INTRODUCTION:Despite widespread awareness, obesity remains an epidemic in the United States. Combating obesity requires contributions from various healthcare professionals, including dental practitioners. This cross-sectional study aims to explore the proportion of dental care providers in Texas who address obesity with their patients and to identify factors influencing their engagement in obesity management. METHODS:A cross-sectional observational design was adopted. A total of 127 dental providers, predominantly dental hygienists (89.9%), completed an anonymous online survey about their perceptions of obesity interventions in the dental setting. Descriptive analysis, independent t-tests, Chi-squared tests, and logistic regression were used to analyze the data. RESULTS:The findings revealed that 58.8% of dental practitioners who completed the survey were interested in addressing obesity, but 3.9% were doing so. Key factors that increased the likelihood of practitioners addressing obesity included believing they had a role in reducing obesity (aOR = 5.15, p = 0.002), noticing an increase in obese patients (aOR = 3.98, p = 0.012), and feeling confident in using behaviour modification techniques (aOR = 5.39, p = 0.003). The main barriers identified were the fear of offending patients (p = 0.011) and low confidence (p < 0.001) in applying nutritional modification skills for weight management. The preferred method for providing obesity interventions was printed materials (75.6%). CONCLUSION:Despite interest in addressing overweight/obesity, most dental hygienists do not engage in overweight/obesity interventions due to barriers like fear of offending patients and low confidence in providing screening, brief advice and referral to dieticians or physicians. Enhancing dental hygienists' confidence and integrating supportive materials may improve obesity management in dental settings.

Abstract Background Previous studies have reported that tobacco use among healthcare providers (HCPs) has a negative impact on their beliefs and attitudes toward tobacco prevention and control measures. However, little is known about these among Italian dental students. Therefore, this single-site study examined tobacco use behaviors and the knowledge, attitudes, and perceptions of dental students at a public university in Southern Italy regarding tobacco prevention and control. Methods A cross-sectional study through an online survey was conducted among 115 students aged 18 + years enrolled in dentistry and dental hygiene programs at a Southern Italy university. Chi-squared, Fisher's, t-tests, and multivariable logistic regression were used to compare the socio-demographic characteristics, tobacco use, prevention and cessation knowledge, attitudes, and perceptions between dentistry and dental hygiene students. Results Current prevalence of cigarette smoking, electronic nicotine delivery systems (ENDS), and other tobacco product use among students was 30.4% (CI: 27.3–33.4), 24.4% (CI: 21.7–28.6), and 16.5% (CI: 12.9–19.2), respectively. There were no significant differences in tobacco use by student type after adjustment for socio-demographic characteristics. About 38% were using at least one form of tobacco product, while 27% were dual users of cigarettes and ENDS products. The prevalence of second-hand smoking, ENDS vapes, and other tobacco product exposure among dental students was 65.2%, 36.5%, and 20.9%, respectively. Around 55% disagreed that HCPs who smoke are less likely to advise patients to quit smoking. Dental students demonstrated greater knowledge on cigarette smoking danger (87.0%), reasons why people smoke (63.5%), and received formal training in cigarette smoking cessation approaches (68.7%) versus their knowledge/motivations/training related to ENDS and other tobacco products. Conclusion The normalization of tobacco use (including ENDS products) among dental students engaged in our study is deeply concerning and highlights the need for targeted tobacco prevention and cessation strategies in dental education, while further multicenter studies are required to assess whether similar patterns exist in other Italian dental schools.

BACKGROUND:Women veterans with HIV represent a growing, diverse population within the Veterans Health Administration (VHA). This study examined HIV care continuum outcomes among women veterans using a multilevel intersectional approach. METHODS:We conducted a retrospective analysis of 1154 women veterans with HIV in VHA care in fiscal year 2022, with outcomes assessed in fiscal year 2023. We applied Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to evaluate how combinations of social positions (age, race/ethnicity, housing status) were associated with HIV outcomes. RESULTS:MAIHDA models showed that younger age (<45 years) and being unhoused were consistently associated with lower odds of care engagement and viral suppression than midlife (45-64) and older (65+) housed women veterans. Additionally, predicted probability analyses revealed distinct clustering patterns. Younger non-Hispanic White women consistently ranked among the lowest performing strata across all outcomes, while midlife and older Hispanic and non-Hispanic Black women veterans clustered among the highest. Variance Partition Coefficients from null models were modest (1.8-3.0%). Fully adjusted models showed no remaining between-stratum variance, suggesting that the included social positions explained the observed differences in our dataset. CONCLUSIONS:These findings highlight disparities in HIV care engagement concentrated among specific groups and reinforce the importance of addressing individual- and system-level barriers to engagement and continuity of care among women Veterans in VHA care.

Objectives Sexual and gender minority (SGM) individuals can experience notable health disparities, including higher HIV prevalence, social isolation, substance abuse, lack of culturally competent providers, and poorer health outcomes compared to heterosexuals due to stigma and discrimination. This study aims to identify predictors of dental care utilization across sexual minorities using the 2023 TEXAS PRIDE Survey.Methods We analyzed data from 517 SGM individuals, assessing sociodemographic characteristics, health behaviors, and recent medical and dental visits. Multivariable logistic regression identified predictors of dental care utilization (i.e., a dental visit in the past year).Results Among sexual orientation groups, reported dental care utilization was highest among gay (23.7%) and lesbian (21%) individuals, followed by bisexual (18.3%), pansexual (11.1%), queer (9.9%), and other sexual orientations (16.2%). Those with a college degree were significantly more likely to report dental utilization compared to those with less education. Individuals who did not have a medical visit in the past year were 0.27 times as likely to utilize dental care than those who did. No significant disparities in dental care utilization were found based on sexual orientation in the regression analysis.Conclusions Higher education and recent medical visits are significant predictors of dental care utilization among SGM individuals. Efforts to reduce oral health disparities should focus on affordable dental care coverage, improving health literacy, fostering inclusive dental environments, and training providers in SGM cultural sensitivity. Future research should explore integrated healthcare approaches and provider cultural competence training to address these gaps.

Understanding HIV care experiences of women veterans is essential for identifying gaps in an understudied population with unique care needs. Much of what is known relies on inferences from civilian women or combines women and men veterans, obscuring important sex-related differences. Mental health conditions are highly prevalent among women veterans and present a critical barrier to HIV care, as nearly half of Veterans Health Administration (VHA)-enrolled women veterans have at least one mental health diagnosis. This retrospective study analyzed a national cohort of 1255 women veterans with HIV from fiscal years 2022–2023. Logistic regression models examined associations between demographic and mental health characteristics and subsequent HIV care continuum outcomes (receipt of care, retention in care, and viral suppression), and one-sample binomial tests compared cohort outcomes to 2022 VHA-wide estimates. Among our cohort, 70.4

Background Tobacco control efforts have succeeded in reducing smoking prevalence and increasing smoking cessation rates in the European Union Member States (EU27). However, the impact of these policies has been unequal across different income groups.Methods Ecological study with the country as unit of analysis. We used the Tobacco Control Scale (TCS) in EU27 in 2010 and the prevalence of smoking and quit ratios from the Eurobarometer surveys (2009, n=27 788; and 2020, n=28 288). We analysed the relationship between the TCS scores (2010) and smoking indicators and their relative changes (between 2009 and 2020) using scatter plots and multiple linear regression models.Findings In the EU27, high inequalities exist among different income groups. High-income residents had lower smoking prevalence (19 vs 40%) and higher quit ratios (55 vs 32%) compared with the low-income group. Positive changes in smoking indicators from 2009 to 2020 were stronger in the high-income group. There was a stronger negative correlation between TCS scores and smoking prevalence in high-income groups (rsp=−0.615, p<0.01; rsp=−0.498; p=0.01) and between its relative changes but only in the high-income group (rsp=−0.478; p=0.01). A positive correlation was observed between TCS scores and quit ratios (rsp=0.580, rsp=0.548, both p<0.01) in high- and moderate-income populations.Conclusions Declines in smoking prevalence and increases in quit ratios were considerably lower in moderate- and low-income groups. Tailoring tobacco control policies to address financial, social and structural barriers, such as ensuring free access to cessation services, implementing targeted outreach programmes, adopting culturally and linguistically appropriate interventions, among others, is essential for making these measures more equitable, which is key for the EU27 to achieve its tobacco-free goal by 2040.

SmokefreeSGM is a text-based smoking cessation intervention developed to support sexual and gender minorities (SGM) with their quitting efforts. We implemented a pragmatic recruitment strategy to enroll a study sample representative for SmokefreeSGM’s feasibility trial. This study outlines the strategies employed to recruit SGM smokers in SmokefreeSGM’s feasibility trial and provides a framework for researchers interested in working with this population. This study recruited SGM smokers using ResearchMatch, social media/internet advertising, and field recruitment in the United States from January to June 2023, using convenience sampling. We evaluated enrollment rates across recruitment methods and various demographic characteristics such as age, gender identity, sexual orientation, etc. Recruitment (those who completed first part of screening divided by those who contacted us) and enrollment (those enrolled divided by those who completed first part of screening) rates were calculated. The recruitment rate for this feasibility trial was 20.5

ABSTRACT Objective: The aim of this study was to identify barriers and facilitators to smoking cessation among Brazilian cancer patients, considering the perspectives of both patients and healthcare professionals at a leading oncology center in the country. Methods: A cross-sectional study was conducted, collecting smoking-related data from two groups: cancer patients and healthcare professionals at the Barretos Cancer Hospital (BCH) between 2019 and 2021. The questionnaire for healthcare professionals was adapted from the 2012 International Association for the Study of Lung Cancer and the Global Adult Tobacco Survey. For the cancer patient group, sociodemographic and clinical data were collected, along with the smoking history and consumption patterns of current smokers. Results: Among oncology patients, the prevalence of former smokers was found to be 37.4%, while current smokers accounted for 16.8%. Most current smokers exhibited low nicotine dependence and high motivation to quit. Key barriers reported by healthcare professionals in providing smoking cessation interventions included patient resistance (86.9%) and lack of training (64.5%). Furthermore, 52.9% of these professionals indicated that they had never discussed cessation strategies during consultations with smoking patients. Regression models revealed that physicians, compared to other professionals, were more likely to address, advise, and offer cessation treatment to smoking patients (p≤0.05). Conclusion: There is a need to enhance training on smoking cessation for healthcare professionals to improve clinical outcomes and survival rates among cancer patients.

Objectives To examine prevalence trends in the use of smoked tobacco products in 11 South American (SA) countries (i.e., Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Suriname, Uruguay, and Venezuela) and their association with country-specific socio-demographic index (SDI) over 30 years. Data and methods The estimates of SDI and smoked tobacco prevalence stratified by age, sex, and country were extracted from the Global Burden of Disease Study (1990-2019) on individuals aged 15+. The annual percentage changes (APCs) of trends in country-specific prevalence of smoked tobacco were evaluated using Joinpoint regression. Correlation analysis was also used to explore the association between country-specific prevalence of smoked tobacco and their SDIs, a measure of developmental status considering income per capita, educational attainment, and total fertility rate. Results While all SA countries showed an overall decline in smoked tobacco use prevalence between 1990 and 2019 (APCs between -0.52%-and -4.73%; p < 0.05), Bolivia and Ecuador showed a significant increasing trend (APCs of 0.34% and 0.20%). Country-specific SDI was strongly and significantly correlated (rs = -0.99 to -0.85) with smoking prevalence in SA countries, except for Ecuador and Bolivia (rs = 0.16 and 0.36, respectively). ConclusionIn recent decades, most SA countries have experienced a significant reduction in the prevalence of smoked tobacco use, except Ecuador and Bolivia, where smoking rates have risen, showing a direct correlation with SDI. These findings can contribute to the design and implementation of strategies and policies for tobacco prevention and control in the SA region especially within the two affected countries - Ecuador and Bolivia.

To achieve evidence-based care for SGM individuals with and at-risk for cancer, we developed and disseminated the “Sexual and Gender Minority Cancer Curricular Advances for Research and Education” (SGM Cancer CARE) workshop using funds provided through two National Cancer Institute funded R25s. In the third year of the five year dissemination award, the project was terminated early in spite of commendable accomplishments. In this presentaton, we provide an overview of the workshop, describe programmatic successes and expansion, and discuss the need for and strategies to sustain this vital training program that prepares early- and mid-career scientists and clinicians to create and conduct SGM-inclusive cancer research to promote equitable care. In 2018 and 2019, we created and piloted the SGM Cancer CARE Workshop. We disseminated the workshop first on-line and then via in person formats between 2021-2025. The initial workshop included training modules on Epidemiology, Clinical Care Research, Behavioral Science, and Community-Based Approaches to SGM cancer research. All workshops were evaluated using mixed methods pre/post module and workshop surveys. Post-workshop focus groups elicited information to assess the degree to which participant needs were met. In 2025, in response to changing federal priorities, a pre conference survey was used to gather participant questions and concerns. All former participants received an alumni survey to increase our understanding of their post workshop career development, collaborative research activities and experiences of SGM cancer research. To date, 110 clinicians and scientists representing 26 states, have successfully completed the SGM Workshop. Participants self-identified as: sexual orientation--29% gay and lesbian, 19% queer, 18% bisexual, 2% fluid, 1% questioning and 31% heterosexual/straight; gender--65% female, 22% male, 3% transgender, and 10% genderqueer/gender nonconforming; and race/ethnicity--60% white, 15% Hispanic/Latinx, 15% Asian, 8% Black, and 2% Native American. Evaluation and focus group results across all workshops demonstrated marked confidence with the design and conduct of SGM cancer research. Based on feedback, we added grantsmanship skills development; participant research presentations for instructor feedback; monthly Trending Topics seminars to address unaddressed topics and highlight alumni research; and developed resources to expand networking capacity using CANVAS and a website hosted by the Building the Next Generation of Academic Physicians (BNGAP) program. Today, we discuss the efficacy and success of the interdisciplinary, competency-based curriculum, and the mentorship and networking opportunities afforded through the workshop. We discuss partnership strategies to continue support of alumni made vulnerable by changes in research priorities and funding terminations that undermine the abilities of the research and cancer care workforces to address the health and oncology care needs of a medically underserved population. Miria Kano, Irene Tamí-Maury, Shine Chang, Nelson Sanchez. The SGM Cancer CARE Workshop: A conversation on the importance of providing training, mentoring and networking to address cancer disparities for underserved populations in the face of changing federal priorities [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C029.

Knowledge gaps remain on stroke risk and disparities between sexual minority (SM) subgroups. In this study, stroke risk between SM subgroups, specifically gay/bisexual men and lesbian/bisexual women (G/BM and L/BW), was assessed. Data were collected in June 2022 using a bilingual (English and Spanish) cross-sectional paper-and-pen survey distributed among 183 SM individuals attending the 2022 Houston Pride Parade and Festival, as well as across Texas via phone call or online format. Relevant sociodemographic and stroke risk factors were compared between G/BM and L/BW using chi-square (or Fisher’s exact, when appropriate) and two-sample t-tests. Sexual orientation was used to predict stroke risk using multiple binomial logistic regression, adjusting for other sociodemographic determinants. While comparing the stroke risk factors between G/BW and L/BW, statistically significant differences were found in hypertension (p = 0.047), age (p < 0.001), smoking status (p = 0.043), cholesterol level (p < 0.001), and HIV (p = 0.038). G/BM were 2.79 times more likely to have a higher stroke risk compared to L/BW (aOR = 2.79; CI, 1.11–6.05, p = 0.032), after adjusting for other sociodemographic factors. This pilot study, conducted in Texas, adds to the existing scientific literature on stroke risk among the SM population and revealed that G/BM might have a higher stroke risk compared to L/BW. These findings can inform future research and intervention designs tailored to G/BM and L/BW communities and improve their overall health.

Abstract Background Digital technologies have positively impacted the availability and usability of clinical algorithms through the advancement in mobile health. Therefore, this study aimed to determine if a web-based algorithm designed to support the decision-making process of cancer care providers (CCPs) differentially impacted their self-reported self-efficacy and practices for providing smoking prevention and cessation services in Peru and Colombia. Methods A simple decision-making tree algorithm was built in REDCap using information from an extensive review of the currently available smoking prevention and cessation resources. We employed a pre-post study design with a mixed-methods approach among 53 CCPs in Peru and Colombia for pilot-testing the web-based algorithm during a 3-month period. Wilcoxon signed-rank test was used to compare the CCPs’ self-efficacy and practices before and after using the web-based algorithm. The usability of the web-based algorithm was quantitatively measured with the system usability scale (SUS), as well as qualitatively through the analysis of four focus groups conducted among the participating CCPs. Results The pre-post assessments indicated that the CCPs significantly improved their self-efficacy and practices toward smoking prevention and cessation services after using the web-based algorithm. The overall average SUS score obtained among study participants was 82.9 (± 9.33) [Peru 81.5; Colombia 84.1]. After completing the qualitative analysis of the focus groups transcripts, four themes emerged: limited resources currently available for smoking prevention and cessation in oncology settings, merits of the web-based algorithm, challenges with the web-based algorithm, and suggestions for improving this web-based decision-making tool. Conclusion The web-based algorithm showed high usability and was well-received by the CCPs in Colombia and Peru, promoting a preliminary improvement in their smoking prevention and cessation self-efficacy and practices.

ABSTRACT BACKGROUND: Delay time to hospital arrival may be influenced by lack of recognition of stroke signs and the necessity to seek emergency medical, which in turn is influenced by language barriers to, a modifiable risk factor, stroke awareness education. The objective was to determine the comprehension and satisfaction of a Spanish stroke awareness acronym, RÁPIDO, among community-living, Hispanic and Latino, Spanish-reading adults. METHODS: A 33-item survey was completed by 166 adults. Data on sociodemographics, language preferences, stroke education, and comprehension and satisfaction with RÁPIDO were collected. Descriptive characteristics were calculated. Fisher exact tests were performed to determine whether reading language (group 1, only or predominantly reads in Spanish; group 2, reads in Spanish and English equally or reads predominately in English) influenced survey responses. Responses to open-ended questions were categorized. RESULTS: Sixty-nine percent of the participants were born outside of the United States, 82% currently resided in the United States, 34% read only or predominately in Spanish, and 7% had a stroke. Most participants thought RÁPIDO was informative, eye-catching, and easily remembered. Significant differences were found between reading language preference groups for correctly identifying RÁPIDO images for facial drooping (group 1, 80%; group 2, 95%; P ≤ .001) and dizziness/loss of balance (group 1, 54%; group 2, 73%; P = .027). Eighty percent or more of all participants were able to correctly interpret RÁPIDO images for facial drooping, blurry vision, impaired speech, and call emergency services. Adding “911” to the RÁPIDO image of the clock was a common suggestion. CONCLUSIONS: RÁPIDO was well received among the participants. Modifications to RÁPIDO images representing dizziness/loss of balance and arm weakness, and the addition of “911” may improve its usefulness. Obtaining more extensive feedback across the United States and testing the effect of RÁPIDO on increasing knowledge of stroke signs and retention of that knowledge are necessary next steps.

BACKGROUND:Limited evidence exists on the population attributable fraction (PAF) of cancer cases and deaths in Latin America. In Peru several studies have been published regarding the PAF of various risk factors and their associated diseases. The objective of this study was to estimate the fraction of cancer cases and deaths attributable to potentially modifiable risk factors in Peru in 2018, before the COVID-19 pandemic in the population of 15 years old and older.METHODS:An ecological study was conducted using the prevalence of exposure of the Peruvian population to modifiable risk factors for cancer, the relative risk associated with each factor, and the number of cancer cases and deaths in 2018 as inputs. We used the Parkin formula with a Montecarlo statistical simulation model to calculate the PAF and confidence intervals. The number of new cancer cases and deaths attributed to each risk factor was determined by multiplying the number of cases and deaths in each gender by the PAF of each risk factor.FINDINGS:In Peru, 38.5% of new cases (34.5% in men and 42% in women) and 43.4% of cancer-related deaths (43.4% in men and 43.4% in women) were attributable to modifiable risk factors. The number of cancers attributable was 25,308 (10,439 in men and 14,869 in women) and the number of deaths attributable to cancer was 14,839 (6,953 in men and 7,886 in women). The predominant modifiable risk factors contributing to the highest number of cases and deaths were HPV infection (4,563 cases, 2,409 deaths), current tobacco use (3,348 cases, 2,180 deaths), and helicobacter pylori infection (2,677 cases, 1,873 deaths). Among the risk factors, oncogenic infections constituted the group with the highest PAF (16.6% for cases, 19.2% for deaths) followed by other unhealthy lifestyle factors (14.2% for cases, 16.7% for deaths), tobacco (7.2% for cases, 7.2% for deaths) and ultraviolet radiation (0.5% for cases, 0.3% for deaths).CONCLUSIONS:Prior to the COVID-19 pandemic, 38.5% of cancer cases and 43.4% of cancer-related deaths in Peru were linked to modifiable risk factors in the population of 15 years old and older. Most preventable cancer cases and deaths were related to oncogenic infections, primarily caused by HPV and helicobacter pylori, followed by tobacco and obesity.

With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Objectives: Human papillomavirus (HPV) vaccination rates among males are suboptimal worldwide. In South Korea, little is known about parents' intention to vaccinate boys against HPV. Therefore, we examined the associations of HPV-related knowledge and perceptions with vaccination intention among Korean mothers of boys. Methods: From August to December 2021, eligible mothers were surveyed about HPV-related knowledge, perceptions, and intention to vaccinate their sons against HPV. Mothers were categorized into no intention, contemplating, and intention to vaccinate groups. Using analysis of variance, we compared the groups' scores on the scales measuring HPV-related knowledge, attitudes, and beliefs. We conducted a multinomial logistic regression analysis to assess the associations between the variables and vaccination intention. Results: Among 361 mothers, 43.9 % had no intention, 60.7 % were contemplating, and 4.4 % intended to vaccinate their sons. The mean percentage of correct answers on the HPV and vaccine knowledge scales were 52.5 % and 62.3 %, respectively. The mean scores on the HPV attitudes and beliefs subscales were significantly different. Higher scores on benefits (OR = 3.04, 95 % CI 1.96 - 4.70; OR = 3.94, 95 % CI 1.54 - 10.70) and influence (OR = 1.48, 95 % CI 1.03 - 2.13; OR = 2.97, 95 % CI 1.44 - 6.14) were associated with contemplating the vaccine and intending to vaccinate sons. Knowledge was not associated with mothers' vaccination intention. Conclusions: Public health authorities and healthcare providers in Korea can use the results of this study to implement effective interventions that emphasize the importance of male HPV vaccination and encourage parent-son communication about the vaccine.