Background: Cervical cancer screening (CCS) participation has decreased in the United States over the last several decades, contributing to cervical cancer's sustained incidence and mortality. This study examined recent trends and racial/ethnic differences in predictors of CCS uptake among US women. Methods: We analyzed combined data from the 2016 to 2020 Behavioral Risk Factor Surveillance System (BRFSS) and included 235,713 women aged 30-64 years without a hysterectomy. We used simple linear regression to assess trends over time and multivariable logistic regression models to evaluate racial/ethnic differences in predictors of up-to-date CCS. Results: We found little change in CCS over the 5-year interval and screening rates disparities among racial minority women. The overall population showed stable CCS completion rates from 2016 to 2018 (84.2% versus 84.6%), and then a small dip from 2018 to 2020 (from 84.6% to 83.3%). Despite a slight decline in 2020, HPV-based testing increased significantly among all subgroups and overall, from 2016 to 2020 (from 43.4% to 52.7%). Multivariable regression models showed racial/ethnic differences in predictors of CCS. Across all racial/ethnic subgroups, older women were less likely to receive timely screening. Women who had routine check-ups had higher odds of being up to date. However, the link between CCS and socioeconomic status varied. Conclusions: Age and racial/ethnic disparities persist in CCS, and predictors of screening vary. Notwithstanding, routine health examinations was positively associated with screening regardless of race/ethnicity. Impact: Our analyses suggest that leveraging primary care to optimize CCS uptake may reduce gaps in screening.

Background: Mortality from cervical cancer (CC) has declined steadily in the US over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared to late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in CC diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and CC diagnosis stage. Methods: We analyzed Texas Cancer Registry data for CC cases diagnosed among women aged 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and CC stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage. Results: Of the 9192 women with CC, 4720 (51.3%) had LCC at diagnosis. Compared to non-Hispanic White (NHW) women (106.13, standard deviation (SD)=13.32), non-Hispanic Black (NHB) (111.46, SD=9.55) and Hispanic (112.32, SD=9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis (Total effects: adjusted odds ratios (AOR) = 1.29 (95% CI 1.11-1.46) and AOR 1.14 (95% CI 1.03-1.25), respectively). Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively. Conclusions: LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women. Impact: Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.

Background: There is an increasing global quest to understand the influence of built environment (BE) on the mental health of people, particularly in later life. Older adults may be more susceptible to environmental factors than other adults for several reasons. Objective: The study aims to provide an overview and synthesis of the scientific literature on the relationships between built environment (BE) and depression among older people and examine possible rural-urban differences in the association. Methods: We conducted a systematic search for articles published in English from 2000-2018 in three electronic databases – PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo. We used the Population, Exposure, Comparator, and Outcomes (PECO) framework to guide the search keywords’ development and inclusion and exclusion criteria. Studies examining associations between built environment attributes and depression were only included if they were original, peer-reviewed, reported at least one objectively measured built environment attribute, any type of depression as an outcome of interest, and the sample included people aged 50 or older. Results: Of 617 citations identified, 13 met our inclusion criteria. BE attributes assessed by studies varied; however, all studies reported a relationship between depression and at least one BE attribute. Four of six papers reported a protective association between green spaces and depression, while other BE attributes did not demonstrate a consistent association with depression. Conclusion: Adverse BE is related to depressive symptoms and should be considered in interventions targeted at preventing depression among older adults who are particularly vulnerable. Future studies focused on the relationship between the urban and rural built environment and depression among older adults are needed.

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This cross-sectional ecological study examined the relationship between neighborhood-level standard occupational groups in the USA and COVID-19 vaccine uptake using 774 census tract data, each consisting of approximately 1600 housing units. The neighborhood-level COVID-19 vaccination uptake data were retrieved from Harris County Public Health, Harris County, Texas. The standard occupational group data were from the US Census Bureau. We calculated the incidence rate ratios (IRRs) for vaccine uptake using bivariate and multivariable Poisson regression models. In the adjusted models, we found that the healthcare practitioner/technician (IRR: 1.008; 95% CI: 1.003–1.014; p = 0.001), business/management/legal (IRR: 1.011; 95% CI: 1.008–1.013; p < 0.001), computer/engineering/life/physical/social science (IRR: 1.018; 95% CI: 1.013–1.023; p < 0.001), and arts/design/entertainment/sports/media (IRR: 1.031; 95% CI: 1.018–1.044; p < 0.001) occupational groups were more likely to have received the full regimen of a COVID-19 vaccine. On the contrary, the building/installation/maintenance/repair (IRR: 0.991; 95% CI: 0.987–0.995; p < 0.001), construction/extraction/production (IRR: 0.991; 95% CI: 0.988–0.995; p < 0.001), transportation/material moving (IRR: 0.992; 95% CI: 0.987–0.997; p = 0.002), food preparation/serving related (IRR: 0.995; 95% CI: 0.990–0.999; p = 0.023), and personal care/services (IRR: 0.991; 95% CI: 0.985–0.998; p = 0.017) groups were less likely to have received the complete dose of a COVID-19 vaccine. White-collar workers were more likely to be vaccinated than blue-collar workers. We adjusted for age, sex, and race/ethnicity in the multivariable analysis. The low vaccine uptake among certain occupational groups remains a barrier to pandemic control. Engaging labor-centered stakeholders in the development of vaccination interventions may increase uptake.