Objective: To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID‐19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic.Methods: We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire‐4 (low/none [0–2], mild [3–5], moderate [6–8], and severe [9–12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed.Results: The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID‐19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50–64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11–0.76; during: OR = 0.33, 95% CI = 0.11–0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05–0.34; during: OR = 0.18, 95% CI = 0.07–0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35–49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11–6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05–1.01) compared to non‐Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01–0.42), some college (before: OR = 0.10, 95% CI = 0.02–0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01–0.26; during: OR = 0.06, 95% CI = 0.01–0.61) compared to those with less than a high school education.Conclusion: Our results suggest the need to increase the provision of mental health services to cancer patients at high risk of developing anxiety/depression symptoms, particularly during public health emergencies, to alleviate further health burdens.

Background: Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. Methods: We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. Results: Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). Conclusions: There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.

Background: Lung cancer (LC) continues to be the leading cause of cancer deaths in the United States. Surgical treatment has proven to offer a favorable prognosis and a better 5‐year relative survival for patients with early or localized tumors. This novel study investigates the factors associated with the odds of receiving surgical treatment for localized malignant LC in Tennessee.Methods: Population‐based data of 9679 localized malignant LC patients from the Tennessee Cancer Registry (2005–2015) were utilized to examine the factors associated with receiving surgical treatment for localized malignant LC. Bivariate and multivariate logistic regression analyses, cross‐tabulation, and Chi‐Square (²) tests were conducted to assess these factors.Results: Patients with localized malignant LC who initiated treatment after 2.7 weeks were 46% less likely to receive surgery (adjusted odds ratio [AOR] = 0.54; 95% confidence interval [CI] = 0.50–0.59; p < 0.0001). Females had a greater likelihood (AOR = 1.14; CI = 1.03–1.24) of receiving surgical treatment compared to men. Blacks had lower odds (AOR = 0.76; CI = 0.65–0.98) of receiving surgical treatment compared to Whites. All marital groups had higher odds of receiving surgical treatment compared to those who were single/never married. Patients living in Appalachian county had lower odds of receiving surgical treatment (AOR = 0.65; CI = 0.59–0.71) compared with those in the non‐Appalachian county. Patients with private (AOR = 2.09; CI = 1.55–2.820) or public (AOR = 1.42; CI = 1.06–1.91) insurance coverage were more likely to receive surgical treatment compared to self‐pay/uninsured patients. Overall, the likelihood of patients receiving surgical treatment for localized malignant LC decreases with age.Conclusion: Disparities exist in the receipt of surgical treatment among patients with localized malignant LC in Tennessee. Health policies should target reducing these disparities to improve the survival of these patients.

There are limited studies on the perceived likelihood of receiving a COVID-19 vaccine among the general US population and its subpopulations. We examined the association between the perceived likelihood of receiving a COVID-19 vaccine with the self-reported likelihood of contracting COVID-19, social-distancing stress, COVID-19 diagnosis status, mental health disorders, and sociodemographic characteristics. The data were collected using a national cross-sectional survey (N = 5404) between 13 May 2021 and 9 January 2022. A multivariable logistic regression analysis was performed. Setting: United States. Participants: Adults aged ≥ 18 years. The majority of US adults (67.34%) indicated they intended to receive a COVID-19 vaccine. There was a decreased perceived likelihood of getting vaccinated associated with those aged 18–49 years (Adjusted Odds Ratio (AOR) = 0.29–59; 95% Confidence Interval (CI) = 0.20–0.85); with a less than college education (AOR = 0.37–58; 95% CI = 0.28–0.68); with no health insurance (AOR = 0.48; 95% CI = 0.40, 0.58); with no perceived likelihood of contracting COVID-19 (AOR = 0.78; 95% CI = 0.68, 0.89); and with anxiety/depression (AOR = 0.67; 95% CI = 0.59, 0.76). Black/African Americans had a lower perceived likelihood of receiving a COVID-19 vaccine (AOR = 0.84; 95% CI = 0.71, 0.98), while Asians (AOR = 1.92; 95% CI = 1.35, 2.74) and Hispanics/Latinos (AOR = 1.34; 95% CI = 1.03, 1.74) had a higher perceived likelihood compared with Whites. Individuals reporting social distancing as stressful (AOR = 1.21; 95% CI = 1.01, 1.45) were associated with an increased perceive likelihood of receiving a COVID-19 vaccine. Our study showed that younger adults, Black/African Americans, and those with a less than college education, no health insurance, or anxiety/depression may be less likely to receive vaccination. Future research should examine the explanatory mechanisms contributing to the lower perceived likelihood of vaccination among these groups, such as barriers to vaccine education or vaccine access. Public health interventions should prioritize these populations to improve vaccination rates.

Background: Early initiation of treatment for lung cancer has been shown to improve patient survival. The present study investigates disparities in time to treatment initiation of invasive lung cancer within and between Black and White patients in Tennessee. Methods: A population-based registry data of 42,970 individuals (Black = 4,480 and White = 38,490) diagnosed with invasive lung cancer obtained from the Tennessee Cancer Registry, 2005–2015, was analyzed. We conducted bivariate ANOVA tests to examine the difference in time to treatment initiation among independent factors, and multivariable Cox proportional hazard models to identify independent factors that influence median time to treatment initiation after diagnosis. Results: When considering the estimate of the proportion of time to treatment initiation based on the combined influence of all independent factors (sex, age, race, marital, county of residence, health insurance, cancer stage, and surgical treatment), Black patients were generally more at risk of delayed treatment compared to Whites. Black patients aged <45 years (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI] = 1.01–1.94) and married White patients (aHR = 1.13; 95% CI = 1.07–1.18) had the highest increased risk of late treatment among their respective racial subgroups. In the general sample, patients with private health insurance had (aHR = 1.08; 95% CI = 1.01–1.16) higher risk of late treatment beyond 2.7 weeks compared to self-pay/uninsured patients. This was consistent among both Black and White subsamples. Patients with localized and regional lung cancer stages had a decreased risk of delayed treatment compared to those diagnosed at the distant stage among both Black and White patients. Conclusions: Black patients were often at greater risk of late initiation of treatment for invasive lung cancer in Tennessee. Additional research is needed to understand factors influencing time to treatment initiation for Black patients in Tennessee. Further, cancer care resources are needed in Black communities to ensure timely treatment of invasive lung cancer, reduce disparities, and promote equitable care for all cancer patients.

Background: Although studies have investigated the impact of the COVID-19 on mental health, few studies have attempted to compare the prevalence of depression/anxiety symptoms among U.S. adults before and after the COVID-19 pandemic declaration. We examined the prevalence and association between depression/anxiety symptoms and COVID-19 pandemic declaration among U.S. adult population and subgroups.Methods: A nationally representative cross-sectional study of the Health Information National Trends Survey (HINTS 5, Cycle 4) assessing health-related information and behaviors in U.S. adults aged ≥18 years from February through June 2020. The primary dependent variable wascurrent depression/anxiety derived from Patient Health Questionnaire-4. The main independent variable was responses before and after the COVID-19 pandemic declaration in addition to sexual identity heterosexual identity, /race/ethnicity and rural-urban commuting areas. Covariates were sociodemographic factors, and health risk behaviors. Weighted percentages, multivariable logistic regression, and Chi-square tests were used to establish the prevalence and association between current depression/anxiety and the independent variables and covariates.Results: A total of 3,865 participants completed the survey and included 35.3% of the participants before the COVID-19 pandemic declaration. Most of the sample were aged 50–64 years [33.0%]; males [51.0%]; and non-Hispanic Whites [70.1%]). The post-pandemic declaration included participants, aged 35–49 years [27.0%]; females [52.6%]; and non-Hispanic Whites [59.6%]). The prevalence of depression/anxiety was higher after the COVID-19 pandemic declaration (32.2%) than before the declaration (29.9%). Higher risks of depression/anxiety symptoms after the declaration were associated with being a sexual minority ([adjusted odds ratio] AOR, 2.91 [95% confidence interval (CI), 1.38–6.14]) and having fair/poor general health (AOR, 2.91 [95% CI, 1.76–4.83]). The probability of experiencing depression/anxiety symptoms after the declaration was highest among homosexuals/lesbians/gays (65.6%) compared to bisexuals (39.6%), and heterosexuals (30.1%).Conclusions: In this study, young adults, non-Hispanic Whites, and those with fair/poor general health had a higher burden of depression/anxiety symptoms after the pandemic declaration. The development of psychological support strategies to promote wellbeing during the pandemic may reduce psychological distress in the population, especially among at-risk populations.