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Breast cancer survivors have an increased risk of colorectal cancer (CRC) and those with chronic diseases are more likely to experience poor mental and physical health. For this study, we examined the mediating effects of mental and physical health on the association between chronic disease conditions and guideline-concordant colorectal cancer (CRC) screening among breast cancer survivors. We included 1,885 breast cancer survivors aged 45-75 years who were eligible for CRC screening in 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System. The exposure was chronic diseases defined as prevalent diabetes, coronary heart disease/myocardial infarction, stroke, chronic obstructive pulmonary disease, emphysema/chronic bronchitis, arthritis, depressive disorders, or kidney diseases. The outcome was receipt of guideline-concordant CRC screening. Mediators were defined as self-reported frequent poor mental/physical health in the past 30 days (14-30 vs. 0-13 days). Multivariable logistic regression models were adjusted for sociodemographic and cancer-related factors. We used the methods proposed by Valeri & VanderWeele for the mediation analyses. Breast cancer survivors with chronic diseases were 1.7-fold more likely to have CRC screening compared to those without any chronic diseases (OR, 1.68; 95% CI, 1.27-2.21). In mediation analysis, we found that frequent poor mental health mediated the association between chronic disease conditions and CRC screening utilization (-4.4% mediated; p-value = 0.035). We also observed a reduction through frequent poor physical health by 10.5% (p-value = 0.008). Frequent poor mental and physical health negatively mediated the association between the presence of chronic diseases and CRC screening utilization with a higher estimate for those with poor physical health. Effective implementation of integrated follow-up care is needed among breast cancer survivors to address chronic disease management and prioritize mental and physical health so that all patients receive guideline concordant CRC screening recommendations.

The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia. We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions. Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival. We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.

Sepsis is the syndrome of life-threatening organ dysfunction resulting from dysregulated host response to infection. Aspirin, an anti-inflammatory agent, may play a role in attenuating the inflammatory response during infection. We evaluated the association between aspirin use and long-term rates of sepsis as well as sepsis outcomes. We analyzed data from 30,239 adults ≥45 years old in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was aspirin use, identified via patient interview. The primary outcome was sepsis hospitalization, defined as admission for infection with two or more systemic inflammatory response syndrome criteria. We fit Cox proportional hazards models assessing the association between aspirin use and rates of sepsis, adjusted for participant demographics, health behaviors, chronic medical conditions, medication adherence, and biomarkers. We used a propensity-matched analysis and a series of sensitivity analyses to assess the robustness of our results. We also examined risk of organ dysfunction and hospital mortality during hospitalization for sepsis. Among 29,690 REGARDS participants with follow-up data available, 43% reported aspirin use (n = 12,869). Aspirin users had higher sepsis rates (hazard ratio 1.35; 95% CI: 1.22-1.49) but this association was attenuated following adjustment for potential confounders (adjusted HR 0.99; 95% CI: 0.88-1.12). We obtained similar results in propensity-matched and sensitivity analyses. Among sepsis hospitalizations, aspirin use was not associated with organ dysfunction or hospital death. In the REGARDS cohort, baseline aspirin use was not associated with long-term rates of sepsis.

Background Prior studies associate steroid use with infection risk but were limited to select populations and short follow-up periods. The association of steroid use with long-term risk of community-acquired infections is unknown. We sought to determine the association of steroid risk with long-term risks of community- acquired infections and sepsis. Methods We used data on 30,239 adults aged ≥ 45 years old from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was oral or injectable steroid use, determined from medication inventory obtained at baseline in-home visit. The primary outcome was time to first infection event during 2003–2012, determined through adjudicated review of hospital records. We determined associations between baseline steroid use and first infection hospitalization events using Cox proportional hazards models, adjusting for demographics, health behaviors, chronic medical conditions, and medication adherence. Among the first infection hospitalization events, we also determined the association between baseline steroid use and sepsis. Results Steroid use was reported in 2.24% (n = 677) of the study population. There were 2593 incident infection events during the 10-year follow-up period. Infection incidence rates were higher for steroid than non-steroid users (37.99 vs. 13.79 per 1000 person-years). Steroid use was independently associated with increased risk of infection (adjusted HR 2.10, 95% CI: 1.73–2.56). Among first-infection events, steroid use was associated with increased odds of sepsis (adjusted OR 2.11, 95% CI: 1.33–3.36). The associations persisted in propensity matched analyses as well as models stratified by propensity score and medication adherence. Conclusions In this population-based cohort study, baseline steroid use was associated with increased long-term risks of community-acquired infections and sepsis.

Black LGBTQ+ adults face significant health disparities stemming from intersecting minority stressors. While community belongingness is often theorized as a protective factor, these communities can also be sites of exclusion, creating a complex dynamic. This study’s objective was to test whether community belongingness moderates the relationship between minority stress, operationalized as microaggressions, and subjective well-being in a national sample of Black LGBTQ+ adults. Data were taken from a national online survey of 345 Black LGBTQ+ adults conducted between November 2020 and January 2021. We used validated scales to measure experiences of microaggressions, subjective well-being, and community belongingness. A moderated multiple regression analysis was conducted using the PROCESS macro to test for an interaction effect, controlling for demographic covariates. Minority stress was significantly negatively associated with well-being (b = −0.11, p = 0.005), while community belongingness was positively associated with well-being (b = 0.43, p < 0.001). A significant interaction emerged (b = −0.01, p = 0.021). Simple slopes analysis revealed that the negative relationship between minority stress and well-being was strongest for individuals with high community belongingness (b = −0.18, p < 0.001) and was not significant for those with low belongingness, potentially indicating an exacerbating effect. Contrary to the buffering hypothesis, community belongingness paradoxically amplified the negative impact of minority stress on well-being. This paradox of belonging suggests that highly connected communities may become sites for trauma bonding, which can amplify distress. Public health efforts must focus not only on fostering connection but on building communities that are resourceful, inclusive, and capable of transforming shared experiences into collective empowerment.

LGBTQ+ individuals face substance use disparities linked to minority stress. While community belongingness may buffer stress, its role is complex. This study examined divergent associations between belongingness within the LGBTQ+ community and lifetime illicit drug use versus past-year alcohol frequency among LGBTQ+ adults in Kentucky (n = 2953), a region with notably high rates of substance use. Methods: Cross-sectional online survey data were analyzed. We measured LGBTQ+ belongingness, lifetime use of cocaine/crack/heroin/methamphetamine, and past-year alcohol frequency. Logistic and linear regressions controlled for age, education, gender identity, and income. Results: Greater belongingness predicted significantly higher odds of lifetime illicit drug use (OR = 1.24) but lower past-year alcohol consumption frequency (B = −0.094). Transgender and gender expansive identity predicted significantly higher illicit drug use odds and higher alcohol frequency. Conclusions: In this Kentucky sample, LGBTQ+ belongingness showed divergent substance use associations: it was protective against frequent alcohol use but, unexpectedly, was associated with higher odds of lifetime illicit drug use. Findings highlight belongingness’s complex, context-dependent nature and the need for nuanced research and interventions considering substance type and specific vulnerabilities, particularly for TGE individuals.

Background After identifying substantial trust gaps between our university and neighboring community, we developed the Co-Researcher Activation Network (CRANE) to cultivate restorative engagement through ongoing transformational relationships. Informed by the Culture-Centered Approach, CRANE is a network of community member groups who identify local health concerns, develop research questions, and generate community-driven solutions. Organized by place rather than interest, groups are systematically created within geographic areas. The model focuses on engaging community members as “co-researchers,” whereby community members play an active role and share in the decision-making process through a collaborative and interdependent relationship with the research team. Methods Using RE-AIM domains, we applied convergent mixed methods to test the effects of CRANE and to identify factors associated with fidelity and sustainability of the model. Results From 2022 to 2023, we convened 21 co-researchers in three groups that met bimonthly. Groups reflected age, racial/ethnic, economic, and educational diversity. Co-researchers’ perceptions of university researcher credibility (trustworthiness, expertise, and caring) significantly increased during the project. Five factors contributed to success: regular, audience-centered communication; small groups; gender segregation; scheduling flexibility; and community meeting spaces. Challenges included hiring issues, travel limits, low technology acceptance, transportation obstacles, and participant payment problems. Conclusions CRANE is a blueprint for community engagement that honors community members and their expertise, strives for equitable partnership, and moves the needle on metrics of trust. The theoretically-grounded, co-researcher model can not only build but sustain restorative community trust and engagement. Key Message A co-researcher network that actively involved community members in decision-making throughout the course of research cultivated restorative trust and engagement through transformational relationships.

The Students Participating as Ambassadors for Research in Kentucky (SPARK) program provides novel health equity research training and targeted mentorship for undergraduates, particularly those from groups underrepresented in the biomedical and behavioral research and workforce. SPARK aims to address inadequate diversity in the medical and scientific research fields by providing comprehensive research mentorship and skill-building. Unlike most existing research training programs that are brief, focus on laboratory research, or are limited to graduate students and junior faculty, SPARK delivers a 16-month intensive behavioral and population health science training, equipping students with needed tools to conceptualize, plan, execute, and analyze their own health equity research study. Trainees complete didactic coursework on health equity, study design and proposal development, data analysis, and ethics. Students receive a stipend and research expenses, and multiple mentors guide them in creating original research projects for which they serve as Principal Investigator. Students disseminate their findings annually at an academic research conference as a capstone. Evaluation data from the first three cohorts suggest SPARK has been pivotal in preparing students for graduate studies and research careers in health equity and behavioral and population health sciences, providing strong support for further investments in similar undergraduate research training models.

Although breastfeeding provides health benefits to both mother and child, this study aimed to explore whether disparities in breastfeeding continue to exist, particularly among non-Hispanic Black (NHB) mothers and children. We performed a cross-sectional analysis among 19,830 children in the United States (US) using the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2020. Breastfeeding initiation and duration rates increased overall from 1999 to 2020. Children who were ever breastfed were more likely to have higher body weight, older mothers, mothers who did not smoke during pregnancy, a higher family poverty–income ratio (PIR), food security, mothers in excellent health, and mothers who had not seen a mental health professional in the past year. NHB children were breastfed at significantly lower rates and for shorter duration than non-Hispanic White (NHW), Mexican, Other Hispanic, and Other/Multi-Racial children. NHB children were breastfed less than other racial groups, including minority Mexican children with similar average PIR, suggesting a possible unique experience for NHB mothers and children. Strategies include impacting social norms and offering culturally tailored breastfeeding supports. The provision of structural supports to remove barriers to breastfeeding is a social justice issue. Breastfeeding confers health benefits to mother and child, and disparities exist among mothers and children, particularly among NHB mothers and children. The current study provides data on the most recent breastfeeding trends, showing that these disparities by race/ethnicity are present. Interestingly, even among Mexican participants of a similar PIR, NHB children were still breastfed less.