Background Tobacco dependence, alcohol abuse, depression, distress, and other adverse patient‐level influences are common in head and neck cancer (HNC) survivors. Their interrelatedness and precise burden in comparison with survivors of other cancers are poorly understood. Methods National Health Interview Survey data from 1997 to 2016 were pooled. The prevalence of adverse patient‐level influences among HNC survivors and matched survivors of other cancers were compared using descriptive statistics. Multivariable logistic regressions evaluating covariate associations with the primary study outcomes were performed. These included 1) current cigarette smoking and/or heavy alcohol use (>14 drinks per week) and 2) high mental health burden (severe psychological distress [Kessler Index ≥ 13] and/or frequent depressive/anxiety symptoms). Results In all, 918 HNC survivors and 3672 matched survivors of other cancers were identified. Compared with other cancer survivors, more HNC survivors were current smokers and/or heavy drinkers (24.6% [95% CI, 21.5%‐27.7%] vs 18.0% [95% CI, 16.6%‐19.4%]) and exhibited a high mental health burden (18.6% [95% CI, 15.7%‐21.5%] vs 13.0% [95% CI, 11.7%‐14.3%]). In multivariable analyses, 1) a high mental health burden predicted for smoking and/or heavy drinking (odds ratio [OR], 1.4; 95% CI, 1.0‐1.9), and 2) current cigarette smoking predicted for a high mental health burden (OR, 1.7; 95% CI, 1.2‐2.3). Furthermore, nonpartnered marital status and uninsured/Medicaid insurance status were significantly associated with both cigarette smoking and/or heavy alcohol use (ORs, 1.9 [95% CI, 1.4‐2.5] and 1.5 [95% CI, 1.0‐2.1], respectively) and a high mental health burden (ORs, 1.4 [95% CI, 1.1 ‐1.8] and 3.0 [95% CI, 2.2‐4.2], respectively). Conclusions Stakeholders should allocate greater supportive care resources to HNC survivors. The interdependence of substance abuse, adverse mental health symptoms, and other adverse patient‐level influences requires development of novel, multimodal survivorship care interventions.
Objective: Nearly 300 million people in India use some type of tobacco product, with about 60% of those using smokeless tobacco. Smokeless tobacco use has been associated with a number adverse health outcomes in India and across South Asia. Method: A cross-sectional study of outpatients at a dental hospital in Navi Mumbai, India was conducted between January and June 2015. Trained interviewers administered a 19-item questionnaire to all patients receiving regular dental care. In addition to demographic information, data about the use of smokeless tobacco was collected. Nicotine dependence was assessed using the six-item Fagerstrom Nicotine Dependence Scale, adapted for smokeless tobacco. Results: Approximately one third of 1,067 respondents (30.55%; N ¼ 326) reported use of smokeless tobacco. Neither use of smokeless tobacco nor nicotine dependence was associated with any demographic variables. High nicotine dependence was associated with a younger age of initiation of smokeless tobacco use (RD ¼ 0.14; 95% CI: 0.03, 0.25) and with frequency of use, with those who reported daily use having an excess risk of high nicotine dependence of 14% (95% CI: 2%, 27%). Conclusion: To reduce dependence on smokeless tobacco in India and subsequent adverse health outcomes, interventions should emphasize a combination of policy
Objective: Half of the people living with HIV (PLWH) with hepatitis C virus (HCV) remain untreated for HCV. We examined predictors of HCV linkage to care among PLWH and the impact of HIV lost to care. Design and methods:We conducted a retrospective review of PLWH/HCV from our HIV clinics between 2014 and 2017, and examined predictors of HCV linkage to care. We used the Kaplan-Meier method to estimate the probability of HIV retention and HCV linkage over time.Results: Of 615 PLWH/HCV, 34% linked to HCV care and 21% were cured. Higher odds of linkage to HCV care were among blacks (adjusted odds ratio [aOR]: 2.95, 95%
BackgroundFew HIV clinics train HIV providers on initiation of HCV treatment for their coinfected patients. We sought to evaluate the changes in comfort levels, attitude and knowledge of HCV evaluation and treatment among providers over time and track the uptake of treatment initiation.MethodsOur program was implemented in an urban, Ryan-White outpatient clinic in 2018. Providers were given initial didactics and completed a survey that assessed their level of comfort and knowledge with treating HCV. We developed pocket cards and flow charts to help providers navigate the HCV cascade to cure. Additional training one year later through presentations and case-based discussions was given and the same survey was conducted again. We evaluated the number of HCV evaluation visits in 2018 and prescriptions written for HCV treatment.ResultsThe first survey was completed by 21 and the second by 20 out of 28 providers; 70% attended at least one of the trainings. After the initial training, 38% of providers felt “confident” about discussing liver disease progression which increased to 50% after the second training. Similarly, 48% of providers felt “somewhat comfortable” talking about HIV/HCV drug interactions which increased to 80%. 33% of providers noted they were “not comfortable” discussing drug interactions which decreased to 15%. Approximately 1/3 providers felt “confident” talking about HCV treatment in both surveys. About 20% of providers disagreed with treating HIV/HCV patients with active substance use and this did not change. The median knowledge score was 7 (IQR) (6–9) after the first survey and changed to 8(5–9) after the second. Between 2018–2019, 81 HCV evaluation visits were scheduled and 64 (80% Male, 53% Black, 39% uninsured, 23% Medicaid, 73% with history of substance use) were completed and 69% of patients were prescribed HCV treatment. Among all HIV providers, 89% completed a median of 1 (1–3) HCV evaluation visits, and 71% prescribed treatment a median of 1 (1–2).ConclusionImplementation of HCV training to all HIV providers requires continued education and resulted in the initiation of HCV evaluation and treatment amongst the large majority of HIV providers who had previously never treated HCV. Disclosures All authors: No reported disclosures.
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