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Camacho-Rivera M, Haile K, Pareek E, D'Angelo D, Gany F, Maglione F, Jack K, Cather A, Phillips E. The Influence of the COVID 19 Pandemic on Food Insecurity Among Cancer Survivors Across New York State. J Community Health 2024; 49:1033-1043. [PMID: 38683277 DOI: 10.1007/s10900-024-01358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 05/01/2024]
Abstract
People surviving cancer represent a particularly vulnerable population who are at a higher risk for food insecurity (FI) due to the adverse short- and long-term effects of cancer treatment. This analysis examines the influence of the COVID-19 pandemic on the prevalence of FI among cancer survivors across New York State (NYS). Data from the 2019 and 2021 NYS Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of FI. Multivariable logistic regression was used to explore socioeconomic determinants of FI. Among cancer survivors, FI varied geographically with a higher prevalence in New York City compared to the rest of the state (ROS) prior to (25.3% vs. 13.8%; p = .0025) and during the pandemic (27.35% vs. 18.52%; p = 0.0206). In the adjusted logistic regression model, pre-pandemic FI was associated with non-White race (OR 2.30 [CI 1.16-4.56]), household income <$15,000 (OR 22.67 [CI 6.39-80.43]) or $15,000 to less than <$25,000 (OR 22.99 [CI 6.85-77.12]), and more co-morbidities (OR 1.39 [CI 1.09-1.77]). During the pandemic, the association of FI with non-White race (OR 1.76 [CI 0.98-3.16]) was attenuated but remained significant for low household income and more co-morbidities. FI was newly associated with being out of work for less than one year (OR 6.36 [CI 1.80-22.54] and having one (OR 4.42 [CI 1.77-11.07]) or two or more children in the household (OR 4.54 [CI 1.78-11.63]). Our findings highlight geographic inequities and key determinants of FI among cancer survivors that are amendable to correction by public health and social policies, for which several were momentarily implemented during the pandemic.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Katherine Haile
- Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, Albany, NY, USA
| | - Eshani Pareek
- Weill Cornell Medicine Division of Biostatistics, Population Health Sciences, New York, NY, USA
| | - Debra D'Angelo
- Weill Cornell Medicine Division of Biostatistics, Population Health Sciences, New York, NY, USA
| | - Francesca Gany
- Immigrant Health & Cancer Disparities Service, Department of Psychiatry & Behavioral Sciences, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Francesca Maglione
- Department of Food and Nutrition, NewYork-Presbyterian/Weill-Cornell Medical Center, New York, NY, USA
| | - Kellie Jack
- Sandra and Edward Meyer Cancer Center, Office of Community Outreach and Engagement, Weill Cornell Medicine, New York, NY, USA
| | - Alexina Cather
- Wellness in the Schools, New York, NY, USA
- Center for Food as Medicine, New York, NY, USA
| | - Erica Phillips
- Sandra and Edward Meyer Cancer Center, Office of Community Outreach and Engagement, Weill Cornell Medicine, New York, NY, USA.
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 338 East 66th Street, Box #46, New York, NY, 10021, USA.
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Dratsky D, McGillivray E, Mittal J, Handorf EA, Berardi G, Astsaturov I, Hall MJ, Yeh MC, Jain R, Fang CY. Food Insecurity and Dietary Quality in African American Patients with Gastrointestinal Cancers: An Exploratory Study. Nutrients 2024; 16:3057. [PMID: 39339658 PMCID: PMC11435398 DOI: 10.3390/nu16183057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
African American (AA) individuals experience food insecurity at twice the rate of the general population. However, few patients are screened for these measures in the oncology setting. The primary aim of this study was to evaluate associations between food insecurity and dietary quality in AA patients with gastrointestinal (GI) malignancies. The secondary aim was to evaluate differences in dietary quality and the level of food insecurity between the participants at Temple University Hospital (TUH) vs. Fox Chase Cancer Center (FCCC). A single-arm, cross-sectional study was conducted, in which 40 AA patients with GI malignancies were recruited at FCCC and TUH between February 2021 and July 2021. Participants completed the US Adult Food Security Survey Module to assess the level of food security (food secure vs. food insecure). An electronic food frequency questionnaire (VioScreenTM) was administered to obtain usual dietary intake. Diet quality was calculated using the Healthy Eating Index 2015 (HEI-2015). Dietary quality and food insecurity were summarized using standard statistical measures. Overall, 6 of the 40 participants (15%) reported food insecurity, and the mean HEI-2015 score was 64.2. No association was observed between dietary quality and food insecurity (p = 0.29). However, we noted that dietary quality was significantly lower among patients presenting at TUH (mean HEI-2015 = 57.8) compared to patients at FCCC (mean HEI-2015 = 73.5) (p < 0.01). Food insecurity scores were also significantly higher in the TUH population vs. the FCCC population (p < 0.01).
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Affiliation(s)
- Daaimah Dratsky
- Department of Nutrition and Public Health, Hunter College, New York, NY 10035, USA; (D.D.); (M.-C.Y.)
| | - Erin McGillivray
- Department of Internal Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Juhi Mittal
- Department of Hematology/Oncology, Temple University Hospital, Philadelphia, PA 19140, USA; (J.M.); (G.B.)
| | - Elizabeth A. Handorf
- Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Giuliana Berardi
- Department of Hematology/Oncology, Temple University Hospital, Philadelphia, PA 19140, USA; (J.M.); (G.B.)
| | - Igor Astsaturov
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (I.A.); (M.J.H.)
| | - Michael J. Hall
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (I.A.); (M.J.H.)
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Ming-Chin Yeh
- Department of Nutrition and Public Health, Hunter College, New York, NY 10035, USA; (D.D.); (M.-C.Y.)
| | - Rishi Jain
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (I.A.); (M.J.H.)
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Carolyn Y. Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Gu D, Max WB, Yao T, Wang Y, Keeler C, Sung HY. Association between e-cigarette use and food insecurity among low-income adults. Tob Control 2023; 32:e212-e219. [PMID: 35279644 PMCID: PMC9464793 DOI: 10.1136/tobaccocontrol-2021-057110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Previous research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data, this study augments the previous research, considering the association of e-cigarette use with food insecurity among low-income adults. METHODS We analysed data from the California Health Interview Survey in 2014-2019. The study sample consisted of 25 948 respondents aged 18-64 who lived in low-income (<200% of the Federal Poverty Level) households. Multivariable logistic regression models were estimated to examine the associations of e-cigarette use as well as dual use of e-cigarettes and cigarettes with food insecurity. RESULTS Of California low-income adults, 6.4% identified as current e-cigarette users (3.0% dual users of e-cigarettes and cigarettes, and 3.4% sole e-cigarette users) and 43.0% reported food insecurity. After controlling for confounding factors, food insecurity was significantly more likely to be reported among current e-cigarette users (adjusted OR (AOR)=1.67; 95% CI 1.25 to 2.23) compared with never e-cigarette users, and among dual users (AOR=2.21; 95% CI 1.63 to 3.00), current sole e-cigarette users (AOR=1.66; 95% CI 1.15 to 2.40), and current sole cigarette smokers (AOR=1.46; 95% CI 1.22 to 1.76) compared with never tobacco users. The odds of food insecurity among dual users were significantly greater than sole cigarette smokers but not statistically different from sole e-cigarette users. CONCLUSIONS Using e-cigarette is an associated risk factor for food insecurity among low-income adults. Dual use of e-cigarettes and cigarettes has a significantly greater risk of food insecurity compared with smoking cigarettes alone.
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Affiliation(s)
- Dian Gu
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
- The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Wendy B Max
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Courtney Keeler
- Department of Population Health Sciences, School of Nursing, University of San Francisco, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Rabin J, Castelin S, Strauss N, Philpotts LL, Park ER, Perez G. Smoking Behaviors Among Black and Hispanic Cancer Patients: A Systematic Review of the Literature. J Immigr Minor Health 2023; 25:925-952. [PMID: 36318437 DOI: 10.1007/s10903-022-01423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Smoking is the leading cause of preventable disease and death in the United States. The risk of smoking poses an even greater threat for racial/ethnic minorities, particularly Black and Hispanic cancer patients who face a range of existing disparities in healthcare. Despite these risks for poor health outcomes among this population, little is known about the smoking behaviors of Black and Hispanic cancer patients. The purpose of this review was to understand differences in smoking prevalence, intensity, and cessation between Black, Hispanic, and non-Hispanic White cancer patients and survivors. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach as our framework, we conducted a systematic review of the literature. Our review discusses the methods, population, and implications of 37 included articles. Conclusions reflect the need to establish intentional and systematic measurement of smoking behaviors to best understand the risks of smoking among Black and Hispanic cancer patients.
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Affiliation(s)
- Julia Rabin
- Department of Psychology, University of Cincinnati, Edwards 1 Bldg, Suite 4130, 47 Corry Blvd, Cincinnati, OH, USA.
| | - Stephanie Castelin
- Department of Psychology, University of Cincinnati, Edwards 1 Bldg, Suite 4130, 47 Corry Blvd, Cincinnati, OH, USA
| | | | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Giselle Perez
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Robien K, Clausen M, Sullo E, Ford YR, Griffith KA, Le D, Wickersham KE, Wallington SF. Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review. J Acad Nutr Diet 2023; 123:330-346. [PMID: 35840079 DOI: 10.1016/j.jand.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown. OBJECTIVE This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic. METHODS Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020. RESULTS Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients. CONCLUSIONS Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.
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Affiliation(s)
- Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC; GW Cancer Center, George Washington University, Washington, DC.
| | | | - Elaine Sullo
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC
| | - Yvonne R Ford
- School of Nursing, North Carolina A&T State University, Greensboro, NC
| | - Kathleen A Griffith
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | - Daisy Le
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | | | - Sherrie Flynt Wallington
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
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Madigan KE, Leiman DA, Palakshappa D. Food Insecurity Is an Independent Risk Factor for Depressive Symptoms in Survivors of Digestive Cancers. Cancer Epidemiol Biomarkers Prev 2021; 30:1122-1128. [PMID: 33849966 PMCID: PMC8172480 DOI: 10.1158/1055-9965.epi-20-1683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Colorectal and other digestive cancer survivors are at increased risk of depression, which can negatively affect health outcomes. Food insecurity (FI), the lack of consistent access to enough food, can also contribute to these health complications. The objective of this study was to determine the relationship between FI and depressive symptoms within this population. METHODS We conducted a cross-sectional analysis of data from the 2007-2016 National Health and Nutrition Examination Survey. We included all adults (≥20 years) with a self-reported history of a digestive cancer (including colorectal, esophageal, stomach, liver, and pancreas cancer). Our primary exposure was household FI, and our outcome of interest was depressive symptoms, as measured by the validated 9-item Patient Health Questionnaire. We used multivariable ordinal logistic regression to test the association between FI and depressive symptoms, controlling for demographic and clinical covariates. RESULTS We included 229 adult digestive cancer survivors (weighted N = 1,510,579). The majority of the study sample was female and non-Hispanic White with mean of 11.0 years since cancer diagnosis; 14.3% reported FI. In multivariable models controlling for demographic and clinical covariates, we found that food insecure digestive cancer survivors had significantly higher odds of depressive symptoms than food secure digestive cancer survivors (OR: 3.25; 95% confidence interval: 1.24-8.55; P = 0.02). CONCLUSIONS Among a nationally representative sample of colorectal cancer and other digestive cancer survivors, FI was associated with increased odds of depressive symptoms. IMPACT This study adds further evidence to the negative impact FI may have on survivors' physical and mental health.
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Affiliation(s)
- Katelyn E Madigan
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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