Traffic-Related Air Pollution and Risk of Lung, Breast, and Urinary Tract Cancer in Halifax, Nova Scotia.

OBJECTIVES: We assessed the association of traffic-related air pollution (TRAP) with the incidence of lung, breast, and urinary tract cancer in Halifax, Nova Scotia. METHODS: Our case-control study included 2315 cancers and 8501 age-sex-matched controls. Land-use regression was used to estimate TRAP concentrations. Logistic regression was used to assess cancer risk in relation to TRAP, adjusting for community social and material deprivation. RESULTS: There was no association between the risk of lung, breast, or urinary tract cancer in relation to TRAP. Lung cancer risk was significantly increased in the most deprived communities, whereas breast cancer risk was highest in the least deprived communities. CONCLUSIONS: In a city characterized by low levels of ambient air pollution, there was no evidence of a linear increased lung, breast, or urinary tract cancer risk in relation to TRAP.

Use of Wearable Activity-Monitoring Technologies to Promote Physical Activity in Cancer Survivors: Challenges and Opportunities for Improved Cancer Care.

The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.

Evaluation of two social norms nudge interventions to promote healthier food choices in a Canadian grocery store.

The objective of this study was to determine the impact of two nudge interventions on customers' produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.

Patterns and determinants of adherence to colorectal cancer primary and secondary prevention recommendations in the BC Generations Project. / Tendances et déterminants de l'adhésion aux recommandations en matière de prévention primaire et secondaire du cancer colorectal dans le cadre du BC Generations Project.

INTRODUCTION: Adherence to cancer prevention recommendations can greatly reduce colorectal cancer risk. This study explored patterns and determinants of adherence to these recommendations by participants (n = 26 074) at baseline in a cohort study in British Columbia, Canada. METHODS: Adherence to five colorectal cancer primary prevention behaviours derived from Canadian Cancer Society/World Cancer Research Fund recommendations (nonsmoking, body mass index (BMI), physical activity, alcohol consumption and fruit and vegetable consumption) was measured, and a composite score constructed based on their sum. The definition of secondary prevention adherence was based on the Canadian Task Force on Preventive Health Care recommendations for colorectal cancer screening. RESULTS: Adherence to primary prevention guidelines ranged from 94.8% (nonsmoking) to 44.2% (healthy BMI). Median composite score was 4. Higher composite scores were associated with being female, being married and with a higher educational attainment. Colorectal cancer screening adherence was 62.4%. Older age, chronic conditions, a recent medical examination and higher income were associated with greater odds of adherence to screening. CONCLUSION: Adherence to some colorectal cancer prevention behaviours was high, consistent with findings that British Columbia has low rates of many risky health behaviours. However, there was a clustering of poorer adherence to prevention behaviours with each other and with other risk factors. Screening adherence was high but varied with some sociodemographic and health factors. Future work should evaluate targeted interventions to improve adherence among those in the lowest socioeconomic status and health groups. A better understanding is also needed of the barriers to access and engagement with colorectal cancer screening that persist even in the Canadian public health care system.

A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors.

AIMS: To explore available health behaviour change interventions in improving key health behaviours in colorectal cancer survivors and patient perspectives about these interventions. DESIGN: A systematic mixed studies review was conducted. DATA SOURCES: Databases searched included Ovid Medline, Ovid Embase, EBSCO PsychoInfo and EBSCO CINAHL. A grey literature search was also completed using Google Scholar and the TRIP database. Identified studies were published between 2003 - 2018. REVIEW METHODS: A parallel-results convergent synthesis design using narrative syntheses was used. Data analysis was conducted following a process of constant comparison. Quality appraisal was conducted using recognized tools appropriate to different study designs. RESULTS: Sixteen unique studies were identified from an initial search of 354 records. There was a pattern of successful physical activity and dietary change associated with behaviour change interventions of varying intensity, modality and length, but sparse description of intervention content was common. Participants preferred clear explanations of health behaviour importance and for interventions to be administered in sessions either with, or led by, other patients. CONCLUSION: The available evidence tentatively suggests that behaviour change interventions can improve the health behaviours of colorectal cancer survivors. However, more research focused on identifying key intervention elements is needed. Patients indicated clear preferences for specific intervention content and delivery, but further research is needed to allow for the appropriate incorporation of patient preferences into the design of such interventions. IMPACT: This review highlights the potential for interventions to improve health behaviours evidenced to influence short and long-term health outcomes in colorectal cancer survivors. However, the examination of the impact of these interventions and patient perspectives indicated a paucity of research. This is an important finding in demonstrating additional research is necessary to improve the support available to a growing group of patients with complex health needs.

Assessing the fidelity of delivery of an intervention to increase attendance at the English Stop Smoking Services.

BACKGROUND: Implementation fidelity refers to the extent to which a proposed intervention is enacted as designed and is necessary to determine how much the intervention in question is the primary mechanism in any changes observed. Start2quit was a randomised controlled trial that aimed to improve attendance at the English Stop Smoking Service (SSS). The complex intervention combining computer-tailored personal risk letters and no-commitment ("taster") sessions aimed at encouraging attendance at the SSS doubled attendance at the SSS and significantly increased abstinence rates, although attendance and abstinence varied between participating SSSs. Assessment of the fidelity of the delivery of the taster sessions to the protocol was embedded into the trial and is the focus of this study. METHODS: Eighteen SSSs participated in the study. Taster sessions were delivered by SSS advisors in the area. Of the 131 sessions delivered, 93 (71 %) were recorded and 41 (31.3 %) were selected for transcription and analysis. The taster session protocol contained 73 specified behaviours, which were independently classified into component behaviour change techniques (BCTs) using an established taxonomy for smoking cessation. All transcripts were coded by two authors with 25 % additionally coded by a third. The fidelity of each taster session was expressed as the percentage of overall protocol-specified behaviours that were delivered. Adherence to each BCT was measured as the number of behaviours applied by the advisors within each BCT divided by the total number classified within each. RESULTS: Adherence of protocol-specified behaviours was relatively high (median 71.23 %), though there was considerable variation (28.76 to 95.89 %) in individual sessions. Median fidelity to specific BCTs across sessions also varied from 50 to 100 %. Shorter sessions, sessions run jointly by two advisors, by female advisors, or by advisors aged 45 to 54 were associated with higher levels of adherence. There was no association between adherence and subsequent attendance at the SSS. CONCLUSIONS: These results suggest that the delivery of the intervention of this study is not likely to have been impacted by issues of fidelity. As such, we can have greater confidence that variability in the main outcome is not due to variability in SSS advisor adherence to the protocol of the taster sessions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN76561916.