Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (5 results)

  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2023)
PURPOSE: Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors. METHODS: We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics. RESULTS: Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers. CONCLUSIONS: We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors. IMPLICATIONS FOR CANCER SURVIVORS: Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.
    Cover page: Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study.
    • Thesis
    • Peer Reviewed
    UC Davis Electronic Theses and Dissertations (2023)

    Patient-Provider Communications and Mental Health among Cancer Survivors in the United States: Health Disparities during COVID Compared to Pre-COVID

    AbstractBackground Patient-Provider Communications play important roles in cancer survivors’ self-care and mental health management. However, the use and associations of perceived patient-centeredness and online-based communications with mental health outcomes among cancer survivors during SARS/COVID-19 (COVID) have been understudied.

    ObjectiveThis dissertation examines the prevalence of and associated factors with optimal patient-centered communications (PCC), online patient-provider communications (OPPC) use, and poor mental health among cancer survivors during COVID in comparison with pre-COVID and those without a history of cancer.

    MethodsNationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) were used for three studies among cancer survivors (n=2,579) and individuals without a history of cancer (n=13,292) during COVID (HINTS 5 2020) vs. pre-COVID (HINTS 5 1-3, 2017-2019). To assess the prevalence of optimal PCC (always perceiving PCC), OPPC use (email/internet, tablet/smartphone, electronic health records (EHR) use to communicate with providers), and poor mental health (depression as a chronic condition or depressive/anxiety symptoms in the past 2 weeks), weighted descriptive analyses were conducted to obtain frequency (n) and weighted percentage (%) with standard errors (SE). To investigate the associations of sociodemographic and health status factors with optimal PCC, OPPC use, and poor mental health, multivariable-weighted logistic regression models were developed to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs).

    ResultsDuring COVID vs. pre-COVID, the prevalence of optimal PCC was lower (OR=0.73, 95% CI 0.54-0.98), and OPPC use was higher (ORs=1.61-1.92 in email/internet, EHR) among cancer survivors. However, the prevalence of poor mental health did not change significantly among cancer survivors from pre-COVID to COVID. Cancer survivors who had no usual source of care, were the oldest (≥75 years), or had poor mental health were less likely to have both optimal PCC and OPPC use. Income, race/ethnicity, marital status, health insurance type, and general health status were found to be associated with either optimal PCC or OPPC use. The COVID pandemic and a history of cancer were not associated with mental health. When adjusted for PCC and OPPC with other sociodemographic and health status factors, individuals who had low income, had low education, had a poor general health condition, or who were younger, were females, were non-Hispanic Whites, were significantly more likely to have poor mental health.

    Conclusions

    Our findings could inform tailored interventions to prevent further inequities in this population. Raising awareness of PCC roles among healthcare providers and patients through early-stage clinician training or collaborating with patient advocate groups for patient education may improve perceived PCC. Efforts to increase the coverage of virtual visits, enhance eHealth literacy, or improve health technology access might help those with low OPPC use. Furthermore, partnering with public health programs to reach target populations and providing life skills-based training and support could also help people with poor mental health.

      Cover page: Patient-Provider Communications and Mental Health among Cancer Survivors in the United States: Health Disparities during COVID Compared to Pre-COVID
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2022)

      Background

      Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers' vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S.

      Methods

      Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017-2020). Female caregivers aged 21-65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving.

      Results

      An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91-6.85, adherence of aged 21-50 vs. 51-65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31-7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14-4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10-5.00, adherence of 5-14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts.

      Conclusions

      There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.
        Cover page: Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2023)
        Poor mental health has been found to be more prevalent among those with cancer and is considered a public health crisis since COVID-19. This study assessed the impact of COVID-19 and cancer survivorship on mental health and investigated factors, including online patient-provider communications (OPPC; email/internet/tablet/smartphone), associated with poor mental health prior to and during the early COVID-19. Nationally representative Health Information National Trends Survey data during 2017-2020 (n = 15,871) was used. While the prevalence of poor mental health was high (40-42%), Difference-In-Difference analyses revealed that cancer survivorship and COVID-19 were not associated with poor mental health. However, individuals that used OPPC had 40% higher odds of poor mental health. Low socioeconomic status (low education/income), younger age (18-64 years), and female birth gender were also associated with poor mental health. Findings highlight the persistence of long-standing mental health inequities and identify that OPPC users might be those who need mental health support.
          Cover page: Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2023)

          Objectives

          Patient-Centered Communication (PCC) is an essential element of patient-centered cancer care. Thus, this study aimed to examine the prevalence of and factors associated with optimal PCC among cancer survivors during COVID-19, which has been less studied.

          Methods

          We used national survey (Health Information National Trends Survey) among cancer survivors (n = 2579) to calculate the prevalence (%) of optimal PCC in all 6 PCC domains and overall (mean) by time (before COVID-19, 2017-19 vs. COVID-19, 2020). Multivariable logistic regressions were performed to explore the associations of sociodemographic (age, birth gender, race/ethnicity, income, education, usual source of care), and health status (general health, depression/anxiety symptoms, time since diagnosis, cancer type) factors with optimal PCC.

          Results

          The prevalence of optimal PCC decreased during COVID-19 overall, with the greatest decrease in managing uncertainty (7.3%). Those with no usual source of care (odd ratios, ORs =1.53-2.29), poor general health (ORs=1.40-1.66), depression/anxiety symptoms (ORs=1.73-2.17) were less likely to have optimal PCC in most domains and overall PCC.

          Conclusions

          We observed that the decreased prevalence of optimal PCC, and identified those with suboptimal PCC during COVID-19.

          Practice implications

          More efforts to raise awareness and improve PCC are suggested, including education and guidelines, given the decreased prevalence during this public health emergency.
            Cover page: Cancer survivors with sub-optimal patient-centered communication before and during the early COVID-19 pandemic
            Top