Potential Economic Impact of a Coordinated Home Visitation Program: Preventing Adverse Birth Outcomes

Background and Purpose Evidence about the efficacy of healthy pregnancy home visitation programs is needed in California’s underserved Hispanic population, where preterm birth rates are higher than nonHispanic Whites. This study describes birth outcome data in a sample of families participating in the MOMS Orange County home visitation program. Methods: A descriptive comparative design was used. Birth outcome data for 1,102 women who participated in MOMS Orange County and had a live birth in 2010 were compared with data from the county of Orange (N = 38, 237) and the state of California (N = 509, 979) for the same time period, derived from county and state birth and death reports. Measures included social background, birth outcomes, and potential cost savings. Results: Although MOMS program mothers were less educated and had a higher level of poverty compared to both county and state samples, they had significantly fewer preterm births compared with the countywide and statewide samples. It was estimated that the provision of a home visitation program both countywide and statewide would result in a potential cost saving that $1.1 and$ 2.1 million, respectively. Conclusion: This coordinated prenatal program may improve birth outcomes among communities of impoverished women at potentially reduced costs

Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis

Background: Globally, tobacco smoking remains the largest preventable cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures, including ‘lockdowns’ that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early pre-vaccination phases of the COVID-19 pandemic in 2020. Methods: We searched Medline/Embase/PsycINFO/BioRxiv/MedRxiv/SSRN databases (January–November 2020) for published and pre-print articles that reported specific smoking behaviour changes or intentions after the onset of the COVID-19 pandemic. We used random-effects models to pool prevalence ratios comparing the prevalence of smoking during and before the pandemic, and the prevalence of smoking behaviour changes during the pandemic. The PROSPERO registration number for this systematic review was CRD42020206383. Findings: 31 studies were included in meta-analyses, with smoking data for 269,164 participants across 24 countries. The proportion of people smoking during the pandemic was lower than that before, with a pooled prevalence ratio of 0·87 (95%CI:0·79–0·97). Among people who smoke, 21% (95%CI:14–30%) smoked less, 27% (95%CI:22–32%) smoked more, 50% (95%CI:41%-58%) had unchanged smoking and 4% (95%CI:1–9%) reported quitting smoking. Among people who did not smoke, 2% (95%CI:1–3%) started smoking during the pandemic. Heterogeneity was high in all meta-analyses and so the pooled estimates should be interpreted with caution (I2\u3e91% and p-heterogeneity\u3c0·001). Almost all studies were at high risk of bias due to use of non-representative samples, non-response bias, and utilisation of non-validated questions. Interpretation: Smoking behaviour changes during the first phases of the COVID-19 pandemic in 2020 were highly mixed. Meta-analyses indicated that there was a relative reduction in overall smoking prevalence during the pandemic, while similar proportions of people who smoke smoked more or smoked less, although heterogeneity was high. Implementation of evidence-based tobacco control policies and programs, including tobacco cessation services, have an important role in ensuring that the COVID-19 pandemic does not exacerbate the smoking pandemic and associated adverse health outcomes

Cancer Risks in Shipyard Workers Exposed to Asbestos and Welding Fumes

The association between asbestos exposure and lung cancer, as well as between asbestos exposure and mesothelioma, had long since been established, while the relationship between asbestos exposure and other types of malignancies remains unclear. Aside from asbestos, numerous other potential exposures are present in the shipyard. Several occupations are exposed to substances such as welding fumes. The purpose of this dissertation is to examine the association between occupational agents in the Long Beach Naval shipyard and the health outcomes experienced by the workers employed in the shipyard. The study will assess the relationship between asbestos exposure and colorectal cancer by asbestos exposures levels, as well as, the incidence and mortality rates of lung cancer in relation to the exposure to welding fumes. The leading causes of deaths and the incidence of cancers was evaluated in 13,924 shipyard workers employed in the Long Beach Naval shipyard employed between 1978 and 1985. Mortality data (1978-2013) was ascertained through the California Deaths Statistical Master files. The incidence of cancer (1988-2011) was ascertained through the California cancer registry. Workers were classified into low, intermediate, and high asbestos exposure groups. Workers were also separated into exposed versus non-exposed to examine the effects of welding fumes exposure. Age-specific standardized mortality ratio and age-specific standardized incidence ratio for cancer were calculated using the general population of the state of California as the standard population. The Kaplan-Meier method was used to determine the time until occurrence of disease for colorectal cancer and lung cancer among workers exposed to asbestos and workers exposed to welding fumes. The leading causes of deaths in the Long Beach Naval shipyard included diseases of the circulatory and neoplasms. There was excess mortality and incidence of cancer in the study cohort including excess mesothelioma, lung, and colorectal cancer. Excess incidence of mesothelioma were observed in all three asbestos exposure groups. The study found no statistical difference in the time to disease occurrence between exposure groups for colorectal and lung cancer outcomes. This study showed that employment in the Long Beach Naval shipyard increased workers’ risk to a wide variety of cancers including asbestos-related malignancies

A Validation Method to Determine Missing Years of Birth in a Cohort Study of Shipyard Workers Using Social Security Number

ObjectiveThe objective of the study is to evaluate the generalizability and feasibility of a prediction method developed by Block et al (1983) to estimate missing age of workers by using their Social Security Numbers (SSNs).MethodsOur study used a retrospective occupational cohort of about 15,000 workers from the Long Beach Naval Shipyard (1978 to 1985).ResultsOur results showed an 89.2% agreement (P < 0.0001) between the predicted and observed years of birth using Block's method. The correlation increased to 93.1% (P < 0.0001) after our modifications by removing workers with SSNs issued in U.S. territories. The method performed better in shipyard workers who obtained their SSNs after 1950.ConclusionAlthough the method is useful in imputing missing age, the accuracy is dependent on the year, age, and location of SSN issuance

Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment delays during the COVID-19 pandemic:a statistical modelling study

Background: Long-term projections of cancer incidence and mortality estimate the future burden of cancer in a population, and can be of great use in informing the planning of health services and the management of resources. We aimed to estimate incidence and mortality rates and numbers of new cases and deaths up until 2044 for all cancers combined and for 21 individual cancer types in Australia. We also illustrate the potential effect of treatment delays due to the COVID-19 pandemic on future colorectal cancer mortality rates. Methods: In this statistical modelling study, cancer incidence and mortality rates in Australia from 2020 to 2044 were projected based on data up to 2017 and 2019, respectively. Cigarette smoking exposure (1945–2019), participation rates in the breast cancer screening programme (1996–2019), and prostate-specific antigen testing rates (1994–2020) were included where relevant. The baseline projection model using an age-period-cohort model or generalised linear model for each cancer type was selected based on model fit statistics and validation with pre-COVID-19 observed data. To assess the impact of treatment delays during the COVID-19 pandemic on colorectal cancer mortality, we obtained data on incidence, survival, prevalence, and cancer treatment for colorectal cancer from different authorities. The relative risks of death due to system-caused treatment delays were derived from a published systematic review. Numbers of excess colorectal cancer deaths were estimated using the relative risk of death per week of treatment delay and different durations of delay under a number of hypothetical scenarios. Findings: Projections indicate that in the absence of the COVID-19 pandemic effects, the age-standardised incidence rate for all cancers combined for males would decline over 2020–44, and for females the incidence rate would be relatively stable in Australia. The mortality rates for all cancers combined for both males and females are expected to continuously decline during 2020–44. The total number of new cases are projected to increase by 47·4% (95% uncertainty interval [UI] 35·2–61·3) for males, from 380 306 in 2015–19 to 560 744 (95% UI 514 244–613 356) in 2040–44, and by 54·4% (95% UI 40·2–70·5) for females, from 313 263 in 2015–19 to 483 527 (95% UI 439 069–534 090) in 2040–44. The number of cancer deaths are projected to increase by 36·4% (95% UI 15·3–63·9) for males, from 132 440 in 2015–19 to 180 663 (95% UI 152 719–217 126) in 2040–44, and by 36·6% (95% UI 15·8–64·1) for females, from 102 103 in 2015–19 to 139 482 (95% UI 118 186–167 527) in 2040–44, due to population ageing and growth. The example COVID-19 pandemic scenario of a 6-month health-care system disruption with 16-week treatment delays for colorectal cancer patients could result in 460 (95% UI 338–595) additional deaths and 437 (95% UI 314–570) deaths occurring earlier than expected in 2020–44. Interpretation: These projections can inform health service planning for cancer care and treatment in Australia. Despite the continuous decline in cancer mortality rates, and the decline or plateau in incidence rates, our projections suggest an overall 51% increase in the number of new cancer cases and a 36% increase in the number of cancer deaths over the 25-year projection period. This means that continued efforts to increase screening uptake and to control risk factors, including smoking exposure, obesity, physical inactivity, alcohol use, and infections, must remain public health priorities. Funding: Partly funded by Cancer Council Australia.</p

A systematic review and meta-analysis of tobacco smoking behaviour changes during the COVID-19 pandemic

Background Globally, tobacco smoking remains the largest cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures including ‘lockdowns’ that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early phases of the COVID-19 pandemic. Methods We searched Medline/Embase/PsycINFO/BioRxiv/MedRxiv/SSRN databases (January-November 2020) for published and pre-print articles that reported specific smoking behaviour changes or intentions after the onset of the COVID-19 pandemic. We used random-effects models to pool prevalence ratios comparing the prevalence of smokers during and before the pandemic, and the prevalence of smoking behaviour changes. Results 33 studies were included in meta-analyses, with smoking data for ∼230,000 participants across 24 countries. The proportions of smokers during and before the pandemic were similar, with a pooled prevalence ratio 0.85 (95%CI:0.76-0.95). In studies limited to smokers, 27% (95%CI:21-32%) smoked more, 17% (95%CI:13-21%) smoked less, 54% (95%CI:47-61%) smoked the same and 5% (95%CI:2-9%) reported quitting smoking. Among all participants, 1% (95%CI:0-2%) started smoking during the pandemic. All studies were at high risk of bias due to use of non-representative samples, likely non-response bias, and utilisation of non-validated questions. Conclusions Smoking behaviour changes during the early phases of the COVID-19 pandemic were highly mixed. Meta-analyses indicated slightly lower overall smoking prevalence during the pandemic, but higher intensity among smokers. Key messages More recent and higher quality studies of smoking behaviour changes are required to measure the longer term impact of the COVID-19 pandemic

Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis

Background Globally, tobacco smoking remains the largest preventable cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures, including ‘lockdowns’ that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early pre-vaccination phases of the COVID-19 pandemic in 2020. Methods We searched Medline/Embase/PsycINFO/BioRxiv/MedRxiv/SSRN databases (January–November 2020) for published and pre-print articles that reported specific smoking behaviour changes or intentions after the onset of the COVID-19 pandemic. We used random-effects models to pool prevalence ratios comparing the prevalence of smoking during and before the pandemic, and the prevalence of smoking behaviour changes during the pandemic. The PROSPERO registration number for this systematic review was CRD42020206383. Findings 31 studies were included in meta-analyses, with smoking data for 269,164 participants across 24 countries. The proportion of people smoking during the pandemic was lower than that before, with a pooled prevalence ratio of 0·87 (95%CI:0·79–0·97). Among people who smoke, 21% (95%CI:14–30%) smoked less, 27% (95%CI:22–32%) smoked more, 50% (95%CI:41%-58%) had unchanged smoking and 4% (95%CI:1–9%) reported quitting smoking. Among people who did not smoke, 2% (95%CI:1–3%) started smoking during the pandemic. Heterogeneity was high in all meta-analyses and so the pooled estimates should be interpreted with caution (I2>91% and p-heterogeneity<0·001). Almost all studies were at high risk of bias due to use of non-representative samples, non-response bias, and utilisation of non-validated questions. Interpretation Smoking behaviour changes during the first phases of the COVID-19 pandemic in 2020 were highly mixed. Meta-analyses indicated that there was a relative reduction in overall smoking prevalence during the pandemic, while similar proportions of people who smoke smoked more or smoked less, although heterogeneity was high. Implementation of evidence-based tobacco control policies and programs, including tobacco cessation services, have an important role in ensuring that the COVID-19 pandemic does not exacerbate the smoking pandemic and associated adverse health outcomes

Innate immunity pathways and breast cancer Risk in African American and European-American women in the Women's Circle of Health Study (WCHS).

African American (AA) women are more likely than European American (EA) women to be diagnosed with early, aggressive breast cancer. Possible differences in innate immune pathways (e.g., inflammatory responses) have received little attention as potential mechanisms underlying this disparity. We evaluated distributions of selected genetic variants in innate immune pathways in AA and EA women, and examined their associations with breast cancer risk within the Women's Circle of Health Study (WCHS). In stage I of the study (864 AA and 650 EA women) we found that genotype frequencies for 35 of 42 tested SNPs (18 candidate genes) differed between AAs and EAs (corroborated by ancestry informative markers). Among premenopausal AA women, comparing variant allele carriers to non-carriers, reduced breast cancer risk was associated with CXCL5-rs425535 (OR=0.61, P=0.02), while among EA women, there were associations with TNFA-rs1799724 (OR =2.31, P =0.002) and CRP-rs1205 (OR=0.54, P=0.01). For postmenopausal women, IL1B-rs1143627 (OR=1.80, P=0.02) and IL1B-rs16944 (OR=1.85, P =0.02) were associated with risk among EA women, with significant associations for TNFA-rs1799724 limited to estrogen receptor (ER) positive cancers (OR=2.0, P =0.001). However, none of the SNPs retained significance after Bonferroni adjustment for multiple testing at the level of P0.0012 (0.05/42) except for TNFA-rs1799724 in ER positive cancers. In a stage II validation (1,365 AA and 1,307 EA women), we extended evaluations for four SNPs (CCL2-rs4586, CRP-rs1205, CXCL5-rs425535, and IL1RN-rs4251961), which yielded similar results. In summary, distributions of variants in genes involved in innate immune pathways were found to differ between AA and EA populations, and showed differential associations with breast cancer according to menopausal or ER status. These results suggest that immune adaptations suited to ancestral environments may differentially influence breast cancer risk among EA and AA women