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Open Access Publications from the University of California

Scholarly Works (9 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2015)

Recent research has linked experiences of child abuse to cancer later in life. However much of the available research has failed to look at the independent effects of child abuse types (i.e. physical, sexual and emotional abuse) and does not attempt to test potential reasons for this association. To address these shortcomings, the purpose of this study is to investigate the contribution of three health behaviors (i.e. smoking, overweight or obesity and alcohol drinking) and two measures of socioeconomic status (i.e. educational attainment and household income) that are hypothesized to mediate the association between abuse type experienced in childhood and cancer risk in adulthood. Overall, evidence exists supporting some of the connections. However, not all evidence examines all abuse types and not all evidence is consistent. Data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS), a representative telephone survey of adults 18 years of age and over living in the United States was used in this investigation.

The following four aims were examined: 1) Assess the representativeness of data from the BRFSS; 2) Determine if each abuse type was independently associated with cancer, after controlling for other abuse types, other adverse childhood experiences and sociodemographic characteristics; 3) Determine if the relationship between child abuse and cancer is mediated by health behaviors 4) Determine if the relationship between child abuse and cancer is mediated by socioeconomic status. Aim 1 was examined using 1 proportion z-tests, comparing BRFSS estimates by state to comparison data obtained from national sources. Aim 2 was examined using logistic regression. Aims 3 and 4 were examined using logistic regression, with Karlson, Holm and Breen’s KHB method used to analyze mediating effects of health behaviors and socioeconomic status. Analyses were conducted using Stata 14.0 and using probability weights.

Results for Aim 1 revealed that data was not entirely representative. For Aim 2, models showed that physical, sexual and emotional abuse were each associated with increased odds of cancer. For Aim 3, mediation analyses revealed that smoking partially mediated the relationship between physical abuse and cancer and between sexual abuse and cancer. Smoking fully mediated the association between emotional abuse and cancer. For Aim 4, mediation analyses revealed that household income partially mediated the relationship between sexual abuse and cancer.

Overall, this study highlighted that abuse is different from other adverse childhood experiences when it comes to its association with cancer. Furthermore, abuse types have unique mediators, suggesting that there are unique causal pathways connecting each abuse type and cancer.

    Cover page: The Role of Health Behaviors and Socioeconomic Status in Explaining the Relationship Between Child Abuse and Cancer
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2016)
    Adverse childhood experiences (ACEs) have been linked to increased use of tobacco products later in life. However, studies to date have ignored smokeless tobacco products. To address this, data from the 2011 Behavioral Risk Factor Surveillance System, which interviewed adults 18 years and over (N = 102,716) were analyzed. Logistic regression models were fit to estimate odds ratios of ever smoking, current smoking and current smokeless tobacco use in relation to ACEs. Results showed that less than 4 % of respondents currently used smokeless tobacco products, while 44.95 and 18.57 % reported ever and current smoking, respectively. Physical abuse (OR 1.40; 95 % CI 1.14, 1.72), emotional abuse (OR 1.41; 95 % CI 1.19, 1.67), sexual abuse (OR 0.70; 95 % CI 0.51, 0.95), living with a drug user (OR 1.50; 95 % CI 1.17, 1.93), living with someone who was jailed (OR 1.50; 95 % CI 1.11, 2.02) and having parents who were separated or divorced (OR 1.31; 95 % CI 1.09, 1.57) were associated with smokeless tobacco use in unadjusted models. After accounting for confounders, physical abuse (OR 1.43; 95 % CI 1.16, 1.78), emotional abuse (OR 1.32; 95 % CI 1.10, 1.57), living with a problem drinker (OR 1.30; 95 % CI 1.08, 1.58), living with a drug user (OR 1.31; 95 % CI 1.00, 1.72) and living with adults who treated each other violently (OR 1.30; 95 % CI 1.05, 1.62) were associated with smokeless tobacco use. Living with someone who was mentally ill (OR 0.70; 95 % CI 0.53, 0.92) was associated with smokeless tobacco use after accounting for confounders and all ACEs. Results indicated that some childhood adversities are associated with use of smokeless tobacco products. Special attention is needed to prevent tobacco use of different types among those experiencing ACEs.
      Cover page: Adverse Childhood Experiences and Use of Cigarettes and Smokeless Tobacco Products
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2017)

      Introduction

      Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products.

      Aims and methods

      Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables.

      Results

      There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites.

      Conclusions

      The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites.

      Implications

      Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities.
        Cover page: Misplaced Trust: Racial Differences in Use of Tobacco Products and Trust in Sources of Tobacco Health Information.
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2017)

        Objectives

        Adverse childhood experiences (ACEs) have been linked to a variety of diseases in adulthood, including cancer. However, current research has yet to determine if all abuse types are associated with cancer and if women are more adversely impacted by ACEs than men.

        Methods

        Data from the 2011 Behavioral Risk Factor Surveillance System, a national survey of American adults 18 and older (N = 111,964) were analyzed. Logistic regression models were fit to estimate odds of ever being diagnosed with cancer after experiencing one or more of eight different ACEs, while adjusting for potential confounders. These analyses were then stratified by gender.

        Results

        Among women, childhood experiences of physical abuse, sexual abuse, emotional abuse, living with someone who was mentally ill, living with a problem drinker, living with a drug user, and living in a household where adults treated each other violently were associated with higher odds of cancer. Among men, only emotional abuse was associated with higher odds of cancer.

        Conclusions

        Results suggest that ACEs increase risk of cancer later in life. However, this impact occurs mostly among women. This finding may be because women experience many ACEs at higher rates than men and because women, via sexual abuse, can be exposed to cancer-causing viruses.
          Cover page: Gender Differences in the Association between Adverse Childhood Experiences and Cancer
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2020)

          Objective

          Research suggests that sociopolitical stressors connected with the 2016 presidential election were associated with increases in preterm birth among Latina women. This study determined whether periviable births (<26 weeks gestation), which exhibit extremely high rates of infant morbidity and mortality, among US Latina women increased above expected levels after the 2016 US presidential election.

          Methods

          We assigned singleton live births among Latina and non-Latina white women in the US to 96 monthly conception cohorts conceived from January 2009 through December 2016. We constructed risk ratios by dividing the rate of periviable birth among Latina women by the rate among non-Latina white women. We used time-series methods to determine if the risk ratio of periviable births in cohorts conceived by Latina women and exposed to the election of 2016 exceeded those expected from autocorrelation and calendar effects.

          Results

          We found an outlying sequence of risk ratios among Latina women starting with the cohort conceived in April and ending with that conceived in November 2016. Increases in the ratios ranged from 0.07 above an expected of 1.61 for the cohort conceived in June, to 0.39 above an expected of 1.27 for the cohort conceived in April.

          Conclusion

          We find that pregnancies in gestation at the time of the 2016 election among Latina women yielded more than expected periviable births. These findings support the argument that the prospect of anti-immigrant policies promised by the Trump campaign sufficiently stressed Latina women to affect the timing of birth.
            Cover page: The 2016 presidential election and periviable births among Latina women
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2018)
            We use data from the 2011-2016 National Health Interview Survey to examine how the Patient Protection and Affordable Care Act (ACA) has influenced disparities in health care-related financial strain, access to care, and utilization of services by categories of the Federal Poverty Level (FPL). We use multivariable regression analyses to determine the ACA's effects on these outcome measures, as well as to determine how changes in these measures varied across different FPL levels. We find that the national implementation of the ACA's insurance expansion provisions in 2014 was associated with improvements in health care-related financial strain, access, and utilization. Relative to adults earning more than 400% of the FPL, the largest effects were observed among those earning between 0% to 124% and 125% to 199% of the FPL after the implementation of the ACA. Both groups experienced reductions in disparities in financial strain and uninsurance relative to the highest FPL group. Overall, the ACA has attenuated health care-related financial strain and improved access to and the utilization of health services for low- and middle-income adults who have traditionally not met income eligibility requirements for public insurance programs. Policy changes that would replace the ACA with less generous age-based tax subsidies and reductions in Medicaid funding could reverse these gains.
              Cover page: The Affordable Care Act Attenuates Financial Strain According to Poverty LevelCreative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2016)
              This study examined differences in access, utilization, and barriers to health care by nativity, language spoken at home, and insurance status in East Los Angeles and Boyle Heights, California. Data from household interviews of neighborhood residents conducted as part of a corner store intervention project were used. Binary and multinomial logistic regression models were fitted. Results showed that uninsured and foreign-born individuals were differentially affected by lack of access to and utilization of health care. While the Affordable Care Act may ameliorate some disparities, the impact will be limited because of the exclusion of key groups, like the undocumented, from benefits.
                Cover page: Access to and Use of Health Care Services Among Latinos in East Los Angeles and Boyle Heights
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2018)

                Purpose

                We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging.

                Materials and methods

                We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed.

                Results

                Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence.

                Conclusions

                In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker.
                  Cover page: Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2015)
                  Cardiovascular disease (CVD) is the leading killer of Americans. CVD is understudied among Latinos, who have high levels of CVD risk factors. This study aimed to determine whether access to health care (ie, insurance status and having a usual source of care) is associated with 4 CVD prevention factors (ie, health care utilization, CVD screening, information received from health care providers, and lifestyle factors) among Latino adults and to evaluate whether the associations depended on CVD clinical risk/disease.Data were collected as part of a community-engaged food environment intervention study in East Los Angeles and Boyle Heights, CA. Logistic regressions were fitted with insurance status and usual source of care as predictors of the 4 CVD prevention factors while controlling for demographics. Analyses were repeated with interactions between self-reported CVD clinical risk/disease and access to care measures.Access to health care significantly increased the odds of CVD prevention. Having a usual source of care was associated with all factors of prevention, whereas being insured was only associated with some factors of prevention. CVD clinical risk/disease did not moderate any associations.Although efforts to reduce CVD risk among Latinos through the Affordable Care Act could be impactful, they might have limited impact in curbing CVD among Latinos, via the law's expansion of insurance coverage. CVD prevention efforts must expand beyond the provision of insurance to effectively lower CVD rates.
                    Cover page: Access to Care and Cardiovascular Disease Prevention: A Cross-Sectional Study in 2 Latino Communities.
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