Alcohol use is a major risk factor for several forms of cancer, though many people have limited knowledge of this link. Public health communicators and cancer advocates desire to increase awareness of this link with the long-term goal of reducing cancer burden. The current study is the first to examine the prevalence and content of information about alcohol use as a cancer risk on social media internationally. We used a three-phase process (hashtag search, dictionary-based auto-identification of content, and human coding of content) to identify and evaluate information from Twitter posts between January 2019 and December 2021. Our hashtag search retrieved a large set of cancer-related tweets (N = 1,122,397). The automatic search process using an alcohol dictionary identified a small number of messages about cancer that also mentioned alcohol (n = 9061, 0.8%), a number that got small after adjusting for human coded estimates of the dictionary precision (n = 5927, 0.5%). When cancer-related messages also mentioned alcohol, 82% (n = 1003 of 1225 examined through human coding) indicated alcohol use as a risk factor. Coding found rare instances of problematic information (e.g., promotion of alcohol, misinformation) in messages about alcohol use and cancer. Few social media messages about cancer types that can be linked to alcohol mention alcohol as a cancer risk factor. If public health communicators and cancer advocates want to increase knowledge and understanding of alcohol use as a cancer risk factor, efforts will need to be made on social media and through other communication platforms to increase exposure to this information over time.

High sugar-sweetened beverages (SSBs) are a controllable risk factor for chronic non-communicable diseases (NCDs), but their effect on the global disease burden is uncertain. The study aims to assess the global burden of high SSBs from 1990 to 2019. Global Burden of Disease (GBD) 2019 provides data on deaths, disability-adjusted life years (DALYs), years of life with disabilities (YLDs) and years of life lost (YLLs) ascribe to high SSBs by ages, genders, regions and countries. For the past 30years, overall exposure to high SSBs decreased for males and increased for females. The number of deaths from chronic NCDs ascribed to high SSBs increased from 149,988 (110,278-182,947) to 242,218 (172,045-302,250), DALYs increased from 3,698,578 (2,693,476-4,559,740) to 6,307,562 (4,300,765-8,079,556), especially the males. Age-standardized YLDs rate (ASYLDs) increased from 11.58 to 17.03. The number of ischemic heart disease (IHD) and diabetes mellitus (DM) deaths and DALYs ascribed to high SSBs has been increasing. Age-standardized death rate (ASDR) for DM risen from 0.56 to 0.62, age-standardized DALYs rate (ASDALYs) risen from 21.41 to 28.21. The burden of disease ascribed to high SSBs was in the elderly significantly higher than in the young and middle-aged, mainly concentrated in Central Asia and Oceania. The disease burden was highest in regions with moderate sociodemographic index (SDI). More extraordinary efforts should be made to raise awareness among the general public about interventions aimed at limiting the use of high SSBs, to reduce disease burden ascribed to high SSBs.

Latinas in the United States have higher mortality from breast cancer, but longitudinal studies of mammography ordering (a crucial initial step towards screening) in primary care are lacking. We conducted an analysis of mammography order rates in Latinas (by language preference) and non-Latina white women (N=181,755) over a>10year period in a multi-state network of community health centers (CHCs). We evaluated two outcomes (ever having a mammogram order and annual rate of mammography orders) using generalized estimating equation modeling. Approximately one-third of all patients had ever had a mammogram order. Among those receiving mammogram orders, English-preferring Latinas had lower mammogram order rates than non-Hispanic white women (RR=0.92, 95% CI=0.89-0.95). Spanish-preferring Latinas had higher odds of ever having a mammogram ordered than non-Hispanic whites (odds ratio=2.12, 95% CI=2.06-2.18) and, if ever ordered, had a higher rate of annual mammogram orders (rate ratio=1.53, 95% CI=1.50-1.56). These findings suggest that breast cancer detection barriers in low-income Latinas may not stem from a lack of orders in primary care, but in the subsequent accessibility of receiving ordered services.

Long working hours cause adverse health outcomes; however, the precise mechanisms underlying this relationship remain unknown. We examined the association between long working hours and health behaviors, as well as gender differences in this association. A nationally representative sample of 26,385 Korean workers was analyzed. The exposure variable was self-reported weekly working hours. The outcomes examined were cigarette smoking, high-level physical activity (defined as engaging in ≥150 min/week of moderate-to-vigorous leisure-time physical activity), and risky alcohol use (defined as consuming seven glasses for men or five glasses for women of alcohol in a single sitting, twice or more per week). Logistic regression models were utilized, and gender differences were examined by incorporating interaction terms into the regression models. Among 26,385 workers, 4,109 (16%) worked ≥55 h/week. The prevalence of cigarette smoking, high-level physical activity, and risky alcohol use was 19%, 18%, and 14%, respectively. The odds ratio (OR) (95% confidence interval [CI]) of the association between working ≥55 h/week and outcomes was 1.26 (1.12-1.43) for cigarette smoking, 0.73 (0.65-0.83) for high-level physical activity, and 0.95 (0.83-1.08) for risky alcohol use compared to working 35-40 h/week. A moderating effect of gender on the association between long working hours and risky alcohol use was observed. The OR (95% CI) of the association between working ≥55 h/week was 0.88 (0.76-1.02) in men and 1.51 (1.12-2.05) in women. Our findings emphasize the need for policy interventions aimed at reducing excessive working hours and fostering healthy lifestyle behaviors among individuals engaged in long working hours.

Food insecurity is associated with an increased likelihood of interpersonal violence. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the U.S. States can eliminate the asset test and/or increase the income limit for SNAP eligibility, expanding the number of households receiving assistance. We examined the association of state elimination of the asset test and increases in the income limit with rates of interpersonal violence, including intimate partner violence (IPV), other relationship violence (violence by a parent, friend, etc.), and stranger violence. We used data from the SNAP Policy Database and state-level estimates of rates of interpersonal violence per 1000 population ages ≥12years from the 2012-2014 to 2016-2018 National Crime Victimization Survey. States that adopted both SNAP eligibility policies (eliminated the asset test and increased the income limit) had a lower rate of IPV (β=-0.4, 95% CI -0.9, 0.0) and other relationship violence (β=-2.4, 95% CI -3.8, -1.1) compared to states that did not adopt either policy. The rate of stranger violence (β=-0.5, 95% CI -2.3, 1.4) did not differ for states that adopted both policies compared to states that did not adopt either policy. Rates of IPV (β=-0.4, 95% CI -0.9, 0.2), other relationship violence (β=-1.2, 95% CI -3.2, 0.7), and stranger violence (β=-0.2, 95% CI -2.0, 1.6) did not differ for states that eliminated the asset test only compared to states that did not adopt either policy. Expanding SNAP eligibility may help prevent interpersonal violence at the population-level.

Incentives are an integral part of Contingency Management (CM) Programs for substance use disorder treatment, primarily for the treatment stimulant use disorders, but because stimulant use often co-occurs with opioid use, the Substance Abuse and Mental Health Services Administration (SAMHSA) permits the use of CM incentives as a part of its State Opioid Response grant program. However, incentives implicate federal laws and could result in either financial penalties or criminal sanctions against programs that use them. The U.S. Department of Health and Human Services Office of Inspector General (OIG) is tasked with enforcing key federal laws that address the issues of kick-backs, inducements, and false claims. By looking at these laws and regulations, this paper seeks to create a clearer understanding of the the barriers providers face when utilizing CM, as well as the guardrails that can be put in place to alleviate those barriers. This paper distills key concerns raised by the OIG and suggests critical guardrails that militate against fraud, waste and abuse. Following the recommended guardrails should allow providers to employ CM strategies to help their patients by making clear that the intent is to help patients without engaging in kickbacks, illegal inducements or false claims.

During the COVID-19 pandemic Norway had to suspend its national breast cancer screening program. We aimed to investigate the effect of the pandemic-induced suspension on the screening interval, and its subsequent association with the tumor characteristics and treatment of screen-detected (SDC) and interval breast cancer (IC). Information about women aged 50-69, participating in BreastScreen Norway, and diagnosed with a SDC (N=3799) or IC (N=1806) between 2018 and 2021 was extracted from the Cancer Registry of Norway. Logistic regression was used to investigate the association between COVID-19 induced prolonged screening intervals and tumor characteristics and treatment. Women with a SDC and their last screening exam before the pandemic had a median screening interval of 24.0months (interquartile range: 23.8-24.5), compared to 27.0months (interquartile range: 25.8-28.5) for those with their last screening during the pandemic. The tumor characteristics and treatment of women with a SDC, last screening during the pandemic, and a screening interval of 29-31months, did not differ from those of women with a SDC, last screening before the pandemic, and a screening interval of 23-25months. ICs detected 24-31months after screening, were more likely to be histological grade 3 compared to ICs detected 0-23months after screening (odds ratio: 1.40, 95% confidence interval: 1.06-1.84). Pandemic-induced prolonged screening intervals were not associated with the tumor characteristics and treatment of SDCs, but did increase the risk of a histopathological grade 3 IC. This study provides insights into the possible effects of extending the screening interval.

The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta=0.12, p-value=0.140) and high-density facility (beta=0.22, p-value=0.025) groups than in the low-density group (p-value for trend-test=0.031). MMSE decline during follow-up was slower in the middle- (beta=0.15, p-value=0.114) and high-density facility (beta=0.27, p-value=0.052) groups than in the low-density group (p-value for trend-test=0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.

Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80years or older) population using the Chinese Longitudinal Healthy Longevity Survey. Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n=14,287), 2) remaining physically active (n=5411), 3) shifting from being inactive to active (n=1364), and 4) shifting from being active to inactive (n=1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups. A total of 15,707 participants died during follow-up (median duration of follow-up=3.0years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata. Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.