We analyzed socioeconomic, rural-urban, and racial inequalities in US mortality from all cancers, lung, colorectal, prostate, breast, and cervical cancers. A deprivation index and rural-urban continuum were linked to the 2003–2007 county-level mortality data. Mortality rates and risk ratios were calculated for each socioeconomic, rural-urban, and racial group. Weighted linear regression yielded relative impacts of deprivation and rural-urban residence. Those in more deprived groups and rural areas had higher cancer mortality than more affluent and urban residents, with excess risk being marked for lung, colorectal, prostate, and cervical cancers. Deprivation and rural-urban continuum were independently related to cancer mortality, with deprivation showing stronger impacts. Socioeconomic inequalities existed for both whites and blacks, with blacks experiencing higher mortality from each cancer than whites within each deprivation group. Socioeconomic gradients in mortality were steeper in nonmetropolitan than in metropolitan areas. Mortality disparities may reflect inequalities in smoking and other cancer-risk factors, screening, and treatment.

Purpose.: To examine the effect of happiness and life satisfaction on health. Design.: Longitudinal data from waves 1 and 3, conducted in 2001 and 2004, respectively, of the Household Income and Labour Dynamics in Australia survey. Setting.: Australia. Subjects.: A total of 9981 respondents aged 18 years and older. Measures.: Outcomes were self-reported health; the absence of long-term, limiting health conditions; and physical health. Happiness was assessed with the following question: “During the past 4 weeks, have you been a happy person”? Life satisfaction was determined with the following question: “All things considered, how satisfied are you with your life”? Analysis.: We used multiple regression analysis to estimate odds ratios (ORs), beta coefficients (β), and 95% confidence intervals (CIs) for the associations between baseline happiness or life satisfaction and health at wave 3. Results.: Baseline happiness and life satisfaction both were positively associated at wave 3 with excellent, very good, or good health (OR = 1.50, CI = 1.33–1.70, p < .0001; and OR= 1.62, CI = 1.27–2.08, p < .0001, respectively); with the absence of long-term, limiting health conditions (OR = 1.53, CI = 135–1.15, p < .0001; and OR = 1.51, CI = 1.25–1.82, p < .0001, respectively); and with higher physical health levels (β̂ = .99, CI = .60–1.39, p < .0001; and β̂ = .99, CI = .20–1.18, p < .0145, respectively). Conclusion.: This study showed that happier people and those who were more satisfied with their lives at baseline reported better health (self-rated health; absence of limiting, long-term conditions; and physical health) at the 2-year follow-up when adjusted for baseline health and other relevant covariates.

Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans.

Little is known about racial/ethnic and socioeconomic variations in the duration of smoking. The goal of this research was to examine these variations. Data came from the 2003, 2006 and 2007 Tobacco Use Supplement of the Current Population Survey. The analysis was limited to ever-smokers (n = 117,168). The outcome was number of years of daily smoking. Survival analysis was employed to predict smoking duration. American Indians with 32 years had the highest median duration of smoking, followed by Blacks and ‘other’ races with 30 years, Whites with 28 years and Hispanics with 24 years. The difference in the duration of smoking between Blacks and Whites disappeared after adjusting for poverty. Individuals in poverty had a median duration of smoking of 40 years, while those with a family income of at least three times that of the poverty threshold had a median duration of 22 years. Median duration of smoking was 40 years among individuals without a high-school diploma and 18 years among those with a bachelors or higher degree. This research revealed large variations in smoking duration between racial/ethnic and socioeconomic groups. Longer exposure to tobacco among groups that are already disadvantaged is likely to exacerbate existing health disparities.