Meredith L. Shoemaker

Prevalence of Modifiable Cancer Risk Factors Among U.S. Adults Aged 18–44 Years

Introduction Carcinogen exposure and unhealthy habits acquired in young adulthood can set the stage for the development of cancer at older ages. This study measured the current prevalence of several cancer risk factors among young adults to assess opportunities to intervene to change the prevalence of these risk factors and potentially reduce cancer incidence. Methods Using 2015 National Health Interview Survey data (analyzed in 2016), the prevalence of potential cancer risk factors was estimated among U.S. adults aged 18–44 years, based on responses to questions about diet, physical activity, tobacco product use, alcohol, indoor tanning, sleep, human papillomavirus vaccine receipt, and obesity, stratified by sex, age, and race/ethnicity. Results The prevalence of some risk factors varied by age and race/ethnicity. Obesity (one in four people) and insufficient sleep (one in three people) were common among men and women. Physical inactivity (one in five men, one in four women); binge drinking (one in four men, one in eight women); cigarette smoking (one in five men, one in seven women); and frequent consumption of red meat (one in four men, one in six women) also were common. More than half of the population of adults aged 18–44 years consumed sugar-sweetened beverages daily and processed meat at least once a week. Most young adults had never had the human papillomavirus vaccine. Conclusions Findings can be used to target evidence-based environmental and policy interventions to reduce the prevalence of cancer risk factors among young adults and prevent the development of future cancers.

Cancer prevention and worksite health promotion: time to join forces.

The workplace is recognized as a setting that can profoundly influence workers’ health and well-being (1,2). The Centers for Disease Control and Prevention (CDC) workplace health promotion efforts address cancer prevention by focusing on cancer screening programs, community–clinical linkages, and cancer risk factors (eg, tobacco use, physical inactivity) that also influence risk for other chronic diseases (http://www.cdc.gov/workplacehealthpromotion/). Some efforts focus specifically on cancer; some focus on general chronic disease prevention. Additionally, the National Institute for Occupational Safety and Health (NIOSH), part of CDC, provides research and recommendations to address workplace hazards posed by chemicals that may increase cancer risk (http://www.cdc.gov/niosh/topics/cancer/policy.html).

Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers

Breast cancer is the most commonly diagnosed cancer and a leading cause of death from cancer among U.S. women. Studies have suggested that breastfeeding reduces breast cancer risk among parous women, and there is mounting evidence that this association may differ by subtype such that breastfeeding may be more protective of some invasive breast cancer types. The purpose of this review is to discuss breast cancer disparities in the context of breastfeeding and the implications for black mothers. Black women in the U.S. have lower rates of breastfeeding and nearly twice the rates of triple-negative breast cancer (an aggressive subtype) compared with white women. In addition to individual challenges to breastfeeding, black women may also differentially face contextual barriers such as a lack of social and cultural acceptance in their communities, inadequate support from the healthcare community, and unsupportive work environments. More work is needed to improve the social factors and policies that influence breastfeeding rates at a population level. Such efforts should give special consideration to the needs of black mothers to adequately address disparities in breastfeeding among this group and possibly help reduce breast cancer risk. Interventions such as peer counseling, hospital policy changes, breastfeeding-specific clinic appointments, group prenatal education, and enhanced breastfeeding programs have been shown to be effective in communities of color. A comprehensive approach that integrates interventions across multiple levels and settings may be most successful in helping mothers reach their breastfeeding goals and reducing disparities in breastfeeding and potentially breast cancer incidence.

News from CDC: applying a life course approach to primary cancer prevention.

Abstractᅟ

Prevalence of Smoking and Obesity Among U.S. Cancer Survivors: Estimates From the National Health Interview Survey, 2008–2012

PURPOSE/OBJECTIVES To describe smoking and obesity prevalence among male and female cancer survivors in the United States.
. DESIGN Cross-sectional survey.
. SETTING Household interviews.
. SAMPLE 9,753 survey respondents who reported ever having a malignancy, excluding nonmelanoma skin cancers. 
. METHODS Data from the National Health Interview Survey (2008-2012) were used to calculate weighted smoking status prevalence estimates. Cross-tabulations of smoking and weight status were produced, along with Wald chi-square tests and linear contrasts.
. MAIN RESEARCH VARIABLES Cancer history, smoking status, obesity status, gender, age, and age at diagnosis.
. FINDINGS Seventeen percent of cancer survivors reported current smoking. Female survivors had higher rates of current smoking than males, particularly in the youngest age category. Male survivors who currently smoked had lower obesity prevalence rates than males who previously smoked or never smoked. Among female survivors, 31% were obese and no significant differences were seen in obesity prevalence by smoking status for all ages combined. 
. CONCLUSIONS The findings highlight the variation in smoking status and weight by age and gender. Smoking interventions may need to be targeted to address barriers specific to subgroups of cancer survivors.
. IMPLICATIONS FOR NURSING Nurses can be instrumental in ensuring that survivors receive comprehensive approaches to address both weight and tobacco use to avoid trading one risk for another.

Intentional outdoor tanning in the United States: Results from the 2015 Summer ConsumerStyles survey

There is limited literature about adults in the United States who usually or always spend time outdoors for the purpose of developing a tan, defined as intentional outdoor tanning. Using data from the 2015 Summer ConsumerStyles, an online cross-sectional survey weighted to the US adult population (n=4,127), we performed unadjusted and adjusted multivariable logistic regressions to examine the associations between demographic characteristics, behaviors, and belief factors related to skin cancer risk and intentional outdoor tanning. Nearly 10% of the study population intentionally tanned outdoors. Outdoor tanning was more prevalent among women (11.4%), non-Hispanic white individuals (11.5%), those aged 18-29years (14.1%), those without a high school diploma (12.7%), and those in the northeast United States (13.2%). The adjusted odds of outdoor tanning were significantly higher among women than men (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI] 1.12-2.04); those with a history of indoor tanning or recent sunburn than those without (AOR 2.61, CI 1.94-3.51; AOR 1.96, CI 1.46-2.63, respectively); those who agreed they looked better with a tan than those who did not (AOR 6.69, CI 3.62-12.35); and those who did not try to protect their skin from the sun when outdoors than those who did (AOR 2.17, CI 1.56-3.04). Adults who engaged in other risky behaviors that expose a person to ultraviolet (UV) radiation were more likely to tan outdoors, further increasing their risk of skin cancer. These findings may guide potential interventions to reduce UV exposure from outdoor tanning.

Cancer Prevention During Early Adulthood: Highlights From a Meeting of Experts

Using a life course approach, the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors co-hosted a 2-day meeting with 15 multidisciplinary experts to consider evidence linking factors in early adulthood to subsequent cancer risk and strategies for putting that evidence into practice to reduce cancer incidence. This paper provides an overview of key themes from those meeting discussions, drawing attention to the influence that early adulthood can have on lifetime cancer risk and potential strategies for intervention during this phase of life. A number of social, behavioral, and environmental factors during early adulthood influence cancer risk, including dietary patterns, physical inactivity, medical conditions (e.g., obesity, diabetes, viral infections), circadian rhythm disruption, chronic stress, and targeted marketing of cancer-causing products (e.g., tobacco, alcohol). Suggestions for translating research into practice are framed in the context of the four strategic directions of the National Prevention Strategy: building healthy and safe community environments; expanding quality preventive services in clinical and community settings; empowering people to make healthy choices; and eliminating health disparities. Promising strategies for prevention among young adults include collaborating with a variety of community sectors as well as mobilizing young adults to serve as advocates for change. Young adults are a heterogeneous demographic group, and targeted efforts are needed to address the unique needs of population subgroups that are often underserved and under-represented in research studies.

Indoor Tanning Initiation Among Tanners in the United States.

Author Contributions: Drs Asgari had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Asgari. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Storer, Zhu, Ford, Neugebauer, Asgari. Critical revision of the manuscript for important intellectual content: Storer, Sokil, Neugebauer, Asgari. Statistical analysis: Zhu, Neugebauer. Obtained funding: Neugebauer, Asgari. Administrative, technical, or material support: Sokil, Neugebauer. Supervision: Neugebauer, Asgari.

Shade as an Environmental Design Tool for Skin Cancer Prevention

Little work has been done to explore the use of shade for skin cancer prevention in the context of the built environment. In an effort to address this gap and draw attention to the intersection between architectural and public health practice, we reviewed research on shade design, use, and policies published from January 1, 1996, through December 31, 2017. Our findings indicate that various features influence the sun-protective effects of shade, including the materials, size, shape, and position of the shade structure; the characteristics of the surrounding area; and weather conditions. Limited research suggests that shade provision in outdoor spaces may increase shade use. Shade audit and design tools are available to inform shade planning efforts. Shade policies to date have mostly been setting specific, and information on the implementation and effects of such policies is limited. Integrating shade planning into community design, planning, and architecture may have a substantial impact and will require a multidisciplinary approach.

Abstract B85: Breast and cervical cancer screening among Hispanic and Asian subgroups in the United States: Estimates from the National Health Interview Survey, 2008, 2010 and 2013

Background: In the United States, Hispanic women are less likely to be screened for cervical and breast cancer than non-Hispanic women. Asian women report lower cervical cancer screening use than other races. Previous studies have not differentiated between Hispanic or Asian subgroups or taken into account the heterogeneous nature of these diverse populations. This study aims to better describe variations of mammography and Pap test use across subpopulations of Hispanic and Asian women in the United States. Methods: Using data from the National Health Interview Survey (2008, 2010, and 2013), we calculated weighted proportions for subgroups of Hispanic and Asian women reporting screening for breast and cervical cancer. We produced cross-tabulations with variables of interest (length of residency, usual source of care, and health insurance), using chi-square tests. Result: The proportion of Hispanic women age 50-74 years who reported a mammogram within the past 2 years did not differ significantly across subgroups. When stratified by insurance status, proportions of breast cancer screening varied by Hispanic subgroup, among publically insured (p = 0.011) and uninsured (p = 0.001) women. The proportion of women age 21-65 years who received a Pap test within the past 3 years differed significantly across Hispanic subgroups (p = 0.005) as follows: Puerto Rican [82.5%, 95%CI (77.9-86.4)], Mexican [75.6%, 95%CI (73.1-77.9)], Mexican American [81.7%, 95%CI (79.1-84.0)], Cuban/Cuban American [75.1%, 95%CI (68.1-80.9)], Dominican [83.0%, 95%CI (75.8-88.4)], Central or South American [79.9%, 95%CI (76.2-83.1)], and Other Hispanic women [82.7%, 95%CI (74.2-88.8)]. Cervical cancer screening use varied across Hispanic subgroups among recent immigrants (p = 0.002) and publicly insured women (p = 0.041). Among Asian women, the proportion who reported breast cancer screening did not differ significantly by subgroup. For cervical cancer screening, the proportion of Asian women who received a Pap test varied across subgroups (p Conclusions: Among Hispanic women, mammography use was comparable across subgroups while Pap test use varied. Among Asian women, Pap test use differed by subgroup and mammography use did not. These data suggest certain ethnic and racial subgroups may have different barriers to screening that vary by usual source of care, insurance status, length of residency, and screening type. These findings offer insights that may be valuable for culturally tailored efforts to promote cancer screening within subgroups of Hispanic and Asian women. Citation Format: Meredith L. Shoemaker, Mary C. White. Breast and cervical cancer screening among Hispanic and Asian subgroups in the United States: Estimates from the National Health Interview Survey, 2008, 2010 and 2013. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B85.