Cancer Risk Behaviors Research Articles

Abstract B015: Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors

Abstract Introduction. Adults who report Adverse Childhood Experiences (ACEs) are more likely to engage in health-risk behaviors. While previous research has explored the associations between ACEs and health-risk behaviors in the general population, studies focusing on cancer survivors are lacking. We examined the association between cannabis use, alcohol consumption, and smoking by race and ACEs among cancer survivors. Methods. Using cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, we analyzed 7,896 cancer survivors aged ≥18. We categorized the main exposure, ACEs, based on severity into four categories: zero, one, two to three, and ≥four, derived from questions assessing exposure to eight types of ACEs before the age of 18. The outcome measures were cannabis use (yes or no) and cancer risk behaviors: smoking status (current/former smoker or never smoker), binge alcohol use (yes or no). Binge drinking was defined as males consuming five or more drinks on one occasion and females consuming four or more drinks on one occasion. Weighted multivariable logistic regression models examined association between ACE and the outcomes; cannabis use, binge alcohol use and smoking adjusting for sociodemographic factors. Results. In this sample of cancer survivors, 44.1%, 22.7%, 20.2%, and 13.0% reported having experienced zero, one, two to three, and ≥four ACEs, respectively. Personal history of cannabis use was reported by 6.0% of respondents, current/former smokers by 43.4%, and binge alcohol use by 6.2%. In the adjusted models, cancer survivors with one ACE (aOR: 1.55, 95% CI: 0.92–2.60), two to three ACEs (aOR: 2.56, 95% CI: 1.57–4.27), or ≥four ACEs (aOR: 4.10, 95% CI: 2.54–6.64) had higher odds of cannabis use compared to those with zero ACEs. Similarly, cancer survivors with one ACE (aOR: 1.53, 95% CI: 0.99–2.39), two to three ACEs (aOR: 2.18, 95% CI: 1.36–3.48), or ≥four ACEs (aOR: 2.08, 95% CI: 1.25–3.48) had higher odds of binge drinking compared to those with zero ACEs. Finally, cancer survivors with one ACE (aOR: 1.40, 95% CI: 1.12–1.74), two to three ACEs (aOR: 1.94, 95% CI: 1.54–2.44), or ≥four ACEs (aOR: 3.06, 95% CI: 2.29–4.08) had higher odds being current/former smoker compared to those with zero ACEs. In terms of racial differences, the adjusted models indicated that Hispanic cancer survivors had higher odds of cannabis use (aOR: 2.49, 95% CI: 1.13–5.48) compared to Whites, but lower odds of smoking (aOR: 0.47, 95% CI: 0.28–0.80) compared to Whites. Conclusion. ACEs are strong predictors of adult cannabis use and cancer risk behaviors such as binge drinking and smoking. Therefore, individuals with a history of ACEs may represent an important target group for preventive interventions aimed at reducing these risks. Citation Format: Oluwole A. Babatunde, Melanie S. Jefferson, Swann Adams, Chanita Hughes Halbert, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B015.

Differences in modifiable cancer risk behaviors by nativity (US-born v. Non-US-born) and length of time in the US.

Previous studies have identified racial-ethnic disparities in modifiable risk factors for cancers. However, the impact of US nativity on these risks is understudied. Hence, we assessed the association between US nativity and length of time in the US on modifiable cancer risk factors. Utilizing the 2010 and 2015 National Health Interview Survey datasets, we analyzed 8,861 US-born and non-US-born adults. Key variables included age, sex, race-ethnicity, education, income, diet, body mass index, physical activity, alcohol consumption, and smoking. Statistical methods included descriptive statistics and regression. Most respondents were US-born (n = 7,370), followed by long-term (≥15 years, n = 928), and recent (<15 years, n = 563) immigrants. Moderate-to-vigorous physical activity was higher among US-born individuals (342.45 minutes/week), compared to recent (249.74 minutes/week) and long-term immigrants (255.19 minutes/week). Recent immigrants consumed more fruits (1.37 cups/day) and long-term immigrants more vegetables (1.78 cups/day) than US-born individuals. Multivariate analyses found recent immigrants had lower odds of consuming alcohol (AOR: 0.33, 95% CI: 0.21-0.50) and smoking (AOR: 0.30, 95% CI: 0.19-0.46), and higher odds of meeting fruit consumption guidelines (AOR: 2.80, 95% CI: 1.76-4.45) compared to US-born individuals. Long-term immigrants had lower odds of alcohol consumption (AOR: 0.56, 95% CI: 0.37-0.84) and smoking (AOR: 0.42, 95% CI: 0.30-0.59), and higher odds for meeting fruit (AOR: 1.87, 95% CI: 1.22-2.86) and fiber (AOR: 2.03, 95% CI: 1.02-4.05) consumption guidelines. Our findings illustrate the importance of considering the impact nativity and length of US residency has on health. Our findings underscore the need for culturally tailored public health strategies.

Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial.

Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492.

Skin cancer risk behaviors in sexual minority men: A mixed methods approach.

Sexual minority men experience disproportionately elevated rates of skin cancers, likely driven by excess ultraviolet radiation exposure-namely through tanning behaviors. However, limited integrated theoretical models exist to explain sexual minority men's elevated skin cancer risk. The aim of the current study is to further test and refine an integrated theory of skin cancer risk behaviors among sexual minority men by incorporating minority stress into the integrated health behavior model of tanning. The study employed a parallel mixed methods design, with a Phase 1 qualitative stage (N = 30) and a Phase 2 quantitative stage (Model 1: N = 320; Model 2: N = 319). In both phases, participants were sexual minority men, equally stratified as those with versus without recent tanning exposure and were recruited from across the United States. Qualitative and quantitative data supported the overall integrated model, with some quantitative paths varying depending on the tanning behavior outcome. Overall, appearance-related motives to tan and beliefs that tanning regulates affect emerged as the most consistent proximal predictors. Minority stress significantly predicted holding more positive attitudes toward tanning as an effective affect regulation strategy. The results from this mixed methods study support the inclusion of minority stressors into the adapted integrative health behavior model of tanning. Replication within prospective designs would strengthen the evidence for this model, which may be helpful in guiding future skin cancer prevention programs tailored to sexual minority men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

AB037. SOH24AB_027. Knowledge and attitudes of inflammatory bowel disease (IBD) patients regarding skin cancer risk and photoprotective behaviours

AB037. SOH24AB_027. Knowledge and attitudes of inflammatory bowel disease (IBD) patients regarding skin cancer risk and photoprotective behaviours

Abstract 4862: Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020

Abstract Purpose: To characterize rural-urban disparities of breast cancer (BC) incidence among younger women by stage and race/ethnicity. Background: Cancer incidence in younger adults is increasing, but trends and disparity patterns in early-onset BC are not well-described for women aged &amp;lt;50 years. Current screening guidelines recommend against routine screening until age 40 for various perceived harms that outweigh benefits which can lead to delayed diagnosis and more aggressive stage when BC is identified among younger women. It is unclear how BC incidence patterns such as stage at diagnosis and race/ethnicity differ by rurality, as rural residents may experience geographic isolation, lower socioeconomic status (SES), higher rates of cancer risk behaviors, and limited access to healthcare, compared to urban residents. Methods: We used incidence data from the North American Association of Central Cancer Registries to identify trends in early-onset BC among women aged 20-49 from 2000-2020, stratified by rurality (2013 USDA Rural-Urban Continuum Codes) and to explore patterns by stage and race/ethnicity. We extracted age-adjusted incidence rates (IR) [adjusted to 2000 US Standard Population] for each year and detected significant increasing or decreasing trends over time using the Joinpoint Regression Program. The annual percentage change (APC) for IR trends were calculated. Results: Of the 854,590 patients, 88% lived in urban areas (12% rural). Cumulatively over 2000-2020, we observed similar average APCs for early-onset BC both in urban (IR = 68.8 per 100,000; avg. APC +0.37, 95% CI 0.23, 0.50) and rural areas (IR = 65.1 per 100,000; avg. APC +0.35, 95% CI 0.14, 0.57). Rural areas did not significantly trend upwards until 2010-2020 (APC +0.71, 95% CI 0.38, 1.05). Rates for localized stage increased from 2000-2020 (APC +0.69%, 95% CI 0.48, 0.89) for urban areas, but declined in rural areas between 2000-2008 (APC -0.77, 95% CI -1.33, -0.20), only to increase again from 2008-2020 (APC +1.01, 95% CI 0.68, 1.34). In rural areas, there is a corresponding dramatic increase in distant stage BC diagnosed between 2000-2007 (APC +5.99%, 95% CI 2.29, 9.93) but slowed in the period after (2007-2020 APC +1.35, 95% CI 0.22, 2.51). While the rate remained stable for Hispanics living in both urban and rural areas, Non-Hispanic Whites (2000-2020 APC +0.59, 95% CI 0.46, 0.72), Non-Hispanic Blacks (2000-2009 APC +0.85, 95% CI 0.33, 1.37), and Other Non-Hispanic racial groups (2000-2020 APC +1.27, 95% CI 1.16, 1.58) saw significant increased rates in urban areas over time. Conclusions: Overall, early-onset BC has risen over the past 20 years in both urban and rural areas, but clear differences exist by stage at diagnosis and race/ethnicity. More research is needed to understand how SES, healthcare access, screening recommendations, and additional cancer risk factors can modulate BC incidence and disparities among younger women. Citation Format: Katherine L. Ho, Avonne Connor. Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4862.

The Impact of Acculturation on Skin Cancer Risk and Protective Behaviors in Hispanic Populations.

The US Hispanic population faces rising skin cancer risks and poorer clinical outcomes, despite lower incidence rates. Acculturation, adopting elements of the dominant culture, may influence skin cancer attitudes and behaviors among Hispanics. We systematically reviewed PubMed articles from 2000 to 2023. Peer-reviewed English articles that assessed the relationship between acculturation and skin cancer in the Hispanic population were included. Andreeva et al. observed that lower acculturation levels correlated with increased use of shade and protective clothing (P < 0.05). More acculturated Latinos were more likely to use sunscreen, but this association weakened after adjusting for covariates (P > 0.48). Heckman et al. highlighted significant differences in skin cancer concern among Hispanic youth, with less acculturated individuals expressing greater worry (P < 0.05). Coups et al. found that higher acculturation was linked to less sun protective clothing usage and more frequent sunburns. Their subsequent online survey indicated that English-acculturated Hispanics engaged less in protective behaviors. Viola et al. reported that English-acculturated Hispanics perceived greater suntan benefits and had lower perceptions of skin cancer risk, severity, and concerns about photo-aging, along with higher melanoma risk factors, compared to Spanish-acculturated Hispanics. Acculturation influences skin cancer attitudes and behaviors in Hispanics. Tailored interventions based on acculturation levels are essential to reduce skin cancer risk. For example, educating English-acculturated Hispanics about skin cancer risks and prioritizing knowledge dissemination for Spanish-acculturated individuals may be effective approaches. These findings emphasize the need for targeted skin cancer prevention efforts to address disparities among US Hispanics.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial.

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158. PRR1-10.2196/50392.

Exploring the associations between adverse childhood experiences (ACEs) and adolescent cancer risk behaviours in the ALSPAC cohort

BackgroundSome modifiable risk factors for cancer originate during adolescence. While there is evidence indicating relationships between adverse childhood experiences and health risk behaviours generally, little is known about how childhood adversity influences the engagement of adolescents in cancer risk behaviours. This study aimed to determine the relationship between adverse childhood experiences and adolescent cancer risk behaviours.MethodsData were collected prospectively from birth to age 18 years on children born to mothers enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study. Multivariable linear regression models assessed relationships of a composite exposure measure comprised of adverse childhood experiences (total number of childhood adversities experienced from early infancy until age 9 years) with multiple cancer risk behaviours. The latter was expressed as a single continuous score for tobacco smoking, alcohol consumption, obesity, unsafe sex, and physical inactivity, at ages 11, 14, 16 and 18 years. Analysis was carried out on the complete case and imputation samples of 1,368 and 7,358 participants respectively.ResultsAll adolescent cancer risk behaviours increased in prevalence as the adolescents grew older, except for obesity. Each additional adverse childhood experience was associated with a 0.25 unit increase in adolescent cancer risk behaviour (95% CI 0.16–0.34; p < 0.001). Individually, parental substance misuse (β 0.64, 95% CI 0.25–1.03, p < 0.001) and parental separation (β 0.56, 95% CI 0.27–0.86, p < 0.001) demonstrated the strongest evidence of association with engagement in adolescent cancer risk behaviour.ConclusionChildhood adversity was associated with a greater degree of engagement in adolescent cancer risk behaviours. This finding demonstrates the need for targeted primary and secondary prevention interventions that reduce engagement across multiple cancer risk behaviours for children and adolescents who have experienced adversity in childhood, such as parental substance misuse and separation, and reduce exposure to adversity.

Supplemental Material for Skin Cancer Risk Behaviors in Sexual Minority Men: A Mixed Methods Approach

Supplemental Material for Skin Cancer Risk Behaviors in Sexual Minority Men: A Mixed Methods Approach

THE ROLE OF SOCIAL DETERMINANTS OF HEALTH ON CANCER RISK BEHAVIORS AMONG OLDER NIGERIAN MEN

Abstract Despite the growing cancer incidence and mortality rate in Nigeria, there exists prevalence of imminent and aggressive stage of cancer diagnosis among Nigerian men due to cancer risk behaviors and lack of cancer preventive behaviors such as early screening. This adds to the increasing rates of cancer disparities in Nigeria and Sub-Saharan Africa. Research links social determinants of health (SDOH) to myriad of cancer outcomes including cancer detection and prevention behaviors. To contribute to our understanding of the complexity of cancer risk behaviors, this cross-sectional study aimed to determine the relationship demographic (age, education, employment, income), health (cancer knowledge, cancer beliefs, illness attitudes) and social determinants of health (health insurance, public health infrastructure, rural vs. urban dwelling) have on cancer risk behaviors among older Nigerian men (N=411, age 50+). Results show a significant association between SDOH and cancer risk behaviors. Lack of insurance, absence of health infrastructures, and rural dwelling were correlates of cancer risk behaviors. Also, cancer beliefs, illness attitude, income, and employment had significant relationships with cancer risk behaviors. Our findings point to the detrimental effects of these factors on the fight against cancer disparities. Understanding the mechanisms by which older Nigerian men experience health, requires efforts in identifying constructs that influence their daily-lived experiences and their impact on health-related behaviors. Our data can inform global health actions to eliminate cancer disparities at the individual, organization, and government levels.

Abstract C018: Cultural variables underlying obesity in Asians: Implications for understanding cancer risk behaviors in Filipinos

Abstract Obesity is associated with 13 different types of cancers (Steele et al., 2017) and in 2014, overweight- and obesity-related cancers accounted for 40% of all cancers that were diagnosed (Steele et al., 2014). Moreover, there are significant disparities associated with obesity in the United States. Filipinos Americans are disproportionately affected by higher obesity rates compared to other Asian American groups (Bates et al., 2008; Maxwell et al., 2012). Filipino immigrants are also at increased risk for hypertension and diabetes due to higher central adiposity (higher waist circumferences) and increased fat intake compared to other racial/ethnic groups (Vargas &amp; Jurado, 2015). The purpose of this presentation is to describe the design and development of an ongoing pilot study examining how cultural variables (e.g., acculturation, acculturative stress, ethnic identity, and cultural values) contribute to the understanding of disparities in modifiable risk factors (e.g., diet, physical activity body image) associated with overweight or obesity among Filipino adults. This culture and health assessment can inform future interventions that are uniquely tailored to the Filipino American community. This study can also serve as a guide for future researchers interested in 1) assessing cultural variables associated with race and ethnicity as it relates to diet, physical activity and body image and 2) developing questionnaires that are feasible to use for a particular racial or ethnic group. The study aims to: 1) develop culturally appropriate materials and measures to successfully assess diet, physical activity and body image, 2) examine the feasibility and acceptability of selected questionnaires administered during planned interviews, and 3) obtain pilot data can be used to guide a future larger study with Filipinos. In partnership with the Filipino Young Leaders Program (FYLPRO) and Filipino Health Community Advisory Board members, this study will enroll 25 Filipino Americans and immigrants, ages 18-65, with body mass index ≥ 18.5 kg/m2. Participants will complete an interview focused on health, culture, diet, physical activity and body image. Additionally, objective measures (e.g., weight, height, body fat) will be collected. This research study is a work in progress. The presentation will describe the purpose and development of a study that will help to inform future community-based, culturally tailored cancer risk reduction interventions focused on overweight and obesity among Filipino adults. Citation Format: Lisa Sanchez-Johnsen, Jacob Less, Angela Rose David, Nicole Aniceto, Irma Rodas, David Sedillo, Sumihiro Suzuki, Annabelle Santos Volgman, Melissa Palma. Cultural variables underlying obesity in Asians: Implications for understanding cancer risk behaviors in Filipinos [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C018.

Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: identifying cornerstones for building effective mammogram screening intervention programs

PurposeBreast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and behaviors of Zuni women in the Southwest United States (U.S.).MethodsIn 2020 and 2021, a survey was administered to better understand cancer screening patterns in Zuni Pueblo; 110 women from 50 to 75 years of age were recruited to respond to the breast cancer screening portion. Inclusion criteria included self-identifying as AI, a member of the Zuni tribe, or married to a Zuni tribal member, and meeting the age and gender requirements. Descriptive statistics and bivariate analyses were conducted examining the associations between measures of breast cancer knowledge, beliefs, and behaviors and breast cancer screening status (never, ever/non-compliant, and ever/compliant).ResultsOf survey participants, 47.3% have had a breast cancer screening and are up-to-date, 39.1% have had a screening in the past but are not up-to-date, and 13.6% have never been screened. Age was the only statistically significant socioeconomic predictor of breast cancer screening; the median (interquartile range) ages of each group are 62 (54, 68) ever/compliant, 56 (54, 68) ever/non-compliant, and 53 (51, 55) never (p-value < 0.001). Significant differences by health status and access to medical care include having a regular health care provider and going to see a provider for routine check-ups. The survey also shows differences in knowledge about breast cancer risk factors, beliefs, and behaviors. Women across all three screening statuses reported that they would get screened if encouraged by a health care provider.ConclusionWhile survey respondents report a relatively high rate of ever having had a breast cancer screening, less than half are compliant with screening guidelines, which shows there is an opportunity to improve breast cancer screening rates. With culturally tailored interventions, providers have the potential to improve breast cancer screening for Zuni women.

Cancer risk behavior and healthcare utilization among people experiencing homelessness in Europe

Abstract Background People experiencing homelessness (PEH) are a vulnerable population, having higher cancer morbidity and mortality compared to the housed population. Reasons for this may be due to higher prevalence of risky health behaviors but also owning to barrier to access and utilize healthcare services. This study aimed to show the prevalence of risky health behavior and utilization of healthcare services in PEH in Austria, Greece, Spain and the UK. Methods Data from 262 PEH participating in an ongoing longitudinal study on cancer prevention and early detection were included in a preliminary analysis (03/2023). Participants were adults, with no history of cancer recruited during their visits to social and healthcare services. Demographic data, high-risk health behaviors and visits to healthcare services were collected via questionnaires. Results Mean age of participants was 47.6 years (SD = 12.9) with 56.2% identifying themselves as male. The majority (50.4%) were homeless for up to 3 years and 61.6% had no history of homelessness. On average, 13.6 (SD = 10.2) cigarettes per day were reported by 62% of active smokers, 51% reported regular alcohol intake and 20.6% reported use of illicit drugs. Multimorbidity (co-occurrence of two or more chronic illnesses) was prevalent in 20.2% of participants. Half of participants reported having health insurance and 55% reported utilizing health care services in the past 12 months. The average number of visits to general practitioners and medical specialists was 3.9 (SD = 5.5) and 2.1 (SD = 5.1), respectively with an average of 2.2 (SD = 7.3) nights spent in hospital. Conclusions The proportion of PHE engaging in high-risk health behaviors is higher and utilization of health services is lower compared to the housed population. PEH may benefit from improved access to preventive and community health services, which is currently assessed by implementing the Health Navigator Model as part of the Horizon 2020 CANCERLESS project (GA965351). Key messages • High prevalence of risky health behaviors and multimorbidity in PEH was observed. • The reported low health care utilization among PEH may be due to structural barriers.

Compliance with public health recommendations of cancer-free female research volunteers: the French Seintinelles study.

Acting on modifiable risk factors can prevent approximately 40% of cancers. Knowing the factors that lead people to adopt healthy behaviors is crucial for designing effective primary prevention campaigns. Our study attempts to provide knowledge in this direction. This cross-sectional study was conducted via the Seintinelles collaborative research platform in a community of women without a personal cancer history, and volunteering to take online questionnaires. We collected data on sociodemographic and health factors, knowledge of cancer risk factors, behaviors, and possible behavior changes (tobacco/alcohol use, diet, body weight, and physical activity) in the last 10years. The study involved 1465 women aged between 18 and 84years. Factors such as young age, living alone, and obesity were associated with some positive or negative behavior changes. Being professionally active and having comorbidities favored certain positive behavior changes, while having dependent children, living in a rural area, and being hospitalized were associated with negative or no change in behaviors. Lack of knowledge about modifiable risk factors for cancer was associated with the non-adoption of various healthy behaviors (consumptions of fruit and vegetables, processed and red meat; physical activity). Only 5.5% of participants currently reported to be compliant with seven public health recommendations (smoking; alcohol, fruit/vegetables, and red/processed meat intakes; body mass index; and physical activity). This study allowed to identify the need to increase the level of knowledge on modifiable risk factors for cancer among the general population and to better clarify the content of prevention messages.

Risk factors and early prevention of skin cancer in rural older outdoor workers: A scoping review

Skin cancer risk increases with age and prolonged exposure to ultraviolet radiation (UVR), particularly in rural geographical locations and for individuals with light skin complexions. However, the impact of UVR-induced skin cancer risk and sun-protective behaviors in rural older populations working outdoors has yet to be explored. A scoping review was conducted to fill this gap, with 12 articles meeting the inclusion criteria of aged 50 years and older among rural outdoor workers. Skin cancer risk factors, prevention strategies, and barriers to sun-protective behaviors were summarized for each study. The scoping review addressed some key differences in age-related effects of UVR among rural older outdoor workers compared to studies among adults in general. Findings have policy and research implications that highlight the need to design feasible preventive strategies to reduce rural disparities in cancer care and enhance access to preventive services for this high-risk population.

A Survey of Cancer Risk Behaviors, Beliefs, and Social Drivers of Health in New Hampshire and Vermont.

In NH and VT, the finding that some associations between cancer risk factors and rural residence are more closely tied to educational attainment than rurality suggest that the design of interventions to address cancer risk should take educational attainment into account.

Kenyan youth’s understanding of cancer and cancer risk: a qualitative study

ABSTRACT Cancer incidence and mortality continues to rise worldwide including in Kenya and Kenyan youth who take part in cancer risk behaviour increase their chances of getting the disease in future. Despite this awareness, little is known about how Kenyan youth conceptualize cancer and cancer risk. Therefore, using a qualitative research study approach, we explored Kenyan youth’s understanding of cancer and cancer risk. Fifty-three youth between ages 12–19 years were engaged through individual interviews and focus group discussions. Using qualitative analysis approaches, we arrived at youth’s conceptualization of cancer and cancer risk. In youth’s conceptualization of cancer, their descriptions are grouped into two themes: ‘Cancer as a mysterious illness’ and ‘Lay representations using metaphors’. In their conceptualization of cancer risk, youth described cancer risk in ways that are grouped as ‘Cancer risk as lifestyle factors’ and ‘The process of understanding risk’. Our study is the first of its kind to be conducted in Kenya and we present critical findings and recommendations for cancer and cancer risk awareness, health education, and promotion for this population.

Lifestyle Related Cancer Risk and Protective Behaviors Vary among a Convenient Sample of Physically Active, Young-to-Middle-Aged Adults 18-49.

It is an assumption that physically active adults lead an overall healthy lifestyle. To examine this assumption, we administered a cross-sectional, web-based survey to a sample of young-to-middle-aged US adults between 18 and 49 who self-reported participation in at least one recreational sporting event in the past month. Logistic regressions were conducted to examine demographic characteristics associated with cancer risk and protective behaviors. Gender was represented equally (N = 938), and the average age was 32 years (SD: 8.4). Most participants reported >three days of moderate- to high-intensity physical activity (79%), but not meeting fruit and vegetable consumption guidelines (78%). Many reported current tobacco use (32%), binge drinking at least once in the past 30 days (62%), and suboptimal sun protection use (67%). Participation in lifestyle-related cancer risk and protective behaviors varied based on age, sex, education, routine doctor visits, perceived overall health, health-information-seeking behavior (how participants obtained health information), or team-based sport participation in regression models. Future interventions should be tailored to address varied cancer risk profiles among even physically active adults to encourage multiple healthy behavior changes.

National utilization and reimbursement patterns for Mohs micrographic surgery in the ambulatory surgery setting

Skin cancer is the most common type of cancer in the US, with certain health behaviors and demographics increasing an individual’s lifetime risk. 1 Guy G.P.J. Machlin S.R. Ekwueme D.U. Yabroff K.R. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med. 2015; 48: 183-187https://doi.org/10.1016/j.amepre.2014.08.036 Abstract Full Text Full Text PDF PubMed Scopus (537) Google Scholar , 2 Singer S. Tkachenko E. Yeung H. Mostaghimi A. Skin cancer and skin cancer risk behaviors among sexual and gender minority populations: A systematic review. J Am Acad Dermatol. 2020; 83: 511-522https://doi.org/10.1016/j.jaad.2020.02.013 Abstract Full Text Full Text PDF Scopus (11) Google Scholar Many skin cancers on cosmetically and functionally sensitive sites can be treated with Mohs micrographic surgery (MMS). These procedures primarily take place in the outpatient setting with either immediate or delayed repair of the resulting defect. In prior studies, characteristics such as insurance status among patients undergoing MMS have been described but these data are limited by small sample sizes from few institutions. 3 Clarke E.L. Willenbrink T.J. Shelton M. et al. Association of Tumor Characteristics With Insurance Type Among Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancer. JAMA Dermatol. 2022; 158: 919-922https://doi.org/10.1001/jamadermatol.2022.1802 Crossref Scopus (0) Google Scholar The objective of this study was to assess patient demographics, spending, and reimbursement trends for MMS in hospital-owned facilities and offices using nationally representative data.