Preventive medicine
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Preventive medicine · Jul 2016
Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status.
About 92% of US older adults have at least one chronic disease or medical condition and 77% have at least two. Low-income and uninsured adults in particular experience a higher burden of comorbidities, and the Medicaid expansion provision of the Affordable Care Act was designed to improve access to healthcare in this population group. However, a significant number of US states have declined expansion. The purpose of this study is to determine the distribution of low-income and uninsured adults in expanded versus non-expanded states, and evaluate the prevalence of comorbidities in both groups. ⋯ States without Medicaid expansion have a greater proportion of poor, uninsured adults with more chronic diseases and conditions.
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Preventive medicine · Jul 2016
Effect of number of human papillomavirus vaccine doses on guideline adherent cervical cytology screening among 19-26year old females.
Little is known about how the number of HPV vaccine doses affect adherence to screening guidelines. This study compared adherence to cervical cancer screening by the number of HPV vaccine doses received by young women and assessed whether the specialty of vaccinating providers affected behavior. ⋯ Women who received 1 or 2 doses of the HPV vaccine were less likely than those who received 3 doses to be screened for cervical cancer 3years following vaccine initiation. Pediatricians and primary care physicians should convey the importance of initiating and continuing screening to HPV vaccinated patients.
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Preventive medicine · Jul 2016
ReviewA systematic review of interventions to improve adherence to melanoma preventive behaviors for individuals at elevated risk.
To examine the effectiveness of behavioral interventions for melanoma prevention targeted to individuals at elevated risk due to personal and/or family history. ⋯ Findings suggest that future interventions should aim to improve adherence across multiple preventive behaviors, over a longer time period (past 8months post-intervention), and target high-risk children. Studies should include adequate sample sizes to investigate moderators and mediators of intervention effectiveness. Interventions may be strengthened by new techniques, such as incorporating family members (e.g., to improve thoroughness of skin self-examinations) and eHealth technology.
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Preventive medicine · Jul 2016
Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence.
More physical activity (PA) and less screen time (ST) are positively associated with mental health in adolescents; however, research is limited by short-term designs and the exclusion of ST when examining PA. We examined: (a) changes in PA, ST, symptoms of depression, and symptoms of anxiety over four assessments spanning 11years, and (b) bidirectional relationships between initial PA, ST, and symptoms of depression and anxiety as predictors of change in each other during adolescence. Between 2006 and 2010, participants from Ottawa Canada (Time1; N=1160, Mean age=13.54years) completed questionnaires at four points covering the ages from 10 to 21years. ⋯ No other significant findings between initial PA, ST, anxiety, or depression were found as predictors of change in each other. Interventions targeting depression around age 13 may be useful to prevent further declines in PA. Similarly, interventions to reduce ST may be beneficial for concurrent reductions in symptoms of depression and anxiety, irrespective of PA.
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Preventive medicine · Jul 2016
Socioeconomic inequalities in the healthiness of food choices: Exploring the contributions of food expenditures.
Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food and beverage purchases, including expenditure, throughout 2010 were obtained for 24,879 UK households stratified by occupational social class. ⋯ However, reverse mediation analyses were also significant, suggesting that 10% of socioeconomic inequalities in expenditure were mediated by healthiness of choices. Findings suggest that lower food expenditure is likely to be a key contributor to less-healthy food choices among lower socioeconomic groups. However, the potential influence of cost may have been overestimated previously if studies did not account for supermarket choice or explore possible reverse mediation between expenditure and healthiness of choices.