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OBJECTIVES: Differences in the availability of a Social Security Number (SSN) by race/ethnicity could affect the ability to link with death certificate data in passive follow-up studies and possibly bias mortality disparities reported with linked data. Using 1989-2009 National Health Interview Survey (NHIS) data linked with the National Death Index (NDI) through 2011, we compared the availability of a SSN by race/ethnicity, estimated the percent of links likely missed due to lack of SSNs, and assessed if these estimated missed links affect race/ethnicity disparities reported in the NHIS-linked mortality data. METHODS: We used preventive fraction methods based on race/ethnicity-specific Cox proportional hazards models of the relationship between availability of SSN and mortality based on observed links, adjusted for survey year, sex, age, respondent-rated health, education, and US nativity. RESULTS: Availability of a SSN and observed percent linked were significantly lower for Hispanic and Asian/Pacific Islander (PI) participants compared with White non-Hispanic participants. We estimated that more than 18% of expected links were missed due to lack of SSNs among Hispanic and Asian/PI participants compared with about 10% among White non-Hispanic participants. However, correcting the observed links for expected missed links appeared to only have a modest impact on mortality disparities by race/ethnicity. CONCLUSIONS: Researchers conducting analyses of mortality disparities using the NDI or other linked death records, need to be cognizant of the potential for differential linkage to contribute to their results.

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The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. This report describes the NCHS Data Presentation Standards for Proportions. The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports.

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In 2011­2014, current asthma prevalence was higher among adults with obesity compared with adults in lower weight categories. This pattern was consistent across most demographic subgroups, except among men, for whom no statistically significant difference in current asthma prevalence by weight status was observed. Other epidemiologic studies of asthma prevalence have shown conflicting results about whether obesity is a risk factor for asthma among males. By race and Hispanic origin, current asthma prevalence was highest among adults with obesity for all groups. Patterns differed slightly among groups. For non-Hispanic black and Hispanic adults, prevalence for those with obesity was higher than for those in the normal weight and overweight categories. For non-Hispanic white adults, there was no signficant difference in asthma prevalence between the obese and overweight categories. For all age groups, current asthma prevalence was highest among adults with obesity, and there was no significant difference in asthma prevalence between those in the normal weight and overweight categories. There was an increasing trend in asthma prevalence as weight increased that was observed most clearly in the 60 and over age group. From 2001 to 2014, there was an increasing trend in current asthma prevalence among adults overall and among overweight adults. However, no significant trend was observed among adults in other weight categories. Findings from an American Thoracic Society workshop on obesity and asthma concluded that obesity is a major risk factor for asthma, and that obesity-related asthma is likely different from other types of asthma (e.g., allergic, occupational, exercise-induced, nocturnal, aspirin-sensitive, and severe asthma).

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This study examined factors that mitigate or heighten HIV risk among HIV-negative wives in serodiscordant relationships in Gujarat, India. Grounded theory was used to analyze 46 interviews (23 couples) where husbands were HIV-positive and wives were HIV-negative. A conceptual framework emerged from analysis from which we identified five pathways and four key behaviors: (a) safer sex, (b) no sex, (c) coercive sex, and (d) unprotected sex. Most couples either practiced safe sex or abstained from sex. Factors such as wives' assertiveness, a wife's fear of acquiring HIV, mutual understanding, positive sex communication, and a husband's desire to protect wife influenced safe sex/sexual abstinence. Factors such as desire for children, a husband's alcohol use, and intimate partner violence influenced coercive and unprotected sex. Counseling topics on sex communication, verbal and non-verbal safer sex strategies, as well as addressing intimate partner violence and alcohol use may be important in preventing risk to HIV-negative wives.

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BACKGROUND: Black men have a higher incidence of prostate cancer than white men in the U.S., but little is known whether incidence or racial differences vary geographically. Understanding these differences may assist future studies on causes of prostate cancer. To address such, we leverage the unique resource of the National Program of Cancer Registries (NPCR) combined with Surveillance, Epidemiology and End Results (SEER). METHODS: Prostate cancer counts and population denominators by race (black, white), age, calendar year, and U.S. census division, for the period 1999-2008, were extracted from NPCR and SEER. We calculated age-standardized incidence rates (ASR) and estimated annual percent changes (EAPC) by race and census division. We assessed black-to-white incidence rate ratios (BWIRR) by census division and by calendar period. RESULTS: This analysis included 1,713,471 prostate cancer cases and 1,217 million person-years. Black ASRs ranged from 176 per 100,000 person-years in Mountain division to 259 in Middle Atlantic. BWIRRs ranged from 1.20 in Western divisions to 1.72 in Southeastern divisions. EAPCs indicated that prostate cancer incidence is not decreasing in East South Central, unlike all other divisions. White EAPCs displayed similar variations by census division, resulting in modest temporal changes in BWIRRs. CONCLUSIONS: Within the U.S., there exists significant geographic variability in prostate cancer incidence rates. Although there are large geographic differences in BWIRRs, temporal trends are fairly stable. This may indicate that primary factors affecting prostate cancer incidence rates vary geographically but affect both black and white men to a similar degree.

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INTRODUCTION: Studies suggest that both affective and cognitive processes are involved in the perception of vulnerability to cancer and that affect has an early influence in this assessment of risk. We constructed a path model based on a conceptual framework of heuristic reasoning (affect, resemblance, and availability) coupled with cognitive processes involved in developing personal models of cancer causation. METHODS: From an eligible cohort of 16 700 women in a managed care organization, we randomly selected 2524 women at high, elevated, and average risk of ovarian cancer and administered a questionnaire to test our model (response rate 76.3%). Path analysis delineated the relationships between personal and cognitive characteristics (number of relatives with cancer, age, ideas about cancer causation, perceived resemblance to an affected friend or relative, and ovarian cancer knowledge) and emotional constructs (closeness to an affected relative or friend, time spent processing the cancer experience, and cancer worry) on perceived risk of ovarian cancer. RESULTS: Our final model fit the data well (root mean square error of approximation (RMSEA) = 0.028, comparative fit index (CFI) = 0.99, normed fit index (NFI) = 0.98). This final model (1) demonstrated the nature and direction of relationships between cognitive characteristics and perceived risk; (2) showed that time spent processing the cancer experience was associated with cancer worry; and (3) showed that cancer worry moderately influenced perceived risk. DISCUSSION: Our results highlight the important role that family cancer experience has on cancer worry and shows how cancer experience translates into personal risk perceptions. This understanding informs the discordance between medical or objective risk assessment and personal risk assessment. Published in 2014. This article is a U.S. Government work and is in the public domain in the USA.

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BACKGROUND: Evidence shows underutilization of cancer genetics services. To explore the reasons behind this underutilization, this study evaluated characteristics of women who were referred for genetic counseling and/or had undergone BRCA1/2 testing. METHODS: An ovarian cancer risk perception study stratified 16,720 eligible women from the Henry Ford Health System into average-, elevated-, and high-risk groups based on family history. We randomly selected 3,307 subjects and interviewed 2,524 of them (76.3% response rate). RESULTS: Among the average-, elevated-, and high-risk groups, 2.3, 10.1, and 20.2%, respectively, reported genetic counseling referrals, and 0.8, 3.3, and 9.5%, respectively, reported having undergone BRCA testing. Personal breast cancer history, high risk, and perceived ovarian cancer risk were associated with both referral and testing. Discussion of family history with a doctor predicted counseling referral, whereas belief that family history influenced risk was the strongest BRCA testing predictor. Women perceiving their cancer risk as much higher than other women their age were twice as likely (95% confidence interval: 2.0-9.6) to report genetic counseling referral. CONCLUSION: In a health system with ready access to cancer genetic counseling and BRCA testing, women who were at high risk underutilized these services. There were strong associations between perceived ovarian cancer risk and genetic counseling referral, and between a belief that family history influenced risk and BRCA testing.

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PURPOSE: Young adolescents who have little interest in participating in competitive team sports are at an increased risk for physical inactivity. Noncompetitive outdoor physical activity can provide young adolescents with increased opportunities to participate in physical activities that appeal to them and have positive health effects. The purpose of this study was to examine factors related to rural young adolescents' participation in noncompetitive outdoor physical activity to inform intervention design. METHOD: Young adolescents aged 10 to 14 years old (N = 1,032) from 1 rural county completed a self-administered questionnaire assessing constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) related to noncompetitive outdoor physical activity. Structural equation modeling was used to examine an integrated conceptual model of hypothesized relationships among constructs. RESULTS: The hypothesized conceptual model provided a good fit to the data with greater perceptions of autonomy support and self-determined motivation having statistically significant positive indirect effects on participation in noncompetitive outdoor physical activity mediated by the constructs of the TPB. All direct paths in the model were statistically significant; however, the direct effect of attitudes on intention was weak (.08) and self-determined motivation had no indirect effect on intention through attitudes (.03). CONCLUSIONS: Constructs of SDT and TPB should be accounted for by interventions targeting noncompetitive outdoor physical activity among young adolescents. More research is needed to determine young adolescents' preferences for noncompetitive and competitive physical activity and the potential influence that noncompetitive outdoor physical activity may have on total daily physical activity.

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BACKGROUND: Young men's involvement in fathering pregnancies has been substantially neglected in unintended pregnancy research. Gender norms give men substantial power and control over sexual encounters, suggesting that understanding men's role is imperative. We tested the hypothesis that young, unmarried South African men who had perpetrated intimate partner violence (IPV) have a greater incidence of fathering pregnancies. METHODS: The data for this study were collected from 983 men aged 15 to 26 who participated in a 2-year community randomized controlled HIV prevention trial in the rural Eastern Cape. Multivariate Poisson models investigated the associations between baseline perpetration of IPV and fathering subsequent pregnancies, while controlling for age, number of sexual partners, socio-economic status, educational attainment, problematic alcohol use, exposure to the intervention, and time between interviews. RESULTS: Of the men in this study, 16.5% (n = 189) had made a girlfriend pregnant over two years of follow up. In addition, 39.1% had perpetrated physical or sexual intimate partner violence and 24.3% had done so more than once. Men who at baseline had perpetrated IPV in the previous year had an increased incidence of fathering, for a first perpetration in that year IRR 1.67 (95% CI 1.14-2.44) and among those who had also been previously violent, IRR 1.97 (95% CI 1.31-2.94). Those who had ever been violent, but not in the past year, did not have an elevated incidence. The incidence among men who had ever perpetrated physical abuse was less elevated than among those who had perpetrated physical and sexual violence IRR 1.64 (95% CI 1.18-2.29) versus IRR 2.59 (95% CI 1.64-4.10) indicating a dose response. CONCLUSION: Young men's perpetration of partner violence is an important predictor of subsequently fathering a pregnancy. The explanation may lie with South African hegemonic masculinity, which valorizes control of women and displays of heterosexuality and virility, and compromises women's reproductive choices.

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BACKGROUND: Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. OBJECTIVE: Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. RESULTS: Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29). CONCLUSION: Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.

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Approximately 40 % of new infections occur among married women. No studies have examined the factors that may contribute to HIV transmission among HIV-negative wives in HIV serodiscordant relationships in Gujarat, India. In 2010, a cross-sectional survey with 185 HIV serodiscordant, married couples (i.e. 185 HIV-positive husbands and their 185 HIV-negative wives) in Gujarat was conducted. Socio-demographic, individual, and interpersonal characteristics of HIV-positive husbands and their HIV negative wives were examined. The association of these characteristics with inconsistent condom use and male-dominated sexual decision-making, were examined using multivariate logistic regression analyses. Approximately 10 % of couples reported inconsistent condom use in the past 3 months and 20 % reported intimate partner violence (IPV). Reports of IPV were associated with a higher odds of inconsistent condom use among HIV-positive husbands (aOR = 6.281). Husbands who reported having received couples counseling had a lower odds of male-dominated decision making about condom use (aOR = 0.372). HIV-negative wives who reported sex communication had a lower odds of male-dominated decision making about condom use (aOR = 0.322) with their HIV-positive husbands. Although condom use is a traditional measure of risk behavior, other factors that facilitate risk, such as male-dominated sexual decision-making need to be considered in analyses of risk.

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BACKGROUND: Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA). METHODS AND RESULTS: HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ(2)(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention. CONCLUSIONS: Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.

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INTRODUCTION: Understanding the characteristics of early and late survey responders has implications for recruitment efforts and for informing potential response bias. The main objective of this analysis was to examine survey responder status (ie, early vs late response) by sociodemographic characteristics and by salience of study variables among respondents. METHODS: We analyzed data from a survey on family cancer history and perceived cancer risk among women at a large managed health-care organization. For baseline and 12-month follow-up surveys, we defined early versus late responder status according to the 95th percentile of the number of days it took to obtain completed interviews. RESULTS: We found no significant associations between responder status and sociodemographic characteristics at baseline or follow-up. At baseline, early responders were significantly more likely than late responders to have a personal history of breast cancer (5.2% vs 3.4%, P = .04) and to have been referred for genetic counseling (4.6% vs 2.0%, P = .004). The association between personal history of breast cancer and responder status persisted at follow-up; only 3.5% of late responders at baseline were also late responders at follow-up. Follow-up survey nonresponse rates did not vary by baseline responder status. CONCLUSION: Survey topic salience is associated with early response and is important for recruitment. However, once recruited, late responders do not remain late responders at follow-up, suggesting that extra efforts made to recruit late responders are worthwhile. Health-related agencies that conduct surveys should consider survey salience in survey administration and recruitment strategies.

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OBJECTIVE: To describe the development and psychometric testing of items measuring connection to the cancer experience through a close friend or relative. METHODS: Ten items assess four aspects of connection to cancer: emotional and cognitive involvement, kind and amount of shared experience, perceived similarity to the affected person, and negative change witnessed. Interviews were conducted with 2200 women close to someone with cancer. The sample was split into two samples for exploratory and confirmatory factor analysis. Sample 1 (n=1342) was used to examine the underlying structure of the items. Sample 2 (n=858) was used for CFA. Internal consistency and reliability analysis were also conducted. RESULTS: Three factors with moderate correlation were extracted: general closeness, resemblance, and cognitive processing. Results from the CFA analysis confirmed a good fit of the three-factor model (Bentler-Bonett NIF=0.973, Bentler-Bonett NNFI=0.975, RMSEA=0.040 and CFI=0.984) and all path coefficients were statistically significant. CONCLUSION: Findings provide preliminary evidence for the reliability and construct validity of the CONNECS scale in measuring individuals' connection to the cancer experience through a close friend or relative. PRACTICE IMPLICATIONS: CONNECS may be a useful tool for examining the impact of the cancer experience on risk perceptions, cancer worry, and medical decision making.

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Intimate Partner Violence (IPV) is a major public health issue occurring in the United States and globally. While little is known in general about IPV, understanding about the prevalence of physical IPV among gay men is even more obscure. There is a clear disparity in violence research attention focused on this vulnerable segment of society. This cross-sectional survey study was conducted to examine the feasibility of enrolling 100 gay men from Atlanta into an IPV survey study. The survey was administered via Facebook. Ninety-nine usable surveys were collected. Chi-square tests reveal that minority ethnic status, illicit drug use, and non-disclosed orientation status were all significantly associated with positive IPV reports--in terms of both victimization as well as perpetration. Overall, the majority of the study sample indicated that they believe IPV is a health problem in the Atlanta gay community. These findings bear importance for the Atlanta gay community and public health professionals who must address this nearly invisible yet increasing public health issue.

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Condom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.

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In this article, the authors explored associations of multiple domains with regular drinking and getting drunk among adult African American men. Questionnaire-based, computer-assisted interviews were conducted with 484 men in Atlanta, Georgia. Data analysis involved multivariate logistic regression analyses. Findings show that being older increased the odds of both drinking behaviors. Sensation seeking increased the odds of regular drinking, and having experienced childhood sexual and physical abuse increased the odds of getting drunk. Having health insurance reduced the odds of both outcomes. Insurance coverage and the heterogeneity among adult African American men must be considered in risk reduction efforts.

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BACKGROUND: The use of complementary and alternative medicine (CAM) among Human Immunodeficiency Virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardize the efficacy of conventional HIV medication, making it critical to understand CAM use among this population. OBJECTIVE: To investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner. METHODS: African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants' CAM use and various psychosocial and socio-demographic characteristics. Participants' most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use. RESULTS: One hundred and eighty two subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female sex, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use. CONCLUSIONS: The implications of these findings are discussed and suggestions for future research are provided.

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OBJECTIVE: This qualitative study investigates the barriers and facilitators to accessing and utilizing healthcare services among women with a serious mental illness (SMI). METHODS: A purposive sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited. Interviews were audio-taped and transcribed verbatim. Data analysis was guided by a modified constant comparison approach. RESULTS: The findings highlight a variety of nonmedical factors that serve as both barriers and facilitators to accessing and utilizing medical healthcare services, such as a trusting relationship with a mental health provider and a women's social network. CONCLUSION: Nonmedical factors and personal circumstances seem to be important factors influencing pathways to healthcare services among women with an SMI. Efforts to better engage and retain women with an SMI into healthcare will need to better acknowledge and incorporate the larger social context of the women's lives.

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