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Health Seeking Behaviors of Current and Former Smokers: 2015 National Health Interview Survey Results
536
Abstracts / Annals of Epidemiology 27 (2017) 504e540
P114. Health Seeking Behaviors of Current and Former Smokers: 2015 National Health Interview Survey Results Cassie L. Odahowski,a,b Erica Sercy,a,b Jan M. Ebertha,b,c. a Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, b Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, c SC Rural Health Research Center, University of South Carolina, Columbia, SC Purpose: Lung cancer screening by LDCT has increased slightly since 2010 but still remains low. The goal of this project is to examine characteristics among current and former smokers that may impact lung cancer screening utilization such as receipt of primary care, having been advised by a health professional to quit smoking, and use of smoking cessation assistance. Methods: 2015 National Health Interview Survey data was used for all analyses. We estimated the total population size of current and former smokers who reported seeing a general doctor, nurse practitioner, physician assistant, or midwife in the previous 12 months. Among this population, we estimated the proportion eligible for screening and receiving screening under the US Preventive Services Take Force (USPSTF) recommendations. We also calculated the proportion of current smokers currently using cessation assistance and those who reported being advised to quit smoking by a health care provider. Multivariable logistic regression examined factors associated with LDCT all among persons eligible for screening by USPSTF recommendations. Preliminary Results: LDCT screening utilization is higher in the eligible population receiving care (6.3% of current smokers,11.9% of former smokers) than in the overall screening eligible population (3.9%). Only 63.1% of current smokers reported being advised to quit smoking while only 18.7% of current smokers reported current use of cessation assistance. Former smokers are receiving care and utilizing lung cancer screening by LDCT at higher rates than current smokers. Conclusions: Lung cancer screening could potentially benefit from coordinated care to ensure eligible subjects follow through with recommended screening. Expanded education on screening guidelines is still needed for both health professionals and the eligible population. Smoking cessation conversations and referral to cessation assistance should be a priority among healthcare providers treating current smokers.
Macro-determinants of health P115. Influence of Socioeconomic Status on the Whole Blood Transcriptome African Americans
in
Amadou Gaye. National Institutes of Health, Rockville Pike, Bethesda, MD, USA Background: The correlation between low socioeconomic status (SES) and poor health outcome or higher risk of disease has been consistently reported by many epidemiological studies across various race/ancestry groups. It is postulated that social factors play an important etiologic role in the racial disparities in health observed in African-Americans. However, the biological mechanisms linking low SES to disease and/or disease risk factors are not well understood and remain relatively under-studied. The analysis of the blood transcriptome is a promising window for elucidating how social and environmental factors influence the molecular networks governing health and disease. To further define the mechanistic pathways between race/ancestry and the social determinants of health; this study examined the impact of SES on the blood transcriptome in a sample of African-Americans. Methods: An integrative approach leveraging three complementary methods (Weighted Gene Correlation Network Analysis, Random Forest and Differential Expression) was adopted to identify the most predictive and robust transcriptome pathways associated with SES. We analyzed the expression of 15079 genes (RNAseq) from whole blood across 36 samples. Results: The results revealed a cluster/module of 141 co-expressed genes overexpressed in the low SES group. Three pro-inflammatory pathways (IL-8 Signaling, NF-kB Signaling and Dendritic Cell Maturation) are activated in this module and over-expressed in low SES. Random Forest analysis revealed 55 of the 141 genes that, collectively, predict SES with an AUC of 0.85. One third of the 141 genes are significantly over-expressed in the low SES group. Conclusion: Lower SES has been consistently and reliably linked to many social and environmental conditions acting as stressors and known to be correlated with
vulnerability to chronic illnesses (e.g. asthma, diabetes) associated with a chronic inflammatory state. Our unbiased analysis of the blood transcriptome in AfricanAmericans revealed evidence of a robust molecular signature of increased inflammation associated with low SES. The results provide a plausible link between the social factors and chronic inflammation in a population at high-risk of disparities in health outcomes.
P116. Distribution of C-reactive Protein among US Adults from National Health and Nutrition Examination Survey (NHANES), 2009-2010 Azad Bhuiyan. Jackson State University, 1400 John R. Lynch St, Jackson, MS, USA Purpose: The cardiovascular disease (CVD) is the leading cause of morbidity and mortality among US adult population. In addition, disparities in CVD morbidity and mortality exist as CVD risk factors differ by gender and ethnicity. According to the American Heart Association in 2014, among blacks, 46.0% males and 47.7 % females had CVD and number of deaths 49,210 in males and 48,573 in females. Recently, C-reactive protein (CRP), a biomarker of chronic inflammation emerges as an independent predictor of CVD. Therefore, the purpose of this study was to assess the distribution of CRP levels by gender and ethnicity among US adult population. Methods: We analyzed data from 5629 participants from NHANES, 20092010, which is a multistage cluster sample design survey and represents noninstitutionalized US population. We analyzed data using SAS 9.4 version, proc survey procedure and weighted sample. Log transformation was applied for CRP variable as it was not normally distributed. Results: Of the sample of 5629, and 51.2% were females, 48.8% males, mean age for females 45.4, SE 0.34 and males 44.8, SE 0.45. The mean levels of CRP were higher among females vs. males (unadjusted mean 0.41, SE 0.02 vs, 0.31, SE 0.02, p value<0.0001) and blacks vs. whites (0.50, SE 0.02 vs. 0.35, SE 0.02, p<0.001). After controlling for CVD risk factors such as age, blood pressure, total cholesterol, HbA1c and smoking history, females vs males (0.43, SE 0.02, 0.31, SE 0.02, p<0.0001) and blacks vs. whites had higher CRP levels (0.49, SE 0.05 vs 0.38, 0.02; p<0.02), respectively. Conclusion: Our results show that both unadjusted and adjusted mean levels of CRP were higher among female gender and black race. Further study is needed to explore the racial and biological differences of CRP.
P117. Associations between Socioeconomic Status Markers and Depressive Symptoms by Race and Sex: Results from the Multi-Ethnic Study of Atherosclerosis (MESA) Brandon Peplinski,a Robyn McClelland,b Moyses Szkloa. a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, b University of Washington, Seattle, WA 98105, USA Purpose: Depression poses a significant public health burden in the US, with varying prevalence by race/ethnicity, sex, and socioeconomic status (SES). It is unclear whether effect modification occurs by race/ethnicity and sex on relationships between SES markers and depression. The purpose of this study was to investigate such effect modification. Methods: A cross-sectional analysis was performed on Multi-Ethnic Study of Atherosclerosis participants (age 45-84) at baseline (n¼6,814). Multivariable logistic regression models stratified by race/ethnicity (White, Black, Hispanic, Chinese) and sex were performed to evaluate effect modification of associations between income, education, occupation, neighborhood SES and depressive symptoms, defined by CES-D 16. Anti-depressant use was added to the definition in sensitivity analyses. Interaction terms were also tested to evaluate effect modification. Results: Although the odds of depressive symptoms were generally lower with increasing income across all groups, this was more pronounced in Blacks and women, with a graded (“dose-response”) pattern seen in White and Hispanic women. Lower odds of depressive symptoms were seen in management/ professional occupations for Hispanic and Black men, although overall race/ ethnicity interaction with occupation was not significant. Neighborhood SES was significantly associated with depressive symptoms only among Blacks,
Abstracts / Annals of Epidemiology 27 (2017) 504e540
P114. Health Seeking Behaviors of Current and Former Smokers: 2015 National Health Interview Survey Results Cassie L. Odahowski,a,b Erica Sercy,a,b Jan M. Ebertha,b,c. a Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, b Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, c SC Rural Health Research Center, University of South Carolina, Columbia, SC Purpose: Lung cancer screening by LDCT has increased slightly since 2010 but still remains low. The goal of this project is to examine characteristics among current and former smokers that may impact lung cancer screening utilization such as receipt of primary care, having been advised by a health professional to quit smoking, and use of smoking cessation assistance. Methods: 2015 National Health Interview Survey data was used for all analyses. We estimated the total population size of current and former smokers who reported seeing a general doctor, nurse practitioner, physician assistant, or midwife in the previous 12 months. Among this population, we estimated the proportion eligible for screening and receiving screening under the US Preventive Services Take Force (USPSTF) recommendations. We also calculated the proportion of current smokers currently using cessation assistance and those who reported being advised to quit smoking by a health care provider. Multivariable logistic regression examined factors associated with LDCT all among persons eligible for screening by USPSTF recommendations. Preliminary Results: LDCT screening utilization is higher in the eligible population receiving care (6.3% of current smokers,11.9% of former smokers) than in the overall screening eligible population (3.9%). Only 63.1% of current smokers reported being advised to quit smoking while only 18.7% of current smokers reported current use of cessation assistance. Former smokers are receiving care and utilizing lung cancer screening by LDCT at higher rates than current smokers. Conclusions: Lung cancer screening could potentially benefit from coordinated care to ensure eligible subjects follow through with recommended screening. Expanded education on screening guidelines is still needed for both health professionals and the eligible population. Smoking cessation conversations and referral to cessation assistance should be a priority among healthcare providers treating current smokers.
Macro-determinants of health P115. Influence of Socioeconomic Status on the Whole Blood Transcriptome African Americans
in
Amadou Gaye. National Institutes of Health, Rockville Pike, Bethesda, MD, USA Background: The correlation between low socioeconomic status (SES) and poor health outcome or higher risk of disease has been consistently reported by many epidemiological studies across various race/ancestry groups. It is postulated that social factors play an important etiologic role in the racial disparities in health observed in African-Americans. However, the biological mechanisms linking low SES to disease and/or disease risk factors are not well understood and remain relatively under-studied. The analysis of the blood transcriptome is a promising window for elucidating how social and environmental factors influence the molecular networks governing health and disease. To further define the mechanistic pathways between race/ancestry and the social determinants of health; this study examined the impact of SES on the blood transcriptome in a sample of African-Americans. Methods: An integrative approach leveraging three complementary methods (Weighted Gene Correlation Network Analysis, Random Forest and Differential Expression) was adopted to identify the most predictive and robust transcriptome pathways associated with SES. We analyzed the expression of 15079 genes (RNAseq) from whole blood across 36 samples. Results: The results revealed a cluster/module of 141 co-expressed genes overexpressed in the low SES group. Three pro-inflammatory pathways (IL-8 Signaling, NF-kB Signaling and Dendritic Cell Maturation) are activated in this module and over-expressed in low SES. Random Forest analysis revealed 55 of the 141 genes that, collectively, predict SES with an AUC of 0.85. One third of the 141 genes are significantly over-expressed in the low SES group. Conclusion: Lower SES has been consistently and reliably linked to many social and environmental conditions acting as stressors and known to be correlated with
vulnerability to chronic illnesses (e.g. asthma, diabetes) associated with a chronic inflammatory state. Our unbiased analysis of the blood transcriptome in AfricanAmericans revealed evidence of a robust molecular signature of increased inflammation associated with low SES. The results provide a plausible link between the social factors and chronic inflammation in a population at high-risk of disparities in health outcomes.
P116. Distribution of C-reactive Protein among US Adults from National Health and Nutrition Examination Survey (NHANES), 2009-2010 Azad Bhuiyan. Jackson State University, 1400 John R. Lynch St, Jackson, MS, USA Purpose: The cardiovascular disease (CVD) is the leading cause of morbidity and mortality among US adult population. In addition, disparities in CVD morbidity and mortality exist as CVD risk factors differ by gender and ethnicity. According to the American Heart Association in 2014, among blacks, 46.0% males and 47.7 % females had CVD and number of deaths 49,210 in males and 48,573 in females. Recently, C-reactive protein (CRP), a biomarker of chronic inflammation emerges as an independent predictor of CVD. Therefore, the purpose of this study was to assess the distribution of CRP levels by gender and ethnicity among US adult population. Methods: We analyzed data from 5629 participants from NHANES, 20092010, which is a multistage cluster sample design survey and represents noninstitutionalized US population. We analyzed data using SAS 9.4 version, proc survey procedure and weighted sample. Log transformation was applied for CRP variable as it was not normally distributed. Results: Of the sample of 5629, and 51.2% were females, 48.8% males, mean age for females 45.4, SE 0.34 and males 44.8, SE 0.45. The mean levels of CRP were higher among females vs. males (unadjusted mean 0.41, SE 0.02 vs, 0.31, SE 0.02, p value<0.0001) and blacks vs. whites (0.50, SE 0.02 vs. 0.35, SE 0.02, p<0.001). After controlling for CVD risk factors such as age, blood pressure, total cholesterol, HbA1c and smoking history, females vs males (0.43, SE 0.02, 0.31, SE 0.02, p<0.0001) and blacks vs. whites had higher CRP levels (0.49, SE 0.05 vs 0.38, 0.02; p<0.02), respectively. Conclusion: Our results show that both unadjusted and adjusted mean levels of CRP were higher among female gender and black race. Further study is needed to explore the racial and biological differences of CRP.
P117. Associations between Socioeconomic Status Markers and Depressive Symptoms by Race and Sex: Results from the Multi-Ethnic Study of Atherosclerosis (MESA) Brandon Peplinski,a Robyn McClelland,b Moyses Szkloa. a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA, b University of Washington, Seattle, WA 98105, USA Purpose: Depression poses a significant public health burden in the US, with varying prevalence by race/ethnicity, sex, and socioeconomic status (SES). It is unclear whether effect modification occurs by race/ethnicity and sex on relationships between SES markers and depression. The purpose of this study was to investigate such effect modification. Methods: A cross-sectional analysis was performed on Multi-Ethnic Study of Atherosclerosis participants (age 45-84) at baseline (n¼6,814). Multivariable logistic regression models stratified by race/ethnicity (White, Black, Hispanic, Chinese) and sex were performed to evaluate effect modification of associations between income, education, occupation, neighborhood SES and depressive symptoms, defined by CES-D 16. Anti-depressant use was added to the definition in sensitivity analyses. Interaction terms were also tested to evaluate effect modification. Results: Although the odds of depressive symptoms were generally lower with increasing income across all groups, this was more pronounced in Blacks and women, with a graded (“dose-response”) pattern seen in White and Hispanic women. Lower odds of depressive symptoms were seen in management/ professional occupations for Hispanic and Black men, although overall race/ ethnicity interaction with occupation was not significant. Neighborhood SES was significantly associated with depressive symptoms only among Blacks,