Johnson‐Mallard, Versie

Background: Understanding personal and geographic factors associated with smoking is important to design and implement interventions focused on reducing cancer health disparities. Scant research has been published recently regarding factors associated with smoking history associations within rural communities. Purpose: To examine demographic factors and rural residence history for associations with smoking history. Methodology: In a cross-sectional study of cancer-related behaviors, 1,786 adults (mean age 47.9 ± 17.5 years; 53% female, 84% White) completed an online survey in 2020. We examined factors associated with smoking history (having smoked at least 100 cigarettes) using independent t-tests, chi-square tests, and logistic regression. Results: Of the participants, 36% had a rural residence history and 49% had a smoking history. A larger proportion of men than women (61% vs. 37%; p < .001), White than Black participants (50% vs. 39%; p = .001), and rural than nonrural residents (53% vs. 46%; p = .005) had a smoking history. Logistic regression analysis revealed that the young age group (18–30) was less likely ( p = .002), whereas the middle age group (31–50) was more likely ( p < .001) to have a smoking history than those older than 50 years. Rural residence was associated with a smoking history among women ( p < .001), but not among men ( p = .70) in this sample. Conclusions: Tobacco control efforts are needed to focus on middle-aged men in general and women with rural residence history. Implications: Nurse practitioners are uniquely positioned to directly contribute to future research with self-identified rural populations that could help inform future public health policy.

Vitamin C remains an important, yet frequently unassessed, component of a healthy immune system though it may prove useful in alleviating the chronic inflammatory processes underlying chronic diseases such as coronary artery disease (CAD). Recent research identified a sizeable proportion of the United States population with insufficient vitamin C plasma levels and significant associations to both acute and chronic inflammation. This cross-sectional study used the 2003–2006 NHANES surveys data to extrapolate associations between plasma vitamin C levels (deficiency, hypovitaminosis, inadequate, adequate, and saturating) and CAD through inflammation (C-reactive protein and red cell distribution width). Increased reports of CAD diagnosis were identified in participants with vitamin C deficiency (OR: 2.31, CI: 1.49–3.58) and inadequate plasma levels (OR: 1.39, CI: 1.03–1.87). No significant correlation was identified between any other plasma vitamin C quintiles and CAD. When inflammation was controlled, previous associations in the deficient level of plasma vitamin C were no longer significant in association with CAD and participants with inadequate plasma vitamin C showed a reduced association to CAD diagnoses (OR: 0.33, CI: 0.13-0.86). Most chronic inflammation and vitamin C plasma statuses do not demonstrate specific signs or symptoms until the deficient level of vitamin C and/or disease. Thus, increased surveillance of both, and healthy nutritional habits remain crucial modifiable risk factors for disease prevention.

Although undisputed for its anti-inflammatory and immune system boosting properties, vitamin C remains an inconsistently investigated nutrient in the United States. However, subclinical inadequacies may partly explain increased inflammation and decreased immune function within the population. This secondary analysis cross-sectional study used the 2003–2006 NHANES surveys to identify more clearly the association between plasma vitamin C and clinical biomarkers of acute and chronic inflammation C-reactive protein (CRP) and red cell distribution width (RDW). From plasma vitamin C levels separated into five defined categories (deficiency, hypovitaminosis, inadequate, adequate, and saturating), ANOVA tests identified significant differences in means in all insufficient vitamin C categories (deficiency, hypovitaminosis, and inadequate) and both CRP and RDW in 7607 study participants. There were also statistically significant differences in means between sufficient plasma vitamin C levels (adequate and saturating categories) and CRP. Significant differences were not identified between adequate and saturating plasma vitamin C levels and RDW. Although inadequate levels of vitamin C may not exhibit overt signs or symptoms of deficiency, differences in mean levels identified between inflammatory biomarkers suggest a closer examination of those considered at risk for inflammatory-driven diseases. Likewise, the subclinical levels of inflammation presented in this study provide evidence to support ranges for further clinical inflammation surveillance.

Abstract Purpose: Smoking rates are higher in rural regions compared to urban regions. Given the mobility within the United States, rural norms around tobacco use may persist even after individuals move to urban areas. Little research is available regarding the difference in smoking history by demographics and rural residence history. The purpose of the study was to examine the influence of age, race, gender, and rural residence history on smoking history. Methods: In a cross-sectional study, we surveyed 1,786 adults using two sampling approaches: representative panels and a community-engaged sample. Participants were asked to complete the Florida Health and Ancestry Study (FHAS) survey through a link or by the phone with a research assistant. The smoking history question asked whether participants had smoked 100 cigarettes in their lifetime (yes/no). The rural residence question asked participants to indicate (yes/no) whether they have lived in a rural or farming community, or on a farm. We examined associations of smoking history with demographic variables using the Chi-square test and logistic regression including as predictors age group (young=18-30, middle age=31-50, old=51+ years), gender, race, and rural living by gender. Results: Participants were mostly White (16% Black, 84% White), female (47% male) and with a mean age around 50 years (mean 47.9±17.5 years, ranged 18 to 91). 36% of the sample reported a history of rural residence, and 51% reported that they had not smoked 100 cigarettes in their lifetime. A larger proportion of males (61%) smoked at least 100 cigarettes compared to females (37%) (p&lt;.001). A significantly larger proportion of White participants (50%) smoked at least 100 cigarettes in their lifetime than Black participants (39%) (p=.001). A larger proportion of participants who had lived in a rural place (53%) had smoked at least 100 cigarettes compared to those who had not lived in a rural place (46%) (p=.005). Difference in mean age for those with or without a history of smoking 100 cigarettes was not statistically significant in this sample (p=.12). Logistic regression analysis revealed that relative to the old age group, the young age group was less likely (p&lt;.001) and the middle age group was more likely (p=.002) to have smoked 100 cigarettes. Males (p&lt;.001) were more likely to have smoked 100 cigarettes than females. Rural residence was associated with smoking among females (p&lt;.001) but not among males (p=.70). Adjusting for other predictors, the association with race was not statistically significant in this sample (p=.06). Conclusion: Findings that the age group 18-30 years is more likely to have avoided becoming smokers is encouraging but must be analyzed more thoroughly relative to possible use of e-cigarettes and other tobacco products. To reduce individuals becoming smokers, we recommend increased cancer control efforts targeted to males in general and to females with a rural residence history. Additional research is planned to examine additional smoking variables and compare them to national data. Citation Format: Tyra Reed, Destiny Gordon, Brenda W. Dyal, Keesha Powell-Roach, Miriam O. Ezenwa, Versie Johnson-Mallard, Janice L. Krieger, Folakemi T. Odedina, Yingwei Yao, Diana J. Wilkie. Demographic factors and rural residence history associated with smoking history [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-012.

Vitamin C, well-established in immune function and a key factor in epigenetic inflammatory modifications, is only obtained through consistent dietary intake. Identifying individuals at risk for Vitamin C insufficiency may guide prevention and treatment, however, national surveillance has not been evaluated in the United States since 2006. A descriptive, cross-sectional secondary analysis was performed utilizing data from the 2003–2006 National Health and Nutrition Examination Surveys (NHANES) assessing non-institutionalized adults. Five categories of plasma Vitamin C were delineated: deficiency (<11 μmol/L), hypovitaminosis (11–23 μmol/L), inadequate (23–49 μmol/L), adequate (50–69 μmol/L), and saturating (≥70 μmol/L). Results indicated 41.8% of the population possessed insufficient levels (deficiency, hypovitaminosis, and inadequate) of Vitamin C. Males, adults aged 20–59, Black and Mexican Americans, smokers, individuals with increased BMI, middle and high poverty to income ratio and food insecurity were significantly associated with insufficient Vitamin C plasma levels. Plasma Vitamin C levels reveal a large proportion of the population still at risk for inflammatory driven disease with little to no symptoms of Vitamin C hypovitaminosis. Recognition and regulation of the health impact of Vitamin C support the goal of Nutrition and Healthy Eating as part of the Healthy People 2030.