Updated Review of Major Cancer Risk Factors and Screening Test use in the United States, with a Focus on Changes During the COVID-19 Pandemic.

We present national and state representative prevalence estimates of modifiable cancer risk factors, preventive behaviors and services, and screening, with a focus on changes during the COVID-19 pandemic. Between 2019 and 2021, current smoking, physical inactivity, and heavy alcohol consumption declined, and human papillomavirus vaccination and stool testing for colorectal cancer screening uptake increased. In contrast, obesity prevalence increased, while fruit consumption and cervical cancer screening declined during the same timeframe. Favorable and unfavorable trends were evident during the second year of the COVID-19 pandemic that must be monitored as more years of consistent data are collected. Yet disparities by racial/ethnic and socioeconomic status persisted, highlighting the continued need for interventions to address suboptimal levels among these population subgroups.

Changes in E-Cigarette Use Among U.S. Adults, 2019–2021

Introduction E-cigarette use increased between 2014 and 2018 among younger U.S. adults who had never smoked combustible cigarettes, potentially increasing nicotine addiction risk and progression to combustible tobacco products. It is unknown how prevalence changed after the E-cigarette, or vaping, product use-associated lung injury epidemic (late 2019) and COVID-19 pandemic (March 2020) by age group and combustible cigarette smoking status. Methods Data from cross-sectional, nationally representative National Health Interview Surveys in 2019, 2020, and 2021 (analyzed in 2022) were used to estimate current E-cigarette use prevalence, adjusted prevalence difference between survey years, and population counts, by age group (younger, 18–29 years, n=11,700;middle age, 30–44 years, n=21,300, 45–59 years, n=21,308;older, ≥60 years, n=36,224) and cigarette smoking status (current, former, and never). Results E-cigarette use prevalence increased among younger adults between 2019 and 2021 (8.8%−10.2%, adjusted prevalence difference=1.7% points, 95% CI=0.1, 3.3), primarily owing to an increase among those who never smoked cigarettes (4.9%−6.4%, adjusted prevalence difference=1.7% points, 95% CI=0.3, 3.1). People who never smoked cigarettes constituted 53% (2.68 million) of younger adults who used E-cigarettes in 2021, increasing by 0.71 million from 2019. Conversely, among middle age and older adults, the prevalence was similar in 2019 and 2021 irrespective of cigarette smoking status, and those who formerly smoked cigarettes constituted the largest proportion of people who used E-cigarettes in 2021 (age 30–44 years: 51.8%, 1.8 million;age 45–59 years: 51.6%, 0.85 million;age ≥60 years: 47.5%, 0.45 million). Conclusions Efforts must address the rise in E-cigarette use among younger adults who never smoked cigarettes. At the same time, assistance is needed to help those who switched to E-cigarettes to stop smoking to transition to non-use of all products.

Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic.

PURPOSE: To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS: Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS: Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION: Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions.[Media: see text].

The First Year of the COVID-19 Pandemic: Changes in Preventive Services in Community Health Centers.

INTRODUCTION: Community Health Centers provide comprehensive primary healthcare services to many underserved populations. It is unknown how routine preventive and chronic care services in Community Health Centers may have changed nationwide during the COVID-19 pandemic. METHODS: The 2014-2020 Health Resources and Services Administration Uniform Data System of Community Health Centers was used, and data analysis was conducted from November 2021 to May 2022. Data for clinical quality measures in 2020 were treated as during the pandemic, whereas receipt of care in 2019 and before were treated as before the pandemic. Outcomes included 6 clinical quality measures of being up to date for colorectal cancer screening, cervical cancer screening, tobacco screening and cessation counseling, BMI screening and follow-up, depression screening and follow-up, and aspirin use for ischemic vascular disease. A mixed effects regression model was used to estimate changes in measures by year. RESULTS: Between 2019 and 2020, receipt of preventive services declined for each of the 6 clinical quality measures: from 40.8% to 37.7% for colorectal cancer screening, from 48.8% to 44.9% for cervical cancer screening, from 85.8% to 83.4% for tobacco screening and cessation counseling, from 70.7% to 65.4% for BMI screening and follow-up, from 71.1% to 64.9% for depression screening and follow-up, and from 81.5% to 79.4% for aspirin use for ischemic vascular disease. CONCLUSIONS: Receipt of preventive services in Community Health Centers declined during the COVID-19 pandemic for each of the 6 clinical quality measures considered in the study. Immediate action is required to support ongoing high-quality, primary healthcare services in Community Health Centers across the nation.

Changes in State-Level Cigarette Sales During the COVID-19 Pandemic.

This cohort study estimates state-level changes in cigarette sales in the US during the COVID-19 pandemic.

The first year of the COVID-19 pandemic and health among cancer survivors in the United States.

BACKGROUND: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years). RESULTS: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years. CONCLUSIONS: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted.

Changes in Smoking Cessation-Related Behaviors Among US Adults During the COVID-19 Pandemic.

Importance: Smoking cessation is an urgent public health priority given that smoking is associated with increased risk of severe COVID-19 outcomes and other diseases. It is unknown how smoking cessation changed nationally during the COVID-19 pandemic. Objective: To investigate changes in smoking cessation-related behaviors in the US during the COVID-19 pandemic. Design, Setting, and Participants: This cross-sectional study was conducted using 2011 to 2020 data on 788 008 individuals who had smoked in the past year from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. Representative retail scanner sales data between January 2017 and July 2021 for 1004 unique nicotine replacement therapy (NRT) universal product codes in 31 US states from NielsenIQ were also used. Exposures: Calendar year and 4-week sales periods. Main Outcomes and Measures: Changes in annual self-reported prevalence of past-year quit attempts and recent successful cessation before (ie, 2011-2019) and during (ie, 2020) the COVID-19 pandemic and changes in sales volumes in millions of pieces of nicotine gum, lozenge, and patch brands before (1271 four-week sales periods between January 2017 and February 2020) and during (558 four-week sales periods between March 2020 and July 2021) the COVID-19 pandemic were calculated. Results: The 2011 to 2020 pooled BRFSS sample (response rate range, 45.2%-49.9%) included 788 008 respondents (243 061 individuals ages 25-44 years [weighted percentage, 42.5%]; 374 519 men [weighted percentage, 55.7%]). For the first time since 2011, annual past-year quit attempt prevalence decreased between 2019 and 2020, from 65.2% (95% CI, 64.5% to 65.9%) to 63.2% (95% CI, 62.3% to 64.0%), with the largest relative decreases among individuals ages 45 to 64 years (61.4% [95% CI, 60.3% to 62.5%] vs 57.7% [95% CI, 56.3% to 59.2%]), those with 2 or more comorbidities (67.1% [95% CI, 66.0% to 68.2%] to 63.0% [95% CI, 61.6% to 64.4%]), and Black individuals (72.5% [95% CI, 70.3 to 74.6] vs 68.4% [95% CI, 65.3% to 71.3%]). Recent successful cessation remained unchanged during 2019 to 2020. Observed mean (SD) 4-week NRT sales volume in the prepandemic period was 105.6 (66.2) million gum pieces, 51.9 (31.6) million lozenges, and 2.0 (1.1) million patches. Compared with expected sales, observed sales during the COVID-19 pandemic were lower by 13.0% (95% CI, -13.7% to -12.3%) for lozenges, 6.4% (95% CI, -7.3% to -5.5%) for patches, and 1.2% (95% CI, -1.7% to -0.7%) for gum. Conclusions and Relevance: This study found that serious smoking cessation activity among US adults decreased immediately and remained depressed for more than a year during the COVID-19 pandemic. These findings suggest that smokers experiencing disproportionately negative outcomes during the pandemic should be reengaged and assisted in quit attempts.

Relative Harm Perceptions of E-Cigarettes Versus Cigarettes, U.S. Adults, 2018-2020.

INTRODUCTION: It is unknown how U.S. adults' relative harm perceptions of E-cigarettes versus cigarettes and associated behaviors changed during the E-cigarette or vaping product use‒associated lung injury epidemic (late 2019) and COVID-19 pandemic (since early 2020). METHODS: Data from cross-sectional nationally representative Health Information National Trends Survey collected in 2018 (n=3,360), 2019 (n=3,217), and 2020 (n=3,677) (analyzed in 2021) were used to estimate changes in relative harm perceptions of E-cigarettes versus cigarettes (less harmful, as harmful, more harmful, don't know as a measure of uncertainty). In addition, changes in exclusive cigarette smoking, exclusive E-cigarette use, and dual use were estimated for each relative harm perception level. RESULTS: Perceptions of E-cigarettes as more harmful than cigarettes doubled year on year, increasing most between 2019 and 2020 (2018: 6.8%, 2019: 12.8%, 2020: 28.3%), whereas uncertainty in relative harm declined (2018: 38.2%, 2019: 34.2%, 2020: 24.7%). Less harmful relative perceptions declined (2018:17.6%, 2019:15.3%, 2020:11.4%), whereas as harmful perceptions remained steady (2018: 37.4%, 2019: 37.7%, 2020: 35.6%). Exclusive cigarette smoking increased between 2019 and 2020 among those who perceived E-cigarettes as relatively more harmful (2018: 18.5%; 2019: 8.4%; 2020: 16.3%), exclusive E-cigarette use increased linearly among those who perceived them as relatively less harmful (7.9%, 15.3%, 26.7%), and dual use increased linearly in those who perceived them relatively as harmful (0.1%, 1.4%, 2.9%). CONCLUSIONS: Perceptions of E-cigarettes as more harmful than cigarettes increased sharply between 2019 and 2020. Increases in tobacco product use were potentially guided by product-specific relative harm perceptions because changes occurred primarily in individuals who perceived their preferred product as relatively less harmful, suggesting the need for accurate messaging of relative and absolute product risks.

Changes in Cancer Screening in the US During the COVID-19 Pandemic.

Importance: Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported. Objective: To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data. Design, Setting, and Participants: This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022. Exposures: Calendar year. Main Outcomes and Measures: Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed. Results: In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020. Conclusions and Relevance: In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.

COVID-19 and Tweets About Quitting Cigarette Smoking: Topic Model Analysis of Twitter Posts 2018-2020.

Background: The risk of infection and severity of illness by SARS-CoV-2 infection is elevated for people who smoke cigarettes and may motivate quitting. Organic public conversations on Twitter about quitting smoking could provide insight into quitting motivations or behaviors associated with the pandemic. Objective: This study explored key topics of conversation about quitting cigarette smoking and examined their trajectory during 2018-2020. Methods: Topic model analysis with latent Dirichlet allocation (LDA) identified themes in US tweets with the term "quit smoking." The model was trained on posts from 2018 and was then applied to tweets posted in 2019 and 2020. Analysis of variance and follow-up pairwise tests were used to compare the daily frequency of tweets within and across years by quarter. Results: The mean numbers of daily tweets on quitting smoking in 2018, 2019, and 2020 were 133 (SD 36.2), 145 (SD 69.4), and 127 (SD 32.6), respectively. Six topics were extracted: (1) need to quit, (2) personal experiences, (3) electronic cigarettes (e-cigarettes), (4) advice/success, (5) quitting as a component of general health behavior change, and (6) clinics/services. Overall, the pandemic was not associated with changes in posts about quitting; instead, New Year's resolutions and the 2019 e-cigarette or vaping use-associated lung injury (EVALI) epidemic were more plausible explanations for observed changes within and across years. Fewer second-quarter posts in 2020 for the topic e-cigarettes may reflect lower pandemic-related quitting interest, whereas fourth-quarter increases in 2020 for other topics pointed to a late-year upswing. Conclusions: Twitter posts suggest that the pandemic did not generate greater interest in quitting smoking, but possibly a decrease in motivation when the rate of infections was increasing in the second quarter of 2020. Public health authorities may wish to craft messages for specific Twitter audiences (eg, using hashtags) to motivate quitting during pandemics.

Unemployment and cancer screening: Baseline estimates to inform health care delivery in the context of COVID-19 economic distress.

BACKGROUND: During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. METHODS: Up-to-date and past-year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000-2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed-versus-employed unadjusted and adjusted prevalence ratios. RESULTS: Unemployed adults (2000-2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P < .001). Unemployed adults had a significantly lower up-to-date prevalence of screening for cervical cancer (78.5% vs 86.2%; P < .001), breast cancer (67.8% vs 77.5%; P < .001), colorectal cancer (41.9 vs 48.5%; P < .001), and prostate cancer (25.4% vs 36.4%; P < .001). These differences were eliminated after accounting for health insurance coverage. CONCLUSIONS: Unemployment was adversely associated with up-to-date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening.

Association of teleworking and smoking behavior of U.S. wage and salary workers.

INTRODUCTION: The COVID-19 pandemic has led to a major shift in workspace from office to home. This report examined how telecommuting is related to smoking behavior of wage and salary workers. METHODS: Self-reported smoking behavior of 1,390 U.S. wage and salary workers aged 16-64 years from the Tobacco Use Supplement of the Current Population Survey 2018/19 were linked to the 2018 American Time Use Survey. Weighted multivariate logistic regression predicting smoking probability and generalized linear regression predicting smoking intensity were used for analysis. RESULTS: Almost a fifth (19%) of wage and salary workers reported working from home and over a half (52%) reported working in telecommuting amenable occupations. Nearly 12% were current smokers, smoking 14.7 cigarettes daily on average. Compared to their counterparts, smoking prevalence (percentage points) was lower among those employed in telecommuting amenable occupations (-0.52, p < .001 for all; 0.01, p = .862 for men; -2.40, p < .001 for women) and who worked more frequently from home (-0.21, p < .001 for all; -0.76, p < .001 for men; -0.03, p = .045 for women). Smoking intensity (cigarettes per day) was lower among those employed in telecommuting amenable occupations (-3.39, p = .03 for all; -0.36, p = .90 for men; -4.30, p = .21 for women). We found no statistically significant association between smoking intensity and telecommuting frequency. CONCLUSIONS: The lower likelihood of smoking and lower level of smoking intensity among telecommuting wage and salary workers suggests the need for proactive efforts to address the potential exacerbation in occupation-related smoking disparities between occupations that are and are not amenable to telecommuting.

Cancer statistics for the US Hispanic/Latino population, 2021.

The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.