Search Results (95)

Background: Ovarian cancer remains the deadliest and leading cause of gynecological cancer-associated mortality in the US. The aim of this study was to characterize the trends in the incidence of ovarian cancer between premenopausal and postmenopausal women to inform future targeted interventions. Methods: This population-based cross-sectional study analyzed data from the US Cancer Statistics (USCS) database, which covered the whole of the US population between 2001 and 2021. Joinpoint regression was used to compute the average annual percentage change (APC) with 95% confidence interval (CI) and age-standardized incidence rates per 1,000,000 population. Results: The results showed that the IR of ovarian cancer declined between 2001 and 2021. Postmenopausal women had greater decreases in the IR of ovarian cancer compared to premenopausal women who showed a small decline. When stratified by race/ethnicity, non-Hispanic American Indian/Alaska Native women aged 20–49 years experienced an increase in the IR of ovarian cancer (APC = 2.4; 95% CI 0.9 to 4.1) compared to other racial/ethnic groups which showed a decline. Joinpoint trend analyses identified one inflection point in localized ovarian cancer incidence trends among all three age groups: an initial decline from 2001 to 2011 among women 20–49 years old and 65+ years old, and from 2001 to 2012 among women 50–64 years old, followed by an upward trend thereafter to 2021. Similarly, there was one inflection point in the IR of ovarian cancer for the clear cell and endometrioid types among women aged 20–49 years old. Conclusions: The IR of ovarian cancer in the US declined significantly among postmenopausal compared to premenopausal women, for whom the IR of ovarian cancer decreased only slightly. Although encouraging, these findings show a need for continued efforts to improve early detection and prevention strategies to mitigate the burden of this deadly disease. Full article

Coccidioidomycosis (Valley fever), caused by Coccidioides spp., is a fungal infection endemic to semi-arid regions of the Americas. Despite 80 years of disease recognition in New Mexico, there is limited disease awareness. We incorporated clinical, epidemiological, and ecological datasets to summarize the knowledge of Valley fever in New Mexico. We analyzed 1541 human cases from 2006 to 2023. On average, 86 cases were reported each year (4.1 cases per 100,000 population per year). The highest levels of incidence were in southwestern New Mexico. American Indian or Alaska Natives in New Mexico had a 1.9 times higher incidence rate of coccidioidomycosis than White people, and among age groups, older populations in New Mexico had the highest incidence rates. We analyzed 300 soil samples near Las Cruces, New Mexico, for the presence of Coccidioides and reported the first known positive soil samples collected from the state, the majority of which were from grassland-dominated sites and from animal burrows. Sequence analyses in clinical specimens, wild animals, and soil samples confirmed that Coccidioides posadasii is the main causative species of coccidioidomycosis in New Mexico. Environmental surveillance validated that locally acquired infections could occur in, but are not limited to, Catron, Doña Ana, Sierra, and Socorro Counties. Full article

Background: The burden of liver cirrhosis correlated with diabetes mellitus (DM) poses a significant public health challenge in the United States. Both conditions independently contribute to high morbidity and mortality rates. While extensive individual analyses have been conducted, US trends in comorbid liver cirrhosis-DM-related mortality remain unexplored. This study seeks to investigate mortality trends associated with the simultaneous occurrence of liver cirrhosis and DM among U.S. adults over the period from 1999 to 2020. Methods: We conducted a descriptive analysis using publicly available mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using the 2000 U.S. standard population. Trends were stratified by year, age, sex, race/ethnicity, urbanization, region, and state. Joinpoint regression analysis was employed to determine annual percentage changes (APCs) and assess statistical significance (p < 0.05). Results: A total of 90,418 deaths were recorded among adults with both cirrhosis and DM between 1999 and 2020. The overall AAMR increased from 1.02/100,000 in 1999 to 1.78/100,000 in 2020, reflecting a significant upward trend in mortality. The highest mortality rates were observed in non-metropolitan regions, in the South, and among males, older adults (65+), and NH American Indian or Alaska Native and Hispanic populations. All demographic groups exhibited a pronounced mortality surge between 2018 and 2020. A state-level analysis revealed notable disparities, with Oklahoma and Texas presenting the highest AAMRs. Conclusions: Liver cirrhosis and diabetes-related mortality have been steadily increasing over the past two decades, with notable disparities in demographics and regions. These findings underscore the urgent necessity for targeted prevention, early intervention, and policy-level strategies specifically designed for high-risk populations to reduce future mortality rates in the US and ultimately, globally. Full article

Queer, trans, and Two Spirit Native youth are rarely represented in research, with extant evidence continuously pointing out health disparities and pathologizing individual characteristics rather than accounting for the structural aspects of colonial society. Global Indigenous scholars have put forth a holistic conception of social and emotional wellbeing that integrates Indigenous sovereignty, strengths, and cultures, positing that Indigenous health is a culturally bound phenomenon. To move beyond these deficit-based framings and collate available scholarship, the present work presents the results of a scoping review surrounding the social and emotional wellbeing of queer, trans, and Two Spirit Native youth. Informed by the Indigiqueer ecological medicine wheel, the present work includes a breadth of health and wellbeing concepts for QT2S Native youth across micro and macro domains. A total of 27 articles met the criteria and were reviewed to (a) illuminate current experiences of QT2S Native youth, (b) provide recommendations for health providers to better support QT2S Native youth clients, and (c) suggest future research and data recommendations to build towards a holistic understanding of social and emotional wellbeing for queer, trans, and Two Spirit Native youth. Full article

Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Results: Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (p-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). Conclusions: CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Impact: Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful. Full article

Syndromic surveillance has evolved into a vital public health tool, providing near real-time data to detect and respond to health threats. While states administer syndromic surveillance systems, Tribal Epidemiology Centers (TECs) serve American Indian and Alaska Native (AIAN) communities across multistate regions, often encountering significant barriers to data access and utilization. This manuscript explores how TECs access and use syndromic surveillance data to address health disparities in AIAN populations, highlighting successes, innovations, and ongoing challenges. The Alaska Native Epidemiology Center (ANEC), Great Plains Tribal Epidemiology Center (GPTEC), and Northwest Tribal Epidemiology Center (NWTEC) provide insights into their syndromic surveillance practices. This includes data access methods, the creation of dashboards and reports, technical assistance for Tribal Health Organizations (THOs), and strategies for overcoming jurisdictional and data-sharing barriers. TECs have successfully leveraged syndromic surveillance to monitor critical health issues, including respiratory illnesses, substance misuse, behavioral health, and maternal care. Collaborative efforts have addressed race misclassification and data gaps, enabling targeted interventions such as air purifier distribution and improving health care delivery for tribal veterans. However, TECs can face restrictive data use agreements, jurisdictional misalignments, and limited access to granular data, hindering their ability to serve AIAN communities comprehensively. Syndromic surveillance offers transformative potential for improving public health in AIAN communities. To fully realize this potential, systemic changes are needed to streamline data-sharing agreements and improve data accuracy. These efforts, along with strong collaborations between TECs and state health departments, are critical to advancing health equity, respecting tribal sovereignty, and ensuring timely, actionable insights for AIAN populations. Full article

Background/Objectives: Early-onset cancer is an emerging global health concern, including in the United States. However, data on early-onset liver and intrahepatic bile duct cancer remain limited. This study aims to fill this gap by analyzing trends in early-onset liver and intrahepatic bile duct cancer in the United States over the past two decades. Methods: This study used National Childhood Cancer Registry data to examine temporal trends in early-onset liver and intrahepatic bile duct cancer in the United States. The analysis involved estimating age-adjusted incidence rates of early-onset liver and intrahepatic bile duct cancer, stratified by histological type, ethnicity, and sex. Results: In 2021, the age-adjusted incidence rate of early-onset liver and intrahepatic bile duct cancer was estimated at 0.53 per 100,000 population (95% Confidence Interval [CI]: 0.48–0.59). From 2001 to 2021, the age-adjusted incidence rate showed a significant annual percent change (APC) of 1.35% (95% CI: 0.87–1.83%). When stratified by sex, the age-adjusted incidence rate in females increased significantly (APC: 3.07%, 95% CI: 2.26–3.87%) while remaining stable in males. Among racial and ethnic groups, non-Hispanic American Indian and Alaska Native (AIAN) individuals had the highest age-adjusted incidence rate, recorded at 2.67 per 100,000 population (95% CI: 0.95–5.85). By histological type, hepatic carcinoma had the highest age-adjusted incidence rate, significantly increasing over time (APC: 1.47%, 95% CI: 0.96–1.99%). In contrast, the incidence rates for hepatoblastoma and unspecified hepatic tumors remained stable between 2001 and 2021. Conclusions: Our study identified an increasing incidence of early-onset liver and intrahepatic bile duct cancer in the United States, primarily driven by cases in females and hepatic carcinoma. Full article

(1) Background: This study aimed to examine adult participants perceptions of the Thiwáhe Gluwáš’akapi (TG) program. We recruited 13 of 85 (15.3%) adult participants from various previous cohorts of the TG program, separated into lower and higher participation groups. Qualitative semi-structured interviews were conducted. This study was conducted on a Northern Plains reservation, and interviews took place via phone. (2) Methods: Semi-structured interviews with 13 adult participants with children aged 10–12 were completed. Audio files were transcribed and analyzed with ATLAS.ti. (3) Results: Qualitative analysis of these interviews revealed several themes: positive reception by families, enhanced connections to Lakota culture and community, and improved familial relationships. Several barriers to participation emerged, such as difficulties with transportation, scheduling conflicts, and lack of time, which can inform implementation strategies. Observed themes showcase positive impacts of TG on parent–child relationships and cultural connection, aiding overall wellbeing and substance use discourse. (4) Conclusions: Participants in the TG program expressed high satisfaction with the program, gained new skills, and improved family dynamics. Future implementation of TG should include additional transportation support and session scheduling options, in addition to updated implementation strategies to further improve Lakota families’ mental health and wellbeing. Full article

Indigenous women experience disproportionately higher rates of adverse health outcomes. Few studies have explored the root of these problems or defined health and wellness from the perspectives of Indigenous women. Our objective was to elicit views on Indigenous women’s health from women who are Indigenous and/or have experience working with Indigenous communities across Turtle Island and Hawai‘i (e.g., United States). Informed by intersectionality as a social critical theory, we convened a workshop to engage in a co-creative consensus-building and expert decision process using design thinking. The two-day workshop embraced Indigenous values of land, sacred spaces, genealogy, family, rituals, and culture. Participants included United States-based Native and Indigenous women (n = 16) and allies (n = 7). Participants focused on answering key questions such as “What are priority areas for Indigenous women’s health”? and “What are the key facilitators and barriers to improving Indigenous women’s health”? Co-created priority lists for each of these topics were generated. Participants overwhelmingly reported satisfaction with the workshop process and emphasis on a strength-based, culturally driven approach to share their stories, which contextualized the ideas, concerns, and priorities of Indigenous women who self-reflected on their own health and wellness. Creating culturally safe spaces for Indigenous people to reflect on their own hopes for the future relates to the theme by describing a process to bridge traditional healing with modern-day practices to build pilina. Full article

The COVID-19 pandemic had a disproportionate impact on American Indian and Alaska Native (“Native”) communities, including factors impacting alcohol-exposed pregnancy (AEP) risk. This is especially true for young Native women in urban settings, where over 70% of the population resides, yet their experiences are rarely accounted for in research. We conducted remote in-depth interviews from March to May 2022, roughly concurrent with the Omicron surge and relaxed lockdown measures, with a subsample of 15 urban Native young women ages 16–20 who were participating in a national randomized controlled trial of an AEP preventive intervention. Participants were asked how the pandemic affected their use of alcohol, sexual health, mental health, and relationships. A qualitative analysis revealed diverse experiences during the pandemic. While some participants experienced greater risks for AEP due to increased alcohol use and reduced access to birth control, other participants drank less alcohol and had greater access to birth control. Additionally, while some participants faced mental health challenges due to isolation and relational strains that emerged during the pandemic, others found the pandemic to be a time that afforded self-reflection, self-development, and a deepening of relationships. Full article

(1) Background: American Indian and Alaska Native (AI/AN) communities faced disproportionate COVID-19 infection rates and a higher prevalence of substance use disorders (SUDs). Telehealth emerged as a key strategy to address these health disparities. (2) Objective: In response to a call to action from an urban Indian organization (UIO), our multidisciplinary team conducted a community-based participatory study to (1) examine the integration of Native practices in SUD treatment during COVID-19, and (2) develop provider training modules based on these findings. (3) Methods: Using a mixed methods approach, we conducted semi-structured interviews with six community SUD providers, surveyed 91 clients, and analyzed 278 de-identified health records from the UIO Native-serving facility in the Southwest U.S. from May 2020 to May 2021. (4) Results: As of October 2024, analysis of Aim 1 is ongoing. With UIO engagement, findings from Aim 1 are being translated into training modules for Aim 2. (5) Conclusion: This community-driven study lays the foundation for future research on Indigenous mental well-being, centering strength, resilience, and cultural knowledge in substance use treatment. Findings will be disseminated through presentations and publications with Native and non-Native communities, treatment centers, educators, and leaders. Future studies will assess the effectiveness of the training modules among clinicians. Full article

Background: Tobacco use remains a global challenge to public health, accounting for almost eight million deaths per year worldwide, with a significant portion attributable to tobacco-related cancers. Examining the epidemiology of tobacco-related cancers and assessing the trends in the incidence and mortality will allow for more effective prevention, treatment, and targeted strategies. Methods: We assessed the trends in the incidence and mortality of tobacco-related cancers among adults in the United States using data from United States Cancer Statistics (USCS) 2001–2021 and mortality data 1975–2022 from the National Center for Health Statistics (NCHS). The incidence and mortality rates of tobacco-related cancers were calculated as cases per 1,000,000 persons and age-adjusted to the 2000 United States standard population. Results: There was a recent overall decreasing trend in both the incidence (2001–2021) and mortality rate (2001–2022). Among adults 20–49 years old, there was an increasing trend from 2001 to 2021 in the incidence among non-Hispanic American Indians/Alaska Natives (APC 2.6, 95% CI 2.1–3.0) and those in the West (APC 0.2, 95% CI 0.0–0.4); in Hispanics, the incidence rate increased most recently from 2013 to 2021 (APC 1.7, 95% CI 1.0–3.0). The mortality rate first increased from 1975 to 1990 among females 50–64 years old and males 65+ years old and from 1975 to 2000 among females 65+ years old, and then decreased thereafter. Conclusions: The rising incidence in some younger groups highlights the need for targeted public health interventions to address disparities and improve cancer prevention in these vulnerable populations. Full article

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good. Conclusions: These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity. Full article

AI/AN communities are disproportionately impacted by food insecurity and gestational diabetes mellitus (GDM). Decreasing the risk of GDM can interrupt the intergenerational cycle of diabetes in AI/AN families, and can decrease diabetes-related health disparities. The goal of this study was to explore ways of supporting holistic health and reducing the risk of GDM among young American Indian and Alaska Native (AI/AN) females prior to pregnancy. Semi-structured interviews were conducted with adult AI/AN women (>18 years) who had GDM or who have young female relatives (e.g., daughters) (n = 41), AI/AN females between 12 and 24 years (n = 18), and key experts in food/nutrition and health within AI/AN communities (n = 32). Three themes emerged: (1) guidance on how to support young females’ holistic wellness; (2) evidence that generations of colonial violence, including forced removal, forced poverty, and the imposition of a Western-based food system, causes deeper, systemic fracturing of traditional cultural food knowledge and practices; and the fact that (3) opportunities for improved adolescent female health are rooted in AI/AN values and how AI/AN people resist the impacts of anti-Indigenous racism through family-based, community-led, and holistic health. These themes suggest alternative understandings about the relationships between food insecurity and holistic pre-pregnancy health and can guide our next steps in decreasing health disparities in these communities. Full article

Background: Radioactive iodine (RAI) ablation therapy is a common minimally invasive treatment for patients diagnosed with differentiated thyroid cancer (DTC). Although previous studies have identified a link between RAI and the mortality from secondary solid cancers, the connection between RAI and leukemia remains under-researched. This study investigated the differential risk of leukemia and its subtypes in DTC patients following RAI treatment. Methods: DTC patients from the Surveillance, Epidemiology, and End Results (SEER) Registry 17 (2000–2019) were analyzed. The standard incidence ratio (SIR) and excess risk (ER) compared to the reference population were calculated. Results: Out of 196,569 DTC patients, 1381 patients developed various types of hematological malignancies. Leukemia was diagnosed in 508 of these patients, and it had the highest risk among the malignancies studied, with an SIR of 1.74 (95%CI: 1.59–1.9). The RAI group had an SIR of 2.12 (95%CI: 1.87–2.39), while the non-RAI group had an SIR was 1.45 (95%CI: 1.37–1.52) (p < 0.001). Those diagnosed before the age of 55 years had a conspicuously elevated risk (SIR 2.74) compared to those diagnosed at 55 years or older (SIR 1.53). American Indian/Alaska Native survivors manifested a pronounced leukemia risk with an SIR of 7.63 (95%CI: 2.46–17.8). Conclusions: RAI treatment increased the risk of developing leukemia when serving as adjuvant therapy in surgical patients (SIR 2.12). There exists a significant association between RAI treatment in DTC patients and the incidence of leukemia. This susceptibility seems to be modulated by factors including time since diagnosis, age, gender, and racial background. Full article