Browsing by Author "Akpan, Idara"
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Item Cannabis Use and Oral Health Behaviors: A Nationally Representative Study of U.S. Adults aged 30-59.(2024-03-21) Balasundaram, Rohit Baal; Rossheim, Mathew; Boateng, Sarpong; Akpan, Idara; Nguyen, Uyen-SaPurpose: Given that individuals who use cannabis may exhibit distinct oral health behaviors, including irregular dental visits, reduced adherence to oral hygiene practices such as flossing, and potentially increased tobacco and alcohol use, this research seeks to compare these behaviors with those of non-users. By highlighting these differences and understanding their impact on oral health, the study aims to inform targeted public health interventions, guide healthcare providers in offering tailored advice, and contribute to the development of policies that address the unique oral health challenges faced by cannabis users. This study aimed to explore the association between cannabis use and oral health behaviors among U.S. adults aged 30-59. Methods: We analyzed secondary data using the 2011-2018 National Health and Nutrition Examination Survey (n = 9345). Self-reported cannabis use was categorized as never (reference), experimental (used at least once in their lifetime), or regular (monthly use for more than one year). Outcomes included dental visit reasons (Routine Checkup (ref), Issues & Treatment, Other reasons), flossing frequency (=<3 vs. > 3 times a week), and oral cancer examination in the past year (Yes vs No). Associations between cannabis use and dental health outcomes were examined via multinomial logistic regression for dental visit reasons and binary logistic regression for flossing frequency and oral cancer exam participation. Models were adjusted for age, sex, race, education, income, marital status, diabetes, smoking, and alcohol use. Results: Analysis revealed that individuals who used cannabis experimentally had elevated odds of receiving an oral cancer examination compared to never users (aOR=1.5, 95% CI: 1.1-1.9). Among individuals who used cannabis regularly, there was an observed increase in the odds of flossing more than three times a week (aOR=1.1, 95% CI: 0.9-1.3), although this association was not statistically significant. Furthermore, individuals who used cannabis regularly were more likely to report dental visits for issues and treatment rather than routine check-ups when compared to never users (aOR=1.3, 95% CI: 1.0-1.7) Conclusion: Study findings suggest that cannabis use is associated with certain oral health behaviors. This research highlights the need for targeted investigations to inform public health strategies for improving oral health outcomes among people who use cannabis. Furthermore, these insights underscore the importance of integrating oral health education and preventive measures into cannabis use counseling to improve oral health outcomes and promote overall well-being among cannabis users.Item Contraceptive Method Use and Insurance Status among U.S. Women aged 15-49 years(2024-03-21) Brilleslyper, Emma; Akpan, Idara; Diener, Anelise; Thompson, ErikaPurpose: Healthy People 2030 set a goal to reduce unintended pregnancies to 36.5%, from the current baseline of 43%. Different methods of contraception have varying efficacy and effectiveness for pregnancy prevention. Insurance coverage is a key determinant for contraception access. This study aimed to investigate disparities in contraceptive method choice based on insurance status. Methods: This was a cross-sectional study of a nationally representative sample of women aged 15-49, using the 2017-2019 National Survey of Family Growth. Women not desiring pregnancy reported their insurance status and current method of contraception. Insurance status was operationalized as Private Insurance/Medi-Gap, Medicaid/CHIP, Medicare/other Government Insurance Plan, and Single-Service Plan. The outcome variable, current method of contraception, was operationalized into four categories: most effective methods (intrauterine devices (IUD), hormonal implant), moderately effective methods (pills, patch, ring, injectable), least effective methods (condoms, diaphragm, withdrawal, natural family planning, etc.)#_msocom_1, and no method of contraception. The association between insurance status and contraceptive method was assessed using multinomial logistic regression. Results: Among the participants, reported insurance statuses were private insurance/medi-gap (56.38%), Medicaid/CHIP/State sponsored (25.16%), Medicare/Military/Other government insurance (4.77%), and Single Service Plan/Indian Health Service/Uninsured (13.69%). For current contraception method, the women self-reported using most effective methods (27.20%), moderately effective methods (27.98%), least effective methods (30.76%), and no method (14.02%). Women insured through a single service plan, the Indian Health Service, or uninsured had lower odds of using most effective methods than no method of contraception (OR=0.32, 95%CI=0.13, 0.77), and lower odds of using the moderately effective methods (OR=0.21, 95%CI=0.07, 0.58), versus no method of contraception, compared to women with private insurance. Additionally, women with Medicaid/CHIP/state-sponsored health plan have lower odds of using the moderately effective methods (OR = 0.382, 95%CI=0.18, 0.84) versus no method of contraception, compared to women with private insurance. Conclusion: There were differences in contraceptive method choice based on insurance status. As all insurance plans are mandated to cover all FDA-approved methods of contraception, our study findings highlight the need to investigate further gaps in access, education, and freedom of choice. Future research should examine the causes underlying our findings and seek to identify potential strategies related to insurance status to improve access and reduce the risk of unintended pregnancy.Item Exploring the Association Between Patient-Centered Communication and Awareness of Human Papillomavirus Vaccine: A Cross-sectional Study(2024-03-21) Akpan, Idara; Nhpang, Roi San; Webb, Nathaniel; Alkhatib, Sarah; Krenek, Brittany; Griner, Stacey; Thompson, ErikaPurpose: Human papillomavirus (HPV) vaccination is effective in preventing anogenital and oropharyngeal cancers, including genital warts. The HPV vaccine is approved for individuals aged 9-45 years old and creates the opportunity for healthcare providers to educate parents, caregivers, and patients on the benefits of the vaccine. Effective provider-patient interactions promote collaboration, increase self-efficacy, and support decision-making. This study aimed to assess the association between patient-centered communication and patient awareness of the HPV vaccine. We also examined sociodemographic factors associated with HPV vaccine awareness. Methods: The sample population included adults aged 18-45 (n=1384) from the 2022 Health Information National Trends Survey (Cycle 6). The outcome variable was HPV vaccine awareness (yes/no), assessed by whether the respondent has ever heard of the cervical cancer vaccine or HPV shot. The primary predictor variable was patient-centered communication, and this was operationalized using the 7-item Patient-Centered Communication scale (PCC scale). The items assessed respondents’ experiences during their healthcare visits, such as the chance to ask questions, attention to their feelings, involvement in decision-making, time availability, clarity of information presented, comprehension of information, and help with uncertainty. The scale response options ranged from 1=Always to 4=Never. The association between patient-centered communication and HPV vaccine awareness was examined using weighted multivariable logistic regression, while controlling for age, sex, race, education attainment, marital status, health insurance status, and number of healthcare visits in the past 12 months. Results: The mean age of the sample population was 34.1 years (SD=7.2 years). Approximately 52.5% and 47.5% identified as women and men, respectively. Individuals identified as White non-Hispanic (56.2%), Black non-Hispanic (10.2%), Hispanic (19.6%), and Asian/Other non-Hispanic (14.0%). Approximately 40.4% of individuals had a college degree or higher, and 89.8% reported having health insurance coverage. Overall, 72.7% self-reported they had heard about the HPV vaccine. The PCC scale mean was 74.0 (range 0-100). Patient-centered communication was not statistically associated with HPV vaccine awareness. Compared to men, women had higher odds of HPV vaccine awareness (aOR=2.83; 95%CI=1.62-4.97). Individuals with some college (aOR=2.25; 95%CI=1.01-5.01) and college degree or higher (aOR=2.87; 95%CI=1.44-5.77) had higher odds of HPV vaccine awareness than those with less than a high school/12 years/high school diploma. Compared to individuals aged 18-26, individuals aged 27-45 had higher odds of HPV vaccine awareness (aOR=1.91; 95%CI=1.02-3.57). Black (aOR=0.24; 95%CI=0.12-0.49), Asian/Other (aOR=0.24; 95%CI=0.12-0.49), and Hispanic (aOR=0.36; 95%CI=0.21-0.59) individuals had lower odds of being aware of the HPV vaccine than whites. Conclusions: The absence of statistically significant relationship between patient-centered communication and HPV vaccine awareness underscores the need to investigate other factors that influence patient knowledge and decision-making regarding the HPV vaccine. Provider recommendation is one of the known strategies to address misconceptions and increase uptake of the HPV vaccine, particularly among populations who are at increased risk for HPV. However, individuals with limited or no access to healthcare may seek health information from other readily available sources. Exploring racial/ethnic disparities in HPV vaccine awareness is imperative, including identifying effective, evidence-based dissemination strategies that meet the information needs of diverse populations.Item Is there a relationship between Religious Affiliation and Adherence to Recommended Cervical Cancer Screening Guidelines?(2024-03-21) Krenek, Brittany; Akpan, Idara; Balasundaram, Rohit; Thompson, Erika; Luningham, Justin M.Purpose: Cervical cancer is a preventable disease that, despite growing research and health advancements, remains a public health concern in the United States (US).The United States Preventative Services Task Force (USPSTF) recommends cervical cancer screenings (CCS) for individuals with a cervix aged 21 to 65 years of age. Adherence Guidelines recommend cytology tests (Pap smears) for individuals 21 to 29 years of age and cytology tests alone or with a high-risk human papillomavirus (hrHPV) test for individuals aged 30 to 65 years old. In 2023, 74.2% of US-eligible adults were determined to adhere to these guidelines. Research has indicated many influential social and cultural factors of CCS adherence, including religion. However, to our knowledge, no studies have been conducted in the US to assess the specific influences of Christian denominations on CCS adherence. Research indicates that discussions about sexual health may be stigmatized among Christian denominations in the US. Additionally, testing for HPV may be viewed as a rejection of abstinence, which is advocated by my many Christian denominations, further applying social stigmas to CCS screening. Therefore, this study explored associations between CCS guideline adherence and religious denomination affiliation, accounting for other demographic characteristics. Method: Women aged21-49 years old (n =4561) were examined for USPSTF CCS adherence from the National Survey of Family Growth (2017-2019). A weighted multivariable logistic regression was used to examine the likelihood of adhering to CCS guidelines by Christian denomination compared to no religious affiliation, controlling for race/ethnicity, education, and age group. Adherence was determined by the last reported Pap test and last reported HPV test, with up-to-date status varying across age groups in accordance with USPSTF guidelines (21-29 years old compared to 30+ years old). Women reporting a history of a hysterectomy were excluded from the analysis. Results: Overall, 56.3% of participants adhered to the CCS guidelines. The rates of adherence to CCS guidelines across the available Christian denominations were 65.8% among Black Protestants, 59.0%amongMainline Protestants, 53.2% among Catholics, 49.6% among Evangelical Protestants,49.3%for those of another Religion, and 58.7% for those with no religious affiliation. Evangelical Protestants and individuals self-identifying with non-Christian religions had lower odds of screening guidelines compared to those with no religious affiliation(OR = 0.80, 95%CI [0.66, 0.98]and OR=0.67,95%CI [0.52,0.86],respectively).Women who self-identified as non-Hispanic Black were more likely to adhere to CCS guidelines than non-Hispanic White women(OR= 1.96, CI [1.52, 2.53]).Women 30 years or older were less likely to adhere than 21–29-year-olds (OR = 0.19,CI [0.16,0.22]).Compared to individuals who obtained bachelor's degrees, there was no significant association with the odds of CCS adherence among other educational levels in the multivariable model. Conclusion: Associations were observed between adhering to CCS guidelines and religious denomination after accounting for race/ethnicity, age, and education. Women who were Evangelic Protestants or part of a non-Christian religion were less likely to adhere. Additional studies should further evaluate associations and advise culturally tailored campaigns to reduce CCS stigmas and increase overall adherence.