Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012

Environmental Health Assessment by Local Environmental Justice Experts for Evidence-based Decision-making in an Agricultural Community of Northern California

Environmental justice research driven by academics and policymakers often overlooks the valuable insights and leadership of the communities most impacted by environmental hazards. When institution-led research approaches are employed, inadequate community ownership and limited institutional accountability hinder the effectiveness of environmental public health interventions. In contrast, a community-owned and -managed approach to environmental justice research can guide community members in developing evidence-based interventions. This paper outlines a community-led environmental health assessment survey (sample= 100) and resulting community actions over six years (2017 to 2023) in a Northern California farmworker community with a perceived high prevalence of cancer and exposure to environmental hazards in households, neighborhoods, and job sites. Local resident experts in Knights Landing, CA, documented community risk factors and exposures in collaboration with interdisciplinary undergraduate and graduate student-researchers. The survey instrument focused on environmental hazards identified by local resident experts including vehicular and agricultural pollution, occupational pesticide contact, and sun exposure. Survey findings highlighted the need for targeted interventions to reduce environmental health risks, such as academic outreach programs, county investments in public services, and community-led mutual aid initiatives. Despite academic reservations about our non-random sampling method and data collection by local resident experts, our project sparked substantial actions and investments with minimal personnel and financial resources. Local leaders working with student-researchers developed more effective environmental public health interventions through a community-owned and -managed approach that went beyond the efforts of local regulatory and research institutions.

Influence of air quality on lung cancer in people who have never smoked

OBJECTIVE

Lung cancer is the leading cause of cancer-related death. The percentage of people who have never smoked with lung cancer has risen recently, but alternative risk factors require further study. Our goal was to determine the influence of air quality on incidence of lung cancer in people who have smoked or never smoked.

METHODS

The cancer registry from a large urban medical center was queried to include every new diagnosis of lung cancer from 2013 to 2021. Air quality and pollution data for the county were obtained from the US Environmental Protection Agency from 1980 to 2018. Patient demographics, location of residence, smoking history, and tumor stage were recorded. Bivariate comparison analyses were conducted in R (R Foundation for Statistical Computing).

RESULTS

A total of 2223 new cases of lung cancer were identified. Mean age was 69.2 years. There was a nonsmoking rate of 8.1%. A total of 37% of patients identified as a racial minority. People who have never smoked were more likely to be diagnosed at an advanced stage. When analyzing geographic distribution, incidence of lung cancer among people who have never smoked was more closely associated with highly polluted areas. People who have never smoked with lung cancer had significantly higher exposure levels of multiple pollutants.

CONCLUSIONS

Newly diagnosed lung cancer appears to be more related to poor air quality among people who have never smoked than people who have smoked. Future studies are needed to examine the associations of specific pollutants with lung cancer incidence.

Disparities in cancer incidence by rurality in California

BACKGROUND

Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations vary jointly by sex, race, and ethnicity.

METHODS

We used 2015-2019 California Cancer Registry data to compare incidence rate ratios (IRRs) and trends for breast, prostate, lung, colorectal, and skin (melanoma) cancers. We leveraged census tract aggregation zones and 7 levels of percentage rural population (0%, >0% to <10%, 10% to <20%, 20% to <30%, 30% to <40%, 40% to <50%, and 50+%).

RESULTS

Zones with higher proportions of rural population were significantly associated with lower incidence of female breast cancer and prostate cancer, though the trends were not statistically significant overall. Zones with higher proportions of rural population were significantly associated with higher incidence of lung cancer and melanoma. There were no statistically significant trends for colorectal cancer overall. Comparing areas with 50% and over rural population with areas with 0% rural population, the IRR for lung cancer in Hispanic females was higher (IRR = 1.43, 95% confidence interval [CI] = 1.17 to 1.74) than in Hispanic males (IRR = 0.90, 95% CI = 0.72 to 1.11). Also, in areas with 50% or more rural population, the IRR for melanoma was higher in Hispanic females (IRR = 1.75, 95% CI = 1.23 to 2.45) than non-Hispanic White females (IRR = 0.87, 95% CI = 0.80 to 0.95).

CONCLUSIONS

Our findings show that rurality is associated with cancer incidence and underscore the importance of jointly examining rural disparities with sex, race, and ethnicity by cancer site.

Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial

BACKGROUND

In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described.

OBJECTIVE

To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation.

METHODS

Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training.

RESULTS

Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10).

CONCLUSION

In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.

Geographical Disparities in Screening and Cancer-Related Health Behaviour

This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014-2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.

Supplementing claims data analysis using self-reported data to develop a probabilistic phenotype model for current smoking status

OBJECTIVES

Smoking status is poorly record in US claims data. IBM MarketScan Commercial is a claims database that can be linked to an additional health risk assessment with self-reported smoking status for a subset of 1,966,174 patients. We investigate whether this subset could be used to learn a smoking status phenotype model generalizable to all US claims data that calculates the probability of being a current smoker.

METHODS

251,643 (12.8%) had self-reported their smoking status as 'current smoker'. A regularized logistic regression model, the Current Risk of Smoking Status (CROSS), was trained using the subset of patients with self-reported smoking status. CROSS considered 53,027 candidate covariates including demographics and conditions/drugs/measurements/procedures/observations recorded in the prior 365 days, The CROSS phenotype model was validated across multiple other claims data.

RESULTS

The internal validation showed the CROSS model achieved an area under the receiver operating characteristic curve (AUC) of 0.76 and the calibration plots indicated it was well calibrated. The external validation across three US claims databases obtained AUCs ranging between 0.82 and 0.87 showing the model appears to be transportable across Claims data.

CONCLUSION

CROSS predicts current smoking status based on the claims records in the prior year. CROSS can be readily implemented to any US insurance claims mapped to the OMOP common data model and will be a useful way to impute smoking status when conducting epidemiology studies where smoking is a known confounder but smoking status is not recorded. CROSS is available from https://github.com/OHDSI/StudyProtocolSandbox/tree/master/SmokingModel.

Tobacco use in Nigerian youth: A systematic review

Background

Tobacco use is the most important preventable cause of premature death and major risk factor for non-communicable diseases. Due to strict tobacco legislation in the western hemisphere, many African nations like Nigeria have shifted from being a tobacco-producing nation to a tobacco-consuming one. The purpose of this study was to systematically review existing literature on tobacco use among Nigerian adolescents and young people and identify the prevalence, distribution and factors influencing of tobacco smoking. These data are necessary to formulate and adapt control measures aimed at tobacco cessation among young people, and preventing long-term smoking behaviors.

Methods

Three databases (African Journals Online, PsychInfo, PubMed) were searched for peer-reviewed publications, published between January 2000 and March 2017. Additional searches were completed on Google Scholar, and other documents and reports of the Nigerian government and the Global Youth Tobacco Survey were consulted. Using the PRISMA guidelines to evaluate studies, we included studies that reported prevalence of tobacco use in adolescents or youths, aged 10 to 24, and excluded evaluations of tobacco-related medical conditions.

Results

A total of 30 studies with a total population of 26,709 were reviewed. Prevalence rates of tobacco smoking ranged from 0.2% to 32.5%. Among the gender-specific studies, the prevalence of smoking among females ranged between 2.2% to 10% while that of males ranged from 1% to 32.5%. Gender distribution among these studies was mixed (80.0%), males only (13.3%) and females only (6.7%). Smoking prevalence was higher among males than females. The most common risk factors for tobacco use included peer influence, family conditions, psychosocial factors and male gender. Additional risk factors included concomitant substance abuse, media advertisements and increasing age.

Conclusions

Tobacco smoking poses a huge burden to Nigerian youths and various determinants were highlighted in this review. It is imperative that all stakeholders engage in concerted efforts to target both in-school and out-of-school youths in tobacco control strategies.

Characteristics of the Tobacco User Adult Cohort in Urban and Rural Ohio

Objectives

Identifying characteristics associated with the use of new and emerging tobacco products is a priority. The enumeration and baseline characteristics of a new cohort of adult tobacco users are described.

Methods

Residents, ≥18 years of age, in urban Franklin County, or one of 6 rural Appalachian counties, and who were exclusive users of combustible, smokeless (SLT), or electronic nicotine delivery systems (ENDS) tobacco products, or were dual users, were targeted for recruitment. Participants were interviewed in-person at baseline on sociodemographic characteristics, tobacco product use, and cognitive/affective and purchasing factors.

Results

We recruited 1210 participants (urban, N = 595; rural, N = 615). Urban participants were less likely to use tobacco daily, began using tobacco later, used tobacco for less time, and had higher cessation interest. ENDS users were significantly less likely to have made a quit attempt than users of other tobacco products. Duration of tobacco use and nicotine dependence also differed by product type.

Conclusion

This cohort's enumeration allowed us to compare factors associated with tobacco product preferences and the use of novel products. The inclusion of rural Appalachia-a region with high tobacco use and disease burden-may provide additional insights into the implementation of tobacco control interventions.

Access to Lung Cancer Screening Services: Preliminary Analysis of Geographic Service Distribution Using the ACR Lung Cancer Screening Registry

PURPOSE

Lung cancer has the highest mortality rate among all types of cancer in the United States. The National Lung Screening Trial demonstrated that low-dose CT for lung cancer screening decreases both lung cancer-related mortality and all-cause mortality. Currently, the only CMS-approved lung cancer screening registry is the Lung Cancer Screening Registry (LCSR) administered by the ACR. The aims of this study were to assess access to lung cancer screening services as estimated by the number and distribution of screening facilities participating in the LCSR, by state, and to evaluate state-level covariates that correlate with access.

METHODS

The ACR LCSR list of participating lung cancer screening facilities was used as a proxy for the availability of lung cancer screening facilities in each state. Additionally, we normalized the number of facilities by state by the number of screening-eligible individuals using Behavioral Risk Factor Surveillance System data. State-level demographics were obtained from the 2015 Behavioral Risk Factor Surveillance System: poverty level, insured population, unemployed, black, and Latino. State-specific lung cancer incidence and death rates, number of active physicians per 100,000, and Medicare expenditure per capita were obtained. Linear regression models were performed to examine the influence of these state-level covariates on state-level screening facility number. QGIS, an open-source geographic information system, was used to map the distribution of lung cancer screening facilities and to estimate the nearest neighbor index, a measure of facility clustering within each state.

RESULTS

As of November 18, 2016, 2,423 facilities participated in the LCSR. When adjusted by the rate of screening-eligible individuals per 100,000, the median population-normalized facility number was 15.7 (interquartile range, 10.7-19.3). There was a positive independent effect (coefficient = 12.87; 95% confidence interval, 10.93-14.8) between state-level number of screening facilities and rate of screening-eligible individuals per 100,000. There were no significant correlations between number of facilities and lung cancer outcomes, state demographic characteristics, or physician supply and Medicare expenditure. In most states, facilities are clustered rather than dispersed, with a median nearest neighbor index of 0.65 (interquartile range, 0.51-0.81).

CONCLUSIONS

Facility number correlated with the rate of screening-eligible individuals per 100,000, a measure of the at-risk population. Alignment of screening facility number and distribution with other clinically relevant epidemiologic factors remains a public health opportunity.