotics is crucial to ensure the quality of food products manufactured at the industrial scale. Although various techniques have been introduced for bacterial identification, randomly amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) is generally accepted as a conventional method for bacterial identification. In this study, RAPD-PCR method was evaluated for the identification of eighteen commercial probiotic strains. In results, cellular and product (lyophilized) forms of each probiotic strain were successfully identified based on band intensities and size of the amplified genes. Therefore, RAPD-PCR method may be applied for the identification of lyophilized probiotics commercially available.

As consumption of healthy foods continues to garner remarkable public attention, ensuring probiotic safety has become a priority. In this study, the safety of Lactobacillus acidophilus IDCC 3302 was assessed in vitro and in vivo. L. acidophilus IDCC 3302 showed negative results for hemolytic and β-glucuronidase activities. The whole-genome analysis (WGA) revealed that L. acidophilus IDCC 3302 did not possess antibiotic resistance or virulence genes. The minimal inhibitory concentrations of L. acidophilus IDCC 3302 confirmed its safety concerning antibiotic resistance. Furthermore, L. acidophilus IDCC 3302 was demonstrated to be nontoxic in the oral toxicity test in rats. Therefore, the results suggested that L. acidophilus IDCC 3302 might be safe for human consumption.

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.

Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews exploring cancer (cervical, breast, colorectal, lung) risk, screening history, and healthcare experiences. From July 2020–July 2021 we collected 37 surveys and 8 interviews. Participants were 24.3% male, 86.5% White race, and had a mean age of 44.8 years. Females were less likely to report seeing a primary care provider on a regular basis, and more likely to report stigmatizing healthcare experiences. A majority of females reporting receiving recommendations and screens for cervical and breast cancer, but only a minority were adherent. Similarly, only a minority of males and females reported receiving screening tests for colorectal and lung cancer. Screening rates for all cancers were substantially below those for the US generally and rural areas specifically. Interviews confirmed stigmatizing healthcare experiences and suggested screening barriers and possible solutions. The opioid epidemic involves millions of individuals and is disproportionately experienced in rural communities. To avoid exacerbating existing rural cancer disparities, methods to engage PWUD in cancer screening need to be developed.

Background: While national human papillomavirus (HPV) vaccination estimates vary by sex, little is known about variation by gender identity. We sought to estimate HPV vaccination initiation and completion by gender identity among US young adults. Methods: We used 2018-2020 Behavioral Risk Factor Surveillance System data from individuals reporting both gender identity and HPV vaccination status. Weighted, multivariable logistic regression was used to identify factors associated with vaccination initiation and completion. Results: The 6,484 individuals included 3,300 cismales, 3,130 cisfemales, 31 transmales, and 23 transfemales. Vaccination initiation/completion were low, at 40.1% and 17.6%, respectively, and varied by gender identity: cismale=29.1%/9.6%, cisfemale=51.3%/25.8%, transmale=50.1%/5.9%, and transfemale=34.7%/13.0% (P Citation Format: Minjee Lee, Wiley D. Jenkins, Bettina Drake, Sarah Van Vickle-Chavez. Human papillomavirus (HPV) vaccination rate by gender identity among US young adults [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A126.

The use of probiotics has been applied for a variety of fields (e.g., immune system, mental health, and heart). In this study, the feasibility of lysates from L. rhamnosus IDCC 3201 for cosmetic ingredients was evaluated. More specifically, enhanced ceramides production in human epidermal keratinocytes by the lysates and its proposed machanism were investigated through in vitro and genome analysis. In results, enhanced spingomyelinase activity and thereby increased ceramides production by the lysates from L. rhamnosus IDCC 3201 was observed. Furthermore, it was found that the existence of glucosylceramdase in L. rhamonsus IDCC 3201 was attributed to enhanced ceramides production. Finally, it was verified that the lysates from L. rhamonsus IDCC 3201 was regarded as safe for its use as cosmetic materials. Thus, these findings have significant implications that might lead to the development of functional and safe cosmetic products from probiotics.

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.

This study investigated the anti-inflammatory activity of Lactiplantibacillus plantarum IDCC 3501 isolated from kimchi (Korean fermented food) and its safety. When lipopolysaccharide (LPS)-induced RAW 264.7 macrophages were treated with cell-free supernatant from L. plantarum IDCC 3501, the mRNA expression level of inflammatory markers (i.e., TNF-α, IL-1β, and IL-6) was significantly reduced. In addition, the decreased cell viability by LPS was recovered and NO production in LPS-induced cell was also decreased. For the safety assessment, the genes responsible for antibiotic resistance and virulence were not detected from the genome analysis of this strain. Consistent with this, minimal inhibitory concentrations against various antibiotics, biogenic amines, and d-lactate production, as well as enzymatic and hemolysis activities, indicated that L. plantarum IDCC 3501 did not produce any harmful compounds during fermentation. Furthermore, no acute toxicity and mortality were observed in a murine mouse model. Based on our findings, L. plantarum IDCC 3501 is safe and beneficial for human consumption. [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42770-021-00603-2.

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.

Purpose Lactobacillus reuteri is one of the most largely studied human-commensal bacteria and widely used as a form of probiotics. Safety of probiotics has become increasingly important for human consumption due to increasing health-concerns in food industry. In this study, the safety of L. reuteri IDCC 3701 isolated from human breast milk was thoroughly investigated. Methods Whole-genome sequence analysis was performed to identify antibiotic resistance and toxigenicity of L. reuteri IDCC 3701. Phenotypic analysis such as minimal inhibitory concentration, β-hemolysis, extracellular enzyme activity, and the production of biological amines and L/D-lactate, was investigated. Finally, acute oral toxicity test was performed to access L. reuteri IDCC 3701 safety. Results Although multiple resistances to gentamicin and kanamycin were observed in L. reuteri IDCC 3701, it was revealed that these resistances are intrinsic and not transferable through whole-genome analysis. In addition, various phenotypic analysis concerning hemolysis, enzyme activity, and D-lactate production did not show any negative results. Although L. reuteri IDCC 3701 harbors a histidine decarboxylase gene, no biogenic amines were detected. Finally, L. reuteri IDCC 3701 exhibited no evidence of acute toxicity according to an in vivo study. Conclusion Our findings demonstrate that L. reuteri IDCC 3701 is considered to be safe for human consumption as probiotics based on the in silico, in vitro and in vivo studies.

The complete chloroplast genome sequence of Paeonia lactiflora was obtained by de novo assembly using next-generation sequencing. The circular molecule of the genome constituted of four parts, with 152,731 bp in the complete chloroplast genome, including a large single-copy (LSC) region of 84,402 bp, a small single-copy (SSC) region of 16,969 bp, and two inverted repeat (IRa and IRb) regions of 25,680 bp each. The genome annotation predicted a total of 111 genes, including 77 protein-coding genes, 30 tRNA genes, and 4 rRNA genes. Phylogenetic analysis showed the close taxonomical relationship to P. veitchii.

Various mechanisms of obesity prevention have been identified; however, the roles of brown or beige fat as regulators of the energy balance are unclear. The effects of anthocyanin-rich black soybean, Glycine max (L.) Merr., testa (ABS) extracts on the energy balance were investigated by comparing beige-like adipocytes (BLA) and white adipocytes (WAT). ABS extracts reduced peroxisome proliferator-activated receptor gamma protein expression and triglyceride accumulation in WAT and BLA without inducing nuclear damage. The biomarkers of fat degradation (phospho-AMPKα and ATGL) or glycerol secretion in the medium and β-oxidation of fatty acids (CPT2) in the ABS-treated BLA were increased compared to those in WAT. ABS extracts significantly increased the expression of thermogenesis markers (UCP1 and CIDEA) and biomarkers related to mitochondrial activation (cytochrome c and NRF1) in BLA. In the primary cell culture of brown adipocytes (BAT) from rats fed ABS, the expression levels of PGC1-α, cytochrome c, and UCP1 proteins were increased compared to those in BAT from nonfed rats. A reduction in the NAD/NADH ratio was consistently associated with an increase in the oxygen consumption rate and basal/maximal respiration rate in ABS-treated BLA. Anthocyanins promote beiging in the body, contribute to the prevention of obesity, and are potentially useful functional materials.

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: Human papillomavirus (HPV) accounts for about 35,000 HPV-associated cancers per year. In the United States, a gender-neutral HPV vaccine was recommended by the Advisory Committee on Immunization Practices in 2011 with the primary goal of preventing HPV-associated cancers. Although the HPV vaccine is safe and effective, vaccine uptake is low especially in young adult population. College students comprise the age-group with the highest risk of HPV infection. The HPV vaccines are thought to be most effective before initiation of sexual activity. However, there is a dearth of information on the association between HPV vaccine uptake and sexual activity among college students. This study examined if sexual naivety was associated with HPV vaccination uptake (initiation and completion) among university students. Methods: A cross-sectional study was conducted between February and May 2021 among students at a Midwestern University. Sexual naivety was assessed with these questions: “Have you ever had vaginal sexual intercourse?”, and “Have you ever had oral sex?” Responses were categorized as “no oral or vaginal sex”, “had oral or vaginal sex”, or “had oral and vaginal sex”. The outcome variable was HPV vaccination uptake; initiation was defined as receipt of ≥1 dose, and completion as receipt of ≥3 doses. Multivariable logistic regression models estimated the association between sexual naivety and vaccine uptake, adjusting for age, gender, race, relationship status, academic level, and rural-urban status. Results: Approximately 18% of students reported being sexually naïve. Overall, 45.5% had initiated the HPV vaccination, and 16.5% had completed the vaccination. After adjusting for covariates, compared to students who reported being sexually naïve, those that had ever had oral and vaginal sex were more likely to have initiated (aOR=2.18, 95% CI: 1.41–3.39) the HPV vaccinations; however, no difference was observed for completion. Other factors associated with lower odds of HPV vaccination initiation included younger age (aOR=0.90, 95% CI: 0.85–0.95), male sex (aOR=0.33, 95% CI: 0.23–0.45), rural residence (aOR=0.67, 95% CI: 0.47–0.96), and freshman/sophomore academic level (aOR=0.55, 95% CI: 0.31–0.95). Only gender was associated with vaccination completion where male students were 74% less likely to have completed the series compared to female students. Conclusions: We show that 1-in-5 students were sexually naïve, and that 4-in-10 had initiated the HPV vaccination but only 16% had completed the series. Sexual naivety was an independent predictor of HPV vaccine initiation, with sexually naïve students less likely to have initiated the vaccination. Since sexually naïve students may benefit the most from receiving the HPV vaccination, targeted interventions should be implemented towards this population to help increase vaccination rates and prevent HPV-associated diseases. Citation Format: Eric Adjei Boakye, Stacey L. McKinney, Maria C. Franca, Kelli D. Whittington, Valerie E. Boyer, Minjee Lee, Richard C. McKinnies, Sandra K. Collins. Association between sexual naivety and human papillomavirus (HPV) vaccination initiation and completion [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-244.

Background: Human papillomavirus (HPV) is associated with virtually all cases of cervical, 90% of anal, 69% of vaginal, 60% of oropharyngeal, 51% of vulvar, and 40% of penile cancers. The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years, and catch-up vaccination is also recommended for both males and females aged 13-26 years. College students not only fall in the age group at high risk for HPV infection but are also of childbearing age; thus, their awareness not only affects current vaccination rates but also those of the next generation. Therefore, understanding college students' awareness of the causal link between HPV and HPV-associated cancers is of great significance for the promotion of HPV vaccine uptake. The objectives of the study were to 1) describe the level of awareness of the link between HPV and HPV-associated cancers; and 2) identify factors associated with awareness. Methods: This was a cross-sectional study at a public Midwestern university. A previously validated questionnaire was distributed online to all students at the university from February to May 2021. The outcomes of interest were student's awareness that HPV causes certain cancers (anal, vaginal, oropharyngeal, vulvar, and penile). Students were asked if they knew whether HPV was causally link with those cancers, with response options ‘yes', ‘no' and ‘don't know'. Students who answered yes were categorized as aware and those who answered ‘no' and ‘don't know' were categorized as unaware. Five multivariable logistic regression models estimated the association between age, gender, race, relationship status, academic level, rural-urban status, sexual naivety; and awareness of the link between HPV and HPV-associated cancers. Results: A total of 862 students were included in the study. Approximately 34% were aware HPV causes anal, 39% were aware HPV cause oral, 38% were aware HPV cause penile, 53% were aware HPV cause vaginal, and 40% were aware HPV cause vulvar cancers. In multivariable analyses, males were less likely to be aware that HPV cause vaginal (aOR=0.42, 95% CI: 0.30–0.59), or vulvar cancers (aOR=0.54, 95% CI: 0.38–0.77) compared to females. Compared with sexually naïve students, those who had have oral and vaginal sex were more likely to be aware that HPV cause anal (aOR=1.98, 95% CI: 1.17–3.34), penile (aOR=1.82, 95% CI: 1.11–2.97), vaginal (aOR=1.81, 95% CI: 1.14–2.88), or vulvar (aOR=2.05, 95% CI: 1.24–3.40) cancers. Conclusion: Overall awareness of the link between HPV and HPV-associated cancers were low, with roughly 4-in-10 students having awareness, except vaginal where half of students had awareness of the link. This underscores the need for more tailored interventions to increase knowledge about HPV and its association with cancer. Increasing students' levels of awareness may impact HPV vaccine uptake. Citation Format: Eric Adjei Boakye, Maria C. Franca, Valerie E. Boyer, Minjee Lee, Kelli D. Whittington, Stacey L. McKinney, Sandra K. Collins, Richard C. McKinnies. Awareness of the link between human papillomavirus (HPV) and HPV-associated cancers among university students [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-269.

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.