The Implications of Racialized Economic Segregation and Allostatic Load on Mortality in Patients with Breast Cancer.

BACKGROUND: The objective of this study was to examine the association between racialized economic segregation, allostatic load (AL), and all-cause mortality in patients with breast cancer. PATIENTS AND METHODS: Women aged 18+ years with stage I-III breast cancer diagnosed between 01/01/2012 and 31/12/2020 were identified in the Ohio State University cancer registry. Racialized economic segregation was measured at the census tract level using the index of concentration at the extremes (ICE). AL was calculated with biomarkers from the cardiac, metabolic, immune, and renal systems. High AL was defined as AL greater than the median. Univariable and multivariable regression analyses using restricted cubic splines examined the association between racialized economic segregation, AL, and all-cause mortality. RESULTS: Among 4296 patients, patients residing in neighborhoods with the highest racialized economic segregation (Q1 versus Q4) were more likely to be Black (25% versus 2.1%, p < 0.001) and have triple-negative breast cancer (18.2% versus 11.6%, p < 0.001). High versus low racialized economic segregation was associated with high AL [adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 1.21-1.61] and worse all-cause mortality [adjusted hazard ratio (aHR) 1.41, 95% CI 1.08-1.83]. In dose-response analyses, patients in lower segregated neighborhoods (relative to the 95th percentile) had lower odds of high AL, whereas patients in more segregated neighborhoods had a non-linear increase in the odds of high AL. DISCUSSION: Racialized economic segregation is associated with high AL and a greater risk of all-cause mortality in patients with breast cancer. Additional studies are needed to elucidate the causal pathways and mechanisms linking AL, neighborhood factors, and patient outcomes.

Associations between race and ethnicity and treatment setting among gynecologic cancer patients.

INTRODUCTION: Racial and ethnic disparities in gynecologic cancer care have been documented. Treatment at academic facilities is associated with improved survival, yet no study has examined independent associations between race and ethnicity with facility type among gynecologic cancer patients. MATERIALS & METHODS: We used the National Cancer Database and identified 484,455 gynecologic cancer (cervix, ovarian, uterine) patients diagnosed between 2004 and 2020. Facility type was dichotomized as academic vs. non-academic, and we used logistic regression to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between race and ethnicity and facility type. Secondarily, we examined joint effects of race and ethnicity and facility type on overall survival using Cox proportional hazards regression. RESULTS: We observed higher odds of treatment at academic (vs. non-academic) facilities among American Indian/Alaska Native (OR = 1.42, 95% CI = 1.28-1.57), Asian (OR = 1.64, 95% CI = 1.59-1.70), Black (OR = 1.69, 95% CI = 1.65-1.72), Hispanic (OR = 1.70, 95% CI = 1.66-1.75), Native Hawaiian/Pacific Islander (OR = 1.74, 95% CI = 1.57-1.93), and other race (OR = 1.29, 95% CI = 1.20-1.40) patients compared with White patients. In the joint effects survival analysis with White, academic facility-treated patients as the reference group, Asian, Hispanic, and other race patients treated at academic or non-academic facilities had improved overall survival. Conversely, Black patients treated at academic facilities [Hazard Ratio (HR) = 1.10, 95% CI = 1.07-1.12] or non-academic facilities (HR = 1.19, 95% CI = 1.16-1.21) had worse survival. DISCUSSION: Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at academic facilities. Importantly, survival outcomes among patients receiving care at academic institutions differed by race, requiring research to investigate intra-facility survival disparities.

Current cannabis use and pain management among US cancer patients.

BACKGROUND: National studies reporting the prevalence of cannabis use have focused on individuals with a history of cancer without distinction by their treatment status, which can impact symptom burden. While pain is a primary motivation to use cannabis in cancer, the magnitude of its association with cannabis use remains understudied. METHODS: We examined cannabis use and pain management among 5523 respondents of the Behavioral Risk Factor Surveillance System with a cancer history. Survey-weighted prevalence proportions of respondents' cannabis use are reported, stratified on cancer treatment status. Regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of cancer-related pain and cannabis use. RESULTS: Cannabis use was slightly more prevalent in those undergoing active treatment relative to those who were not undergoing active treatment (9.3% vs. 6.2%; P=0.05). Those under active treatment were more likely to use cannabis medicinally (71.6% vs. 50.0%; P=0.03). Relative to those without cancer-related pain, persons with pain under medical control (OR 2.1, 95% CI, 1.4-3.2) or uncontrolled pain were twice as likely to use cannabis (OR 2.0, 95% CI, 1.1-3.5). CONCLUSIONS: Use of cannabis among cancer patients may be related to their treatment and is positively associated with cancer-related pain. Future research should investigate the associations of cannabis use, symptom burden, and treatment regimens across the treatment spectrum to facilitate interventions.

Associations between neighborhood disinvestment and breast cancer outcomes within a populous state registry.

BACKGROUND: Breast cancer (BrCa) outcomes vary by social environmental factors, but the role of built-environment factors is understudied. The authors investigated associations between environmental physical disorder-indicators of residential disrepair and disinvestment-and BrCa tumor prognostic factors (stage at diagnosis, tumor grade, triple-negative [negative for estrogen receptor, progesterone receptor, and HER2 receptor] BrCa) and survival within a large state cancer registry linkage. METHODS: Data on sociodemographic, tumor, and vital status were derived from adult women who had invasive BrCa diagnosed from 2008 to 2017 ascertained from the New Jersey State Cancer Registry. Physical disorder was assessed through virtual neighborhood audits of 23,276 locations across New Jersey, and a personalized measure for the residential address of each woman with BrCa was estimated using universal kriging. Continuous covariates were z scored (mean ± standard deviation [SD], 0 ± 1) to reduce collinearity. Logistic regression models of tumor factors and accelerated failure time models of survival time to BrCa-specific death were built to investigate associations with physical disorder adjusted for covariates (with follow-up through 2019). RESULTS: There were 3637 BrCa-specific deaths among 40,963 women with a median follow-up of 5.3 years. In adjusted models, a 1-SD increase in physical disorder was associated with higher odds of late-stage BrCa (odds ratio, 1.09; 95% confidence interval, 1.02-1.15). Physical disorder was not associated with tumor grade or triple-negative tumors. A 1-SD increase in physical disorder was associated with a 10.5% shorter survival time (95% confidence interval, 6.1%-14.6%) only among women who had early stage BrCa. CONCLUSIONS: Physical disorder is associated with worse tumor prognostic factors and survival among women who have BrCa diagnosed at an early stage.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors.

BACKGROUND: Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort. METHODS: Demographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women's Circle of Health Follow-up Study - a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant's residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals. RESULTS: Higher perceived neighborhood disorder was associated with higher objective neighborhood disorder (ß = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (ß = - 0.11, 95% CI: - 0.24, 0.02). CONCLUSION: Objective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors.

PURPOSE: To determine the association of pre-diagnostic allostatic load (AL) with health-related quality of life (HRQOL) among Black women with breast cancer. METHODS: In a sample of 409 Black women with non-metastatic breast cancer enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), two pre-diagnostic AL measures were estimated using medical records data from up to 12 months prior to breast cancer diagnosis: AL-lipid/metabolic profile-based measure and AL-inflammatory profile-based measure. HRQOL was assessed approximately 24 months post diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) instrument, including 5 subscale scores [presented by physical well-being (PWB), social & family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer-specific scale (BCS)] and 3 derived total scores [presented by trial outcome index (TOI), Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-B]. We used multivariable logistic regression models, using dichotomized AL scores (lower AL: 0-3 points, higher AL: 4-8 points), to assess the associations between the two pre-diagnostic AL measures and HRQOL. RESULTS: Higher pre-diagnostic AL was associated with poorer FWB and lower FACT-G, but these associations were statistically significant for the AL-inflammatory profile-based measure (FWB: OR 1.63, 95% CI 1.04, 2.56; FACT-G: OR 1.62, 95% CI 1.04, 2.54), but not the AL-lipid/metabolic profile-based measure (FWB: OR 1.45, 95% CI 0.81, 2.59; FACT-G: OR 1.33, 95% CI 0.75, 2.37). CONCLUSION: These findings suggest that higher AL, particularly when measured using the inflammatory profile-based measure, was associated with poorer HRQOL, namely FWB and FACT-G, among Black breast cancer survivors.

Spatial predictive properties of built environment characteristics assessed by drop-and-spin virtual neighborhood auditing.

BACKGROUND: Virtual neighborhood audits have been used to visually assess characteristics of the built environment for health research. Few studies have investigated spatial predictive properties of audit item responses patterns, which are important for sampling efficiency and audit item selection. We investigated the spatial properties, with a focus on predictive accuracy, of 31 individual audit items related to built environment in a major Metropolitan region of the Northeast United States. METHODS: Approximately 8000 Google Street View (GSV) scenes were assessed using the CANVAS virtual audit tool. Eleven trained raters audited the 360° view of each GSV scene for 10 sidewalk-, 10 intersection-, and 11 neighborhood physical disorder-related characteristics. Nested semivariograms and regression Kriging were used to investigate the presence and influence of both large- and small-spatial scale relationships as well as the role of rater variability on audit item spatial properties (measurement error, spatial autocorrelation, prediction accuracy). Receiver Operator Curve (ROC) Area Under the Curve (AUC) based on cross-validated spatial models summarized overall predictive accuracy. Correlations between predicted audit item responses and select demographic, economic, and housing characteristics were investigated. RESULTS: Prediction accuracy was better within spatial models of all items accounting for both small-scale and large- spatial scale variation (vs large-scale only), and further improved with additional adjustment for rater in a majority of modeled items. Spatial predictive accuracy was considered 'Excellent' (0.8 ≤ ROC AUC < 0.9) for full models of all but four items. Predictive accuracy was highest and improved the most with rater adjustment for neighborhood physical disorder-related items. The largest gains in predictive accuracy comparing large- + small-scale to large-scale only models were among intersection- and sidewalk-items. Predicted responses to neighborhood physical disorder-related items correlated strongly with one another and were also strongly correlated with racial-ethnic composition, socioeconomic indicators, and residential mobility. CONCLUSIONS: Audits of sidewalk and intersection characteristics exhibit pronounced variability, requiring more spatially dense samples than neighborhood physical disorder audits do for equivalent accuracy. Incorporating rater effects into spatial models improves predictive accuracy especially among neighborhood physical disorder-related items.

Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio.

The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.92, 95% confidence interval [CI; 1.71, 4.99]) and had twice the odds of talking to a doctor/nurse about screening in the past year (OR = 2.15, 95% CI [1.29, 3.60]) compared to those who did not see the billboards. Participants in F&V counties who reported seeing F&V billboards had twice the odds (OR = 2.27, 95% CI [1.35, 3.84]) of talking to a doctor/nurse in the past year about F&Vs compared to those who did not see the billboards. Participants who reported campaign exposure lived closer to the billboards compared to those who did not report campaign exposure (mean distance in miles from home to billboard: 8.8 vs. 10.9; p < .01). Most participants reported campaign messages were clear and important. Results suggest that partnering with community members to develop campaign materials is important to ensure cultural appropriateness and that exposure to the intervention components may affect health-related outcomes.

The geographic distribution of cardiovascular health in the stroke prevention in healthcare delivery environments (SPHERE) study.

BACKGROUND: Community-level factors have been clearly linked to health outcomes, but are challenging to incorporate into medical practice. Increasing use of electronic health records (EHRs) makes patient-level data available for researchers in a systematic and accessible way, but these data remain siloed from community-level data relevant to health. PURPOSE: This study sought to link community and EHR data from an older female patient cohort participating in an ongoing intervention at the Ohio State University Wexner Medical Center to associate community-level data with patient-level cardiovascular health (CVH) as well as to assess the utility of this EHR integration methodology. MATERIALS AND METHODS: CVH was characterized among patients using available EHR data collected May through July of 2013. EHR data for 153 patients were linked to United States census-tract level data to explore feasibility and insights gained from combining these disparate data sources. Analyses were conducted in 2014. RESULTS: Using the linked data, weekly per capita expenditure on fruits and vegetables was found to be significantly associated with CVH at the p<0.05 level and three other community-level attributes (median income, average household size, and unemployment rate) were associated with CVH at the p<0.10 level. CONCLUSIONS: This work paves the way for future integration of community and EHR-based data into patient care as a novel methodology to gain insight into multi-level factors that affect CVH and other health outcomes. Further, our findings demonstrate the specific architectural and functional challenges associated with integrating decision support technologies and geographic information to support tailored and patient-centered decision making therein.

Effects of Patient Navigation on Patient Satisfaction Outcomes.

Patient navigation (PN) may reduce cancer health disparities. Few studies have investigated the effects of PN on patient-reported satisfaction with care or assessed patients' satisfaction with navigators. The objectives of this study are to test the effects of PN on patient satisfaction with cancer care, assess patients' satisfaction with navigators, and examine the impact of barriers to care on satisfaction for persons with abnormal cancer-related screening tests or symptoms. Study participants included women and men with abnormal breast, cervical, or colorectal cancer screening tests and/or symptoms receiving care at 18 clinics. Navigated (n=416) and non-navigated (n=292) patients completed baseline and end-of-study measures. There was no significant difference between navigated and non-navigated patients in change in patient satisfaction with cancer care from baseline to exit. African-American (p<0.001), single (p=0.03), low income (p<0.01), and uninsured patients (p<0.001) were significantly less likely to report high patient satisfaction at baseline. A significant effect was found for change in satisfaction over time by employment status (p=0.04), with full-time employment showing the most improvement. The interaction between satisfaction with navigators and satisfaction with care over time was marginally significant (p=0.08). Baseline satisfaction was lower for patients who reported a barrier to care (p=0.02). Patients reporting other-focused barriers (p=0.03), including transportation (p=0.02), had significantly lower increases in satisfaction over time. Overall, results suggested that assessing barriers to cancer care and tailoring navigation to barrier type could enhance patients' experiences with health care. PN may have positive effects for healthcare organizations struggling to enhance quality of care.

Association Between Neighborhood Opportunity, Allostatic Load, and All-Cause Mortality in Patients With Breast Cancer.

PURPOSE: Adverse neighborhood contextual factors may affect breast cancer outcomes through environmental, psychosocial, and biological pathways. The objective of this study is to examine the relationship between allostatic load (AL), neighborhood opportunity, and all-cause mortality among patients with breast cancer. METHODS: Women age 18 years and older with newly diagnosed stage I-III breast cancer who received surgical treatment between January 1, 2012, and December 31, 2020, at a National Cancer Institute Comprehensive Cancer Center were identified. Neighborhood opportunity was operationalized using the 2014-2018 Ohio Opportunity Index (OOI), a composite measure derived from neighborhood level transportation, education, employment, health, housing, crime, and environment. Logistic and Cox regression models tested associations between the OOI, AL, and all-cause mortality. RESULTS: The study cohort included 4,089 patients. Residence in neighborhoods with low OOI was associated with high AL (adjusted odds ratio, 1.21 [95% CI, 1.05 to 1.40]). On adjusted analysis, low OOI was associated with greater risk of all-cause mortality (adjusted hazard ratio [aHR], 1.45 [95% CI, 1.11 to 1.89]). Relative to the highest (99th percentile) level of opportunity, risk of all-cause mortality steeply increased up to the 70th percentile, at which point the rate of increase plateaued. There was no interaction between the composite OOI and AL on all-cause mortality (P = .12). However, there was a higher mortality risk among patients with high AL residing in lower-opportunity environments (aHR, 1.96), but not in higher-opportunity environments (aHR, 1.02; P interaction = .02). CONCLUSION: Lower neighborhood opportunity was associated with higher AL and greater risk of all-cause mortality among patients with breast cancer. Additionally, environmental factors and AL interacted to influence all-cause mortality. Future studies should focus on interventions at the neighborhood and individual level to address socioeconomically based disparities in breast cancer.

Associations of Cancer Patients' Demographic and Clinical Characteristics With Cannabis-Related Interest and Behaviors.

Background: Cannabis interest and use is increasing in the United States, yet research on its use among cancer patients is limited. Methods: Individuals with cancer completed an anonymous cross-sectional questionnaire. Multivariable logistic regressions estimated odds ratios (OR) between patients' demographic and clinical characteristics with cannabis-related interest, current use, and provider recommendation. Results: Participants (n = 943) were, on average, 61.7 years old. Older patients were less likely to use cannabis products (OR = 0.42, confidence interval [95% CI]: 0.26-0.69) and less likely to be interested in cannabis (OR = 0.60, 95% CI: 0.44-0.84) than younger patients. Those with higher education were less likely to be using cannabis (OR = 0.41, 95% CI: 0.25-0.67) and less likely to have received a provider recommendation of cannabis use than the least educated (OR = 0.38, 95% CI: 0.19-0.76). Cancer spread and type were significant correlates of provider recommendation of cannabis use. Conclusions: Additional research is warranted to better understand cancer patients' motivations for cannabis use and interest.

Persistent Neighborhood Poverty and Breast Cancer Outcomes.

IMPORTANCE: Patients with breast cancer residing in socioeconomically disadvantaged communities often face poorer outcomes (eg, mortality) compared with individuals living in neighborhoods without persistent poverty. OBJECTIVE: To examine persistent neighborhood poverty and breast tumor characteristics, surgical treatment, and mortality. DESIGN, Setting, and Participants: A retrospective cohort analysis of women aged 18 years or older diagnosed with stage I to III breast cancer between January 1, 2010, and December 31, 2018, and followed up until December 31, 2020, was conducted. Data were obtained from the Surveillance, Epidemiology, and End Results Program, and data analysis was performed from August 2023 to March 2024. EXPOSURE: Residence in areas affected by persistent poverty is defined as a condition where 20% or more of the population has lived below the poverty level for approximately 30 years. MAIN OUTCOME AND MEASURES: All-cause and breast cancer-specific mortality. RESULTS: Among 312 145 patients (mean [SD] age, 61.9 [13.3] years), 20 007 (6.4%) lived in a CT with persistent poverty. Compared with individuals living in areas without persistent poverty, patients residing in persistently impoverished CTs were more likely to identify as Black (8735 of 20 007 [43.7%] vs 29 588 of 292 138 [10.1%]; P < .001) or Hispanic (2605 of 20 007 [13.0%] vs 23 792 of 292 138 [8.1%]; P < .001), and present with more-aggressive tumor characteristics, including higher grade disease, triple-negative breast cancer, and advanced stage. A higher proportion of patients residing in areas with persistent poverty underwent mastectomy and axillary lymph node dissection. Living in a persistently impoverished CT was associated with a higher risk of breast cancer-specific (adjusted hazard ratio [AHR], 1.10; 95% CI, 1.03-1.17) and all-cause (AHR, 1.13; 95% CI, 1.08-1.18) mortality. As early as 3 years following diagnosis, mortality risks diverged for both breast cancer-specific (rate ratio [RR], 1.80; 95% CI, 1.68-1.92) and all-cause (RR, 1.62; 95% CI, 1.56-1.70) mortality. CONCLUSIONS AND RELEVANCE: In this cohort study of women aged 18 years or older diagnosed with stage I to III breast cancer between 2010 and 2018, living in neighborhoods characterized by persistent poverty had implications on tumor characteristics, surgical management, and mortality.

Racial and ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia.

BACKGROUND: Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both. METHODS: We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment. RESULTS: Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained. CONCLUSIONS: A substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.

Measuring changes in neighborhood disorder using Google Street View longitudinal imagery: a feasibility study.

Few studies have used longitudinal imagery of Google Street View (GSV) despite its potential for measuring changes in urban streetscapes characteristics relevant to health, such as neighborhood disorder. Neighborhood disorder has been previously associated with health outcomes. We conducted a feasibility study exploring image availability over time in the Philadelphia metropolitan region and describing changes in neighborhood disorder in this region between 2009, 2014, and 2019. Our team audited Street View images from 192 street segments in the Philadelphia Metropolitan Region. On each segment, we measured the number of images available through time, and for locations where imagery from more than one time point was available, we collected 8 neighborhood disorder indicators at 3 different times (up to 2009, up to 2014, and up to 2019). More than 70% of streets segments had at least one image. Neighborhood disorder increased between 2009 and 2019. Future studies should study the determinants of change of neighborhood disorder using longitudinal GSV imagery.

The impact of socioeconomic status on changes in cancer prevention behavior during the COVID-19 pandemic.

BACKGROUND: The impacts of socioeconomic status (SES) on COVID-19-related changes in cancer prevention behavior have not been thoroughly investigated. We conducted a cohort study to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. METHODS: We invited adult participants from previous studies conducted at Ohio State University to participate in a study assessing the impact of COVID-19 on various behaviors. Post-COVID-19 cancer prevention behaviors, including physical activity, daily intake of fruits and vegetables, alcohol and tobacco consumption, and qualitative changes in post-COVID-19 behaviors relative to pre-COVID levels, were used to construct a prevention behavior change index that captures the adherence status and COVID-related changes in each behavior, with higher index scores indicating desirable changes in prevention behaviors. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted regression models were used to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. RESULTS: The study included 6,136 eligible participants. The average age was 57 years, 67% were women, 89% were non-Hispanic Whites, and 33% lived in non-metro counties. Relative to participants with high SES, those with low SES had a 24% [adjusted relative ratio, aRR = 0.76 (95%CI 0.72-0.80)], 11% [aRR = 0.89 (95%CI 0.86-0.92)], and 5% [aRR = 0.95 (95%CI 0.93-0.96)], lower desirable changes in prevention behaviors for physical activity, fruit and vegetable intake, and tobacco use, respectively. Low SES had a higher desirable change in alcohol consumption prevention behaviors, 16% [aRR = 1.16 (95%CI 1.13-1.19)] relative to high SES. The adjusted odds of an overall poor change in prevention behavior were adjusted odds ratio (aOR) 1.55 (95%CI 1.27 to 1.89) and aOR 1.40 (95%CI 1.19 to 1.66), respectively, higher for those with low and middle SES relative to those with high SES. CONCLUSION: The adverse impacts of COVID-19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

Associations between observed neighborhood physical disorder and health behaviors, New Jersey behavioral risk factor Surveillance System 2011-2016.

This study tested associations between observed neighborhood physical disorder and tobacco use, alcohol binging, and sugar-sweetened beverage consumption among a large population-based sample from an urban area of the United States. Individual-level data of this cross-sectional study were from adult respondents of the New Jersey Behavioral Risk Factor Surveillance System, 2011-2016 (n = 62,476). Zip code tabulation area-level observed neighborhood physical disorder were from virtual audits of 23,276 locations. Tobacco use (current cigarette smoking or chewing tobacco, snuff, or snus use), monthly binge drinking occasions (5+/4+ drinks per occasion among males/females), and monthly sugar-sweetened beverages consumed were self-reported. Logistic and negative binomial regression models were used to generate odds ratios, prevalence rate ratios (PRR), 95 % confidence intervals (CI) by levels of physical disorder. Compared to the lowest quartile, residence in the second (PRR: 1.16; 95 % CI: 1.03, 1.13), third (PRR: 1.24; 95 % CI: 1.10, 1.40), and fourth (highest) quartile of physical disorder (PRR: 1.24; 95 % CI: 1.10, 1.40) was associated with higher monthly sugar-sweetened beverage consumption. Associations involving tobacco use and alcohol binging were mixed. Observed neighborhood disorder might be associated with unhealthy behaviors, especially sugar-sweetened beverage consumption.

Marijuana and Cannabidiol Use Prevalence and Symptom Management Among Patients with Cancer.

Symptoms such as pain, nausea, and anxiety are common in individuals with cancer. Treatment of these issues is often challenging. Cannabis products may be helpful in reducing the severity of these symptoms. While some studies include data on the prevalence of cannabis use among patients with cancer, detailed data remain limited, and none have reported the prevalence of cannabidiol (CBD) use in this population. Adult patients with cancer attending eight clinics at a large, NCI-designated Comprehensive Cancer Center completed a detailed, cannabis-focused questionnaire between 2021 and 2022. Eligible participants were diagnosed with invasive cancer and treated in the past 12 months. Summary statistics were calculated to describe the sample regarding cannabis use. Approximately 15% (n = 142) of consented patients (n = 934) reported current cannabis use (defined as use within the past 12 months). Among which, 75% reported cannabis use in the past week. Among current cannabis users, 39% (n = 56; 6% overall) used CBD products. Current users reported using cannabis a median of 4.5 (interquartile range: 0.6­7.0) days/week, 2.0 (1.0­3.0) times per use/day, and for 3 years (0.8­30.0). Use patterns varied by route of administration. Patients reported moderate to high relief of symptoms with cannabis use. This study is the most detailed to date in terms of cannabis measurement and provides information about the current state of cannabis use in active cancer. Future studies should include complete assessments of cannabis product use, multiple recruitment sites, and diverse patient populations. SIGNIFICANCE: Clinicians should be aware that patients are using cannabis products and perceive symptom relief with its use.

Association of census-tract level gentrification and income inequality with 6-year incidence of metabolic syndrome in the Hispanic Community Health Study/Study of Latinos, an epidemiologic cohort study.

BACKGROUND: Metabolic syndrome varies by socio-demographic characteristics, with younger (18-29 years) and older (50-69 years) Hispanic/Latino having higher prevalence compared to other groups. While there is substantial research on neighborhood influences on cardiometabolic health, there are mixed findings regarding the effects of gentrification and few studies have included Hispanic/Latinos. The role of neighborhood income inequality on metabolic health remains poorly understood. OBJECTIVES: Examined associations of neighborhood gentrification and income inequality with metabolic syndrome (MetSyn) using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). DESIGN, SETTING AND PARTICIPANTS: The HCHS/SOL is a community-based cohort of adults of Hispanic/Latinos (aged 18-74). Analyses included 6710 adults who did not meet criteria for MetsS at baseline (2008-2011) and completed the visit 2 examination (2014-2017). Poisson regressions estimated odds ratios (IRR) and 95% confidence intervals (CI) for neighborhood gentrification and change in income inequality with MetSyn incidence. MAIN OUTCOME AND EXPOSURE MEASURES: Gentrification was measured with an index that included changes (2000 to 2006-2010) in education, poverty, and income. Change in neighborhood income inequality (2005-2009 to 2012-2016) was measured using the Gini coefficient of income distribution. MetSyn was defined using National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Among 6647 Hispanic/Latino adults, 23% (N = 1530) had incident MetSyn. In models adjusted for socio-demographic, health insurance status, and neighborhood characteristics, gentrification (IRR, 1.00, 95%CI, 0.96-1.03) and income inequality change (IRR, 1.00, 95%CI, 0.99-1.00) were not associated with MetSyn at visit 2. There was no association between cross-sectional income inequality (2005-2009) and MetSyn at visit 2 (IRR, 0.97, 95%CI, 0.82-1.15). CONCLUSION: Neighborhood gentrification and income inequality change were not associated with incidence of MetSyn over 6 years among Hispanic/Latino adults. This study demonstrated that income-based residential changes alone may not be sufficient to explain neighborhood influences on health outcomes among this population.