Preventive medicine
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Preventive medicine · Mar 2019
Acceptability of receiving lifestyle advice at cervical, breast and bowel cancer screening.
Cancer screening could be an opportunity to deliver cancer prevention advice, but it is not known how such information would be received. We explored willingness to receive lifestyle advice in the context of the English National Health Service cervical, breast, and bowel (FS; flexible sigmoidoscopy) screening programmes. A population-based survey was conducted in 2016 to collect nationally representative data on willingness to receive lifestyle advice across cervical (n = 768), breast (n = 420) and FS (n = 308) screening programmes. ⋯ Women were more likely to be willing to receive advice at FS screening than men. Providing lifestyle advice at cancer screening is likely to be acceptable to the general population. The optimal approach for delivery needs careful consideration to minimise potential negative effects on screening attendance.
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Preventive medicine · Mar 2019
Interracial couples and breastfeeding initiation in the United States.
In the past decade, the prevalence of interracial couples has steadily increased. Recent reports state that nearly one in five marriages are between spouses of different races. Interracial couples receive less social support and are more likely to separate. ⋯ The lowest odds of breastfeeding initiation were observed among intraracial black parents, who had 43% lower odds of breastfeeding initiation compared to intraracial white parents. Breastfeeding non-initiation continues to pose the greatest risk for infants with at least one black parent. Nurses, midwives, physicians, and other medical staff should discuss potential barriers that may be unique to interracial couples and provide additional breastfeeding education and support.
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Preventive medicine · Mar 2019
Comparative StudyMode of HPV vaccination delivery and equity in vaccine uptake: A nationwide cohort study.
Ten years after its introduction, equity in human papillomavirus (HPV) vaccine uptake remains unattained, not least for the groups at highest risk of cervical cancer. In Sweden, three different delivery modes of the vaccine have been in effect since May 2007. We used this as a natural experiment to investigate girls' HPV vaccine uptake in relation to parental country of birth and socioeconomic characteristics, by mode of delivery. ⋯ The associations were partially reduced in catch-up outside-school, and strongly reduced in school-based vaccination delivery [HR (95% CI) =0.82 (0.81-0.83), 0.92 (0.91-0.94), 0.87 (0.85-0.88), respectively]. Free-of-charge school-based HPV vaccination achieved the highest uptake and displayed the least disparity in country of birth and socioeconomic background of the parents. This appears to be the most effective and equitable delivery mode for reaching high population vaccination coverage, including high-risk groups for cervical cancer.
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Preventive medicine · Mar 2019
Personality and preventive healthcare utilisation: Evidence from the Irish Longitudinal Study on Ageing.
There is extensive empirical evidence that personality is associated with many outcomes and behaviours, such as educational outcomes, labour market participation, savings behaviour, health behaviours, physical health status and mortality. Use of preventive healthcare services (e.g., vaccinations, screening, etc.) is a potential pathway explaining the link between personality and health, and is an important component of healthy ageing. ⋯ We find that openness to experience is a significant predictor of breast lump check and mammogram in women aged 65+ after adjustment for other confounders and multiple hypothesis testing. While uptake of many preventive healthcare services remains below national recommendations for the older population, with the exception of breast lump checks and mammograms for women aged 65+, we find little evidence to link this heterogeneity in uptake to personality.
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Preventive medicine · Mar 2019
Review Multicenter StudySimulated impacts and potential cost effectiveness of Communities Putting Prevention to Work: Tobacco control interventions in 21 U.S. communities, 2010-2020.
In 2010, the Centers for Disease Control and Prevention (CDC) funded communities to implement policy, systems, and environmental (PSE) changes under the Communities Putting Prevention to Work (CPPW) program to make it easier for people to make healthier choices to prevent chronic disease. Twenty-one of 50 funded communities implemented interventions intended to reduce tobacco use. To examine the potential cost-effectiveness of tobacco control changes implemented under CPPW from a healthcare system perspective, we compared program cost estimates with estimates of potential impacts. ⋯ We found $735 million in potentially averted medical costs cumulatively from 2010 through 2020 because of the CPPW-supported interventions. If the CPPW tobacco control PSE changes are sustained through 2020 without additional funding after 2013, we find that medical costs averted will likely exceed program costs by $604 million. Our results suggest that the medical costs averted through 2020 may more than offset the initial investment in CPPW tobacco control interventions, implying that such interventions may be cost saving, especially over the long term.