Crohn's Disease Mortality and Ambient Air Pollution in New York City.

BACKGROUND: The worldwide increase in Crohn's disease (CD) has accelerated alongside rising urbanization and accompanying decline in air quality. Air pollution affects epithelial cell function, modulates immune responses, and changes the gut microbiome composition. In epidemiologic studies, ambient air pollution has a demonstrated relationship with incident CD and hospitalizations. However, no data exist on the association of CD-related death and air pollution. METHODS: We conducted an ecologic study comparing the number of CD-related deaths of individuals residing in given zip codes, with the level of air pollution from nitric oxide, nitrogen dioxide, sulfur dioxide (SO2), and fine particulate matter. Air pollution was measured by the New York Community Air Survey. We conducted Pearson correlations and a Poisson regression with robust standard errors. Each pollution component was modeled separately. RESULTS: There was a higher risk of CD-related death in zip codes with higher levels of SO2 (incidence rate ratio [IRR], 1.16; 95% confidence interval [CI], 1.06-1.27). Zip codes with higher percentage of Black or Latinx residents were associated with lower CD-related death rates in the SO2 model (IRR, 0.58; 95% CI, 0.35-0.98; and IRR, 0.13; 95% CI, 0.05-0.30, respectively). There was no significant association of either population density or area-based income with the CD-related death rate. CONCLUSIONS: In New York City from 1993 to 2010, CD-related death rates were higher among individuals from neighborhoods with higher levels of SO2 but were not associated with levels of nitric oxide, nitrogen dioxide, and fine particulate matter. These findings raise an important and timely public health issue regarding exposure of CD patients to environmental SO2, warranting further exploration.

Ecologic study comparing the number of Crohn's disease related deaths of individuals residing in given zip codes within New York City, with levels of air pollution from nitric oxide, nitrogen dioxide, sulfur dioxide, and fine particulate matter.

Community perceptions and individual experiences of breast cancer in communities in and around Bangalore, India: a qualitative study.

Breast cancer is the most common cause of cancer mortality in India, yet breast cancer literacy remains poor. This study aimed to assess community perceptions and experiences with breast cancer in order to identify and address the gaps in our understanding of the socio-cultural barriers to awareness and care-seeking for breast cancer.Qualitative focus group discussions and in-depth interviews were conducted among breast cancer survivors and caretakers, health workers, and general population individuals in a tertiary care facility, urban underprivileged community, and rural setting around Bangalore city. Data was thematically analyzed using inductive approach.Breast cancer awareness was commonly gained through interpersonal relationships or self-experiencing breast cancer, mass media, and medical personnel. The most significant barriers to seeking care for breast cancer were cost of care, lack of female doctors, fears of diagnosis, and death. Stigma of breast cancer was attributed to possible isolation by the community members and misconception that cancer is infectious thereby delaying care-seeking.This study provides an understanding of what individuals perceive about breast cancer and highlights some important anecdotes from breast cancer survivors who have experienced the full extent of a breast cancer diagnosis in India. The institutional and social barriers brought out by this study may be taken into consideration when planning targeted interventions for breast cancer in India.

Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 "lockdown": A qualitative study in the United States.

BACKGROUND: The COVID-19 pandemic and associated public health prevention measures (e.g., "stay at home" orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 "lockdown" period in the United States. METHODS: Between April and May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework. RESULTS: Nearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes. CONCLUSION: To mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.