Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Correction: Menthol levels in cigarettes from eight manufacturers
Ai J , Taylor KM , Lisko JG , Tran H , Watson CH , Holman MR . Tob Control 12/28/2021 30 e173-e175 The research letter “Menthol levels in cigarettes from eight manufacturers” reports concentrations of menthol in whole cigarettes from eight manufacturers in the United States. As our research has progressed, we have re-examined our results and have identified an error in the calculations that were used to determine the reported menthol concentrations. The analytical method used to quantitate menthol concentrations in whole cigarettes was originally developed for only unburned tobacco (eg, tobacco filler). When the method was applied to whole cigarettes, we discovered that we did not account for the mass of the tobacco (400 mg) that was used in the validation of the analytical method. Because the calibration curve originally used to quantitate menthol concentrations has units of μg/g, the cigarette mass was also applied incorrectly. As a result, the calibration curve and subsequent product menthol concentrations quantitated under the original conditions in μg/g should have been adjusted by a factor of 0.4 to provide the correct concentration of menthol found in each cigarette product (μg/cig). Figure 1, has been revised to reflect the correct menthol concentrations from the different manufacturers. Table 1 contains the measured menthol concentration ranges for each manufacturer so that readers can see the measured menthol concentrations used to create figure 1. Because the calculation error applies to all products, relative concentration comparisons made in the manuscript between products remain unchanged. | |
Melanoma incidence rates among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019
Townsend JS , Melkonian SC , Jim MA , Holman DM , Buffalo M , Julian AK . JAMA Dermatol 2023 IMPORTANCE: Non-Hispanic American Indian/Alaska Native people have the second highest incidence rate of invasive cutaneous melanoma in the US after non-Hispanic White people. OBJECTIVE: To examine invasive cutaneous melanoma incidence rates and trends over time among non-Hispanic American Indian/Alaska Native people. DESIGN, SETTING, AND PARTICIPANTS: This descriptive, observational cross-sectional study used population-based cancer registry data (US Cancer Statistics AI/AN Incidence Analytic Database) linked to the Indian Health Service administrative database to examine incidence rates by age, sex, region, histology, tumor site, stage, and other demographic and clinical characteristics. The study examined trends from 1999 to 2019 time period by age, sex, stage at diagnosis, and region. Non-Hispanic American Indian/Alaska Native people 15 years and older who received a diagnosis of invasive cutaneous melanoma from 1999 to 2019 who were members of federally recognized tribes and resided in Indian Health Service purchased/referred care delivery areas were included in this study to reduce racial misclassification and provide more accurate rates. The data were analyzed in 2022. EXPOSURES: Demographic and clinical characteristics, such as age, sex, geographic region, histology, stage, and tumor site. MAIN OUTCOMES AND MEASURES: Invasive cutaneous melanoma incidence rates by age group, sex, region, resident county characteristics (poverty level, rurality, education level, and socioeconomic status), stage at diagnosis, tumor site, and histology. Trends over time by age, sex, region, and stage. RESULTS: From 1999 to 2019, 2151 non-Hispanic American Indian/Alaska Native people (1021 female individuals [47.5%]) received a diagnosis of incident cutaneous melanoma (rate, 10.7 per 100 000; 95% CI, 10.3-11.2). Rates were higher among male than female individuals (13.0 [95% CI, 12.2-13.8] vs 9.2 [95% CI, 8.6-9.8]) and for people 55 years and older (24.2; 95% CI, 22.8-25.7) compared with those aged 15 to 39 years (3.5; 95% CI, 3.2-3.9). Rates were highest for male individuals 55 years and older (34.5; 95% CI, 31.8-37.3) and people living in the Southern Plains (male individuals: 23.8; 95% CI, 21.5-26.2; female individuals: 15.5; 95% CI, 14.0-17.2) and Pacific Coast region (male individuals: 16.5; 95% CI, 14.5-18.7; female individuals: 12.3; 95% CI, 10.9-13.9). Rates increased among female individuals from 1999 to 2019 (average annual percent change [AAPC], 2.5; P < .001); among regional/distant stage tumors (AAPC, 2.5; P = .01) and people 55 years and older (AAPC, 2.8; P = .001). CONCLUSIONS AND RELEVANCE: The results of this study suggest that additional studies could potentially identify risk factors among non-Hispanic American Indian/Alaska Native people. |
Reducing cancer risk through primary prevention activities among children: A demonstration project
Tai E , Chovnick G , Momin B , Townsend JS , Holman DM , Siegel D , House M . J Public Health Manag Pract 2023 CONTEXT: Opportunities to reduce the risk of cancer, including cervical, liver, and skin cancer, start early in life. To encourage adoption of primary prevention activities in childhood to reduce cancer risk later in life, Centers for Disease Control and Prevention conducted a demonstration project with 3 National Comprehensive Cancer Control Program (NCCCP) recipients. PROGRAM: Iowa, Northwest Portland Area Indian Health Board (NPAIHB), and Pennsylvania NCCCP recipients implemented evidence-based primary prevention activities for cervical, liver, and skin cancer among children using health care provider education, patient education, and policy development. IMPLEMENTATION: Iowa implemented an announcement approach to improve provider education on human papillomavirus (HPV) vaccination. Pennsylvania focused on patient education for reducing skin cancer risk and both provider and patient education for liver cancer prevention. NPAIHB created a sun safety intervention for tribal organizations, including a policy guide, media materials, and patient education. RESULTS: In Iowa, health care providers taking the announcement approach reported significantly higher mean scores on a posttest compared with a pretest regarding perceptions about HPV vaccination, self-efficacy, and behavioral intentions related to vaccination. Pennsylvania integrated sun safety education and sunscreen dispenser programs as a health and wellness initiative in 8 state parks and the Pennsylvania Department of Conservation and Natural Resources incorporated the program in its Pennsylvania Outdoor Recreation Plan. Pennsylvania also implemented health care provider education on the primary prevention of liver cancer through hepatitis B and hepatitis C screening and hepatitis B vaccination. The NPAIHB skin cancer policy guide was created and distributed for use to all 43 federally recognized tribes of Oregon, Washington, and Idaho served by NPAIHB. DISCUSSION: The identification, dissemination, and implementation of these efforts can serve as best practices for future childhood primary prevention programs. NCCCP recipients and public health professionals can use health care provider education, patient education, and policy development to reduce future risk for cervical, liver, and skin cancer among children. |
Acral lentiginous melanoma incidence by sex, race, ethnicity, and stage in the United States, 2010-2019
Holman DM , King JB , White A , Singh SD , Lichtenfeld JL . Prev Med 2023 175 107692 INTRODUCTION: Acral lentiginous melanoma (ALM) is a rare type of melanoma associated with delayed diagnosis and poor survival rates. This study examines ALM incidence rates in comparison to all other melanoma types. METHODS: We used data from the Centers for Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, which together cover 99% of the US population. We calculated age-adjusted rates and rate ratios for ALM and all other malignant melanomas by sex, race and ethnicity, stage, and year of diagnosis (2010-2019). RESULTS: ALM incidence rates were significantly lower among non-Hispanic Black persons (1.8 per 1,000,000); non-Hispanic Asian/Pacific Islander (API) persons (1.7 per 1,000,000); and Hispanic Black, American Indian/Alaska Native (AI/AN), and API persons (1.5 per 1,000,000) compared to non-Hispanic White persons (2.3 per 1,000,000). Rates were significantly higher among Hispanic White persons (2.8 per 1,000,000) compared to non-Hispanic White persons. For all other melanoma types, incidence rates were significantly higher among non-Hispanic White persons compared to persons in each of the other racial and ethnic categories. The percentage of melanomas that were ALM ranged from 0.8% among non-Hispanic White persons to 19.1% among Hispanic Black, AI/AN, and API persons. CONCLUSION: These findings suggest that awareness of the potential for ALM in patients of all races and ethnicities could be balanced with an understanding of the rarity of the disease and the potential for the development of other melanoma types in racial and ethnic minority groups. |
Sunless and indoor tanning among U.S. non-Hispanic white women ages 18-49 years
Seidenberg AB , Julian AK , Hartman AM , Holman DM . J Dermatol Nurses' Assoc 2023 15 (3) 123-132 The use of indoor ultraviolet tanning devices (also known as "indoor tanning") has declined in recent years. Less is known about use of dihydroxyacetone-containing products used for tanning (also known as "sunless tanning"). We analyzed data from the 2015 National Health Interview Survey. Analysis was limited to non-Hispanic white women ages 18-49 years. We estimated the proportion of women reporting spray tanning, self-applied lotion tanning, and indoor tanning and used weighted multivariable logistic regression models to examine the relationships between sociodemographic characteristics, skin cancer risk factors, and other cancer risk factors with sunless and indoor tanning. Overall, 17.7% of women reported sunless tanning. Lotion tanning was more common (15.3%) than spray tanning (6.8%), whereas 12.0% of women engaged in indoor tanning. Among sunless tanners, 23.7% also engaged in indoor tanning. Younger age, ever having a skin examination, skin reactions to the sun, binge drinking, and being at a healthy weight were associated with sunless tanning. Although sunless tanning may be less harmful for skin cancer risk than indoor tanning, the frequency with which the two behaviors co-occur suggests that efforts to address societal pressures for women to alter their skin color may have important public health benefits. © Lippincott Williams & Wilkins. |
Evaluation of serial testing after exposure to COVID-19 in early care and education facilities, Illinois, March-May 2022
Holman EJ , Winfield CM , Borkowf CB , Kauerauf J , Baur C , Ahmed S , Funk M , Pinsoneault A , Barnes A , Hutcherson H , Oberholtzer Z , Carter B , Ruth LJ , Thomas ES . Public Health Rep 2023 333549231173014 OBJECTIVE: To understand SARS-CoV-2 transmission in early care and education (ECE) settings, we implemented a Test to Stay (TTS) strategy, which allowed children and staff who were close contacts to COVID-19 to remain in person if they agreed to test twice after exposure. We describe SARS-CoV-2 transmission, testing preferences, and the number of in-person days saved among participating ECE facilities. METHODS: From March 21 through May 27, 2022, 32 ECE facilities in Illinois implemented TTS. Unvaccinated children and staff who were not up to date with COVID-19 vaccination could participate if exposed to COVID-19. Participants received 2 tests within 7 days after exposure and were given the option to test at home or at the ECE facility. RESULTS: During the study period, 331 TTS participants were exposed to index cases (defined as people attending the ECE facility with a positive SARS-CoV-2 test result during the infectious period); 14 participants tested positive, resulting in a secondary attack rate of 4.2%. No tertiary cases (defined as a person with a positive SARS-CoV-2 test result within 10 days after exposure to a secondary case) occurred in the ECE facilities. Most participants (366 of 383; 95.6%) chose to test at home. Remaining in-person after an exposure to COVID-19 saved approximately 1915 in-person days among children and staff and approximately 1870 parent workdays. CONCLUSION: SARS-CoV-2 transmission rates were low in ECE facilities during the study period. Serial testing after COVID-19 exposure among children and staff at ECE facilities is a valuable strategy to allow children to remain in person and parents to avoid missing workdays. |
Highlights From an Expert Meeting on Opportunities for Cancer Prevention Among Older Adults
Cancer Prevention During Older Adulthood Writing Group , Ekwueme Donatus U , Flagg T’Ronda , Holman Dawn M , Peipins Lucy , Qin Jin , Shoemaker Meredith , White Mary C . Gerontologist 2019 59 S94-s101 This paper provides highlights from an expert meeting to explore opportunities to reduce cancer risk and promote health at older ages. Factors that increase cancer risk among older adults include exposure to carcinogens from multiple sources, chronic conditions such as obesity and diabetes, and unhealthy behaviors. Emerging research points to chronic social stressors - social isolation, loneliness, and financial hardship - as being linked to accelerated biological aging and increased cancer risk later in life. Older adults may disproportionately encounter these stressors as well as barriers to preventive health care services, accurate health information, and environments that promote health. Researchers can use existing cohort studies of older adults to deepen our understanding of the relative benefit of modifying specific behaviors and circumstances. The evidence points to the value of comprehensive, transdisciplinary approaches to promote health and reduce cancer risk across the entire lifespan, extending through older adulthood. Clinical encounters with older adults provide opportunities for psychosocial and behavioral screening and counseling. In the presence of multiple morbidities, preventive health services may offer greater health benefits than cancer-screening tests. Strategies that involve families and caregivers, promote positive attitudes about aging, and engage many different community sectors have the potential to prevent or delay the development of cancer at older ages. |
Perceived benefits and barriers of a COVID-19 test to stay program in a school district serving Black or African American people with low income, December 2021
Kamitani E , Holman EJ , Philpott D , Parasram VD , Ruth LJ , Onyeuku C , Carter B , Gwynn E , Beck TW , Regan K , Hagler LR , Clark A , Shelley G , Thomas ES . Public Health Rep 2023 333549231155472 OBJECTIVES: Quarantine after exposure to COVID-19 has resulted in substantial loss of in-person learning in schools from prekindergarten through grade 12. Test to Stay (TTS), a strategy that limits the spread of SARS-CoV-2 while prioritizing in-person learning, requires substantial investment in resources. The objective of this study was to assess the perceived benefits, barriers, and facilitators of implementing TTS in an urban school district in the Midwest serving primarily Black or African American people with low income. METHODS: In December 2021, we used a concurrent mixed-methods approach to understand perceived benefits, barriers, and facilitators of implementing TTS by combining quantitative analysis of telephone surveys conducted with parents (n = 124) and a qualitative inquiry involving key informants from the school district and local health department (n = 22). We analyzed quantitative data using descriptive statistics. We used thematic analysis to analyze qualitative data. RESULTS: Quantitative findings showed that parents supported TTS because it was convenient (n = 83, 97%) and effective (n = 82, 95%) in keeping students learning in person (n = 82, 95%) and preventing the spread of COVID-19 (n = 80, 93%). Qualitative interviews with informants found that having a clear protocol and assigning staff to specified tasks allowed for successful TTS implementation. However, insufficient staffing and testing resources, parent mistrust of testing, and lack of communication from schools were perceived barriers. CONCLUSION: The school community strongly supported TTS despite the many implementation challenges faced. This study emphasized the importance of ensuring resources for equitable implementation of COVID-19 prevention strategies and the critical role of communication. |
Economic burden of skin cancer treatment in the USA: an analysis of the Medical Expenditure Panel Survey Data, 2012-2018
Kao SZ , Ekwueme DU , Holman DM , Rim SH , Thomas CC , Saraiya M . Cancer Causes Control 2022 34 (3) 205-212 PURPOSE: We report the prevalence and economic cost of skin cancer treatment compared to other cancers overall in the USA from 2012 to 2018. METHODS: Using the Medical Expenditure Panel Survey full-year consolidated data files and associated medical conditions and medical events files, we estimate the prevalence, total costs, and per-person costs of treatment for melanoma and non-melanoma skin cancer among adults aged ≥ 18 years in the USA. To understand the changes in treatment prevalence and treatment costs of skin cancer in the context of overall cancer treatment, we also estimate the prevalence, total costs, and per-person costs of treatment for non-skin cancer among US adults. RESULTS: During 2012-15 and 2016-18, the average annual number of adults treated for any skin cancer was 5.8 (95% CI: 5.2, 6.4) and 6.1 (95% CI: 5.6, 6.6) million, respectively, while the average annual number of adults treated for non-skin cancers rose from 10.8 (95% CI: 10.0, 11.5) to 11.9 (95% CI: 11.2, 12.6) million, respectively. The overall estimated annual costs rose from $8.0 (in 2012-2015) to $8.9 billion (in 2016-18) for skin cancer treatment and $70.2 to $79.4 billion respectively for non-skin cancer treatment. CONCLUSION: The prevalence and economic cost of skin cancer treatment modestly increased in recent years. Given the substantial cost of skin cancer treatment, continued public health attention to implementing evidence-based sun-safety interventions to reduce skin cancer risk may help prevent skin cancer and the associated treatment costs. |
Test-to-Stay Implementation in Four Pre-K-12 School Districts.
Lammie SL , Ford L , Swanson M , Guinn AS , Kamitani E , van Zyl A , Rose CE , Marynak K , Shields J , Donovan CV , Holman EJ , Mark-Carew M , Welton M , Thomas ES , Neatherlin J . Pediatrics 2022 150 (4) OBJECTIVE: Globally, COVID-19 has affected how children learn. We evaluated the impact of Test to Stay (TTS) on secondary and tertiary transmission of SARS-CoV-2 and potential impact on in-person learning in four school districts in the United States from September 13-November 19, 2021. METHODS: Implementation of TTS varied across school districts. Data on index cases, school-based close contacts, TTS participation, and testing results were obtained from four school districts in diverse geographic regions. Descriptive statistics, secondary and tertiary attack risk, and a theoretical estimate of impact on in-person learning were calculated. RESULTS: Fifty-one schools in four school districts reported 374 COVID-19 index cases and 2,520 school-based close contacts eligible for TTS. The proportion participating in TTS ranged from 22%-79%. By district, the secondary attack risk (SAR) and tertiary attack risk (TAR) among TTS participants ranged between 2.2%-11.1% and 0%-17.6%, respectively. Nine clusters were identified among secondary cases and two among tertiary cases. The theoretical maximum number of days of in-person learning saved by using TTS was 976-4,650 days across jurisdictions. CONCLUSIONS: TTS preserves in-person learning days. Decisions to participate in TTS may have been influenced by ease of access to testing, communication between schools and families, testing logistics, and school resources. TAR determination became more complicated when numbers of close contacts increased. Minimizing exposure through continued implementation of layered prevention strategies is imperative. To ensure adequate resources for implementation of TTS, community transmission levels should be considered. |
Beliefs associated with sunscreen use among non-Hispanic white older adults
Holman DM , Glanz K , Jordan A , Bleakley A , Dasari S . J Dermatol Nurses Assoc 2022 14 (3) 107-112 This study examines beliefs about sunscreen use among non-Hispanic white adults aged 50 years or older using online survey data (n = 237). Multiple logistic regression analyses were conducted to examine beliefs associated with sunscreen use, adjusted by age, gender, education, geographic location, and skin cancer risk score. Those who believed sunscreen use would prevent them from getting sunburned (odds ratio [ OR ] = 1.84) and those who believed that their romantic partners thought they should use sunscreen (OR = 1.72) were more likely to report sunscreen use. Those who believed sunscreen use would "take too much time" were less likely to report sunscreen use (OR = 0.65). These findings can inform future research and messaging efforts, including the evaluation of intervention approaches that highlight the immediate benefits of sunscreen use, address concerns about sunscreen use taking too much time, and tap into the potential influence that older adults may have on the sunscreen use of their romantic partners. |
Evaluation of Test to Stay Strategy on Secondary and Tertiary Transmission of SARS-CoV-2 in K-12 Schools - Lake County, Illinois, August 9-October 29, 2021.
Nemoto N , Dhillon S , Fink S , Holman EJ , Cope AK , Dinh TH , Meadows J , Taryal D , Akindileni F , Franck M , Gelber E , Bacci L , Ahmed S , Thomas ES , Neatherlin JC . MMWR Morb Mortal Wkly Rep 2021 70 (5152) 1778-1781 The COVID-19 pandemic has resulted in school closures and reduction of in-person learning (1). In August 2021, the Lake County Health Department (LCHD) in Illinois introduced a Test to Stay (TTS) strategy, whereby unvaccinated students, teachers, and staff members with certain school-related COVID-19 exposures could remain in school and participate in school-related extracurricular activities. Eligibility to participate in TTS required the following conditions to be met: 1) the exposure occurred while both the person with COVID-19 (index patient) and the close contact were masked; 2) the close contact remained asymptomatic, practiced consistent mask wearing, and maintained physical distancing; and 3) the close contact underwent testing for SARS-CoV-2 (the virus that causes COVID-19) on days 1, 3, 5, and 7 after exposure to the index patient. LCHD permitted kindergarten through grade 12 (K-12) schools in Lake County to implement TTS; 90 schools, representing 31 school districts in Lake County, implemented TTS during August 9-October 29, 2021. During the implementation period, 258 COVID-19 cases were reported. Among 1,035 students and staff members enrolled in TTS, the secondary attack risk (number of close contacts who received a positive SARS-CoV-2 test result within 14 days after exposure to an index patient, divided by total number of close contacts) was 1.5% (16 of 1,035). Among the 16 secondary cases identified, all were in students, and none appeared to transmit SARS-CoV-2 to other school-based contacts. However, nine tertiary cases were identified among household contacts of the 16 secondary cases, and four of the nine were fully vaccinated. Assuming a maximum of 8 missed school days for every 10-day quarantine period, up to 8,152 in-person learning days were saved among TTS participants. Implementation of TTS with other concurrent prevention strategies, including masking and physical distancing, limited further spread of SARS-CoV-2 within K-12 schools and allowed students to safely sustain in-person learning. Although vaccination remains the leading public health recommendation to protect against COVID-19 for those aged ≥5 years, schools might consider TTS as an option for allowing close contacts who are not fully vaccinated to remain in the classroom as an alternative to home quarantine. |
The context of sunburn among U.S. adults: Common activities and sun protection behaviors
Holman DM , Ragan KR , Julian AK , Perna FM . Am J Prev Med 2021 60 (5) e213-e220 INTRODUCTION: Sunburn increases skin cancer risk and is common among U.S. adults. However, little is known about the contexts in which sunburns often occur. The purpose of this study is to examine the contextual factors surrounding sunburns among U.S. adults. METHODS: Cross-sectional data from a 2018 online panel survey were analyzed. A total of 4,088 panel members were recruited by mail using probability-based, random sampling by address. Respondents were asked about their most recent sunburn, and analyses were limited to those who remembered their most recent sunburn (N=3,106). Data were weighted to match the U.S. Current Population Survey proportions; analyses were conducted in 2018 and 2019. RESULTS: Participants' age ranged from 18 to 93 years. About half (50.8%) were women, and most (82.3%) were non-Hispanic White adults. Swimming or spending time in water (32.5%), working outside at home (26.2%), traveling/vacationing (20.7%), and engaging in nonswimming physical activity (14.2%) were the most frequently reported activities. Using sunscreen on the face, neck, and chest (38.8%) and on the body (19.9%) and wearing sunglasses (34.2%) were the most frequently reported sun safety behaviors. Wearing clothes to the ankles (6.6%) and a long-sleeved shirt (4.5%) were least frequently reported. CONCLUSIONS: This study provides new information about the contexts in which adult sunburns often occur, especially about contexts unrelated to intentional tanning, which was relatively infrequent. The results suggest the need to promote multiple forms of sun protection tailored to specific outdoor activities and develop innovative solutions for outdoor physical and aquatic activities, which present unique sun safety challenges. |
The Lancet Commission on diabetes: using data to transform diabetes care and patient lives
Chan JCN , Lim LL , Wareham NJ , Shaw JE , Orchard TJ , Zhang P , Lau ESH , Eliasson B , Kong APS , Ezzati M , Aguilar-Salinas CA , McGill M , Levitt NS , Ning G , So WY , Adams J , Bracco P , Forouhi NG , Gregory GA , Guo J , Hua X , Klatman EL , Magliano DJ , Ng BP , Ogilvie D , Panter J , Pavkov M , Shao H , Unwin N , White M , Wou C , Ma RCW , Schmidt MI , Ramachandran A , Seino Y , Bennett PH , Oldenburg B , Gagliardino JJ , Luk AOY , Clarke PM , Ogle GD , Davies MJ , Holman RR , Gregg EW . Lancet 2020 396 (10267) 2019-2082 2020 will go down in history as the year when the global community was awakened to the fragility of human health and the interdependence of the ecosystem, economy, and humanity. Amid the COVID-19 pandemic, the vulnerability of people with diabetes during a public health emergency became evident by their at least 2 times increased risk of severe disease or death, especially in individuals with poorly controlled diabetes, comorbidities, or both. The disease burden caused by COVID-19, exacerbated by chronic conditions like diabetes, has inflicted a heavy toll on health-care systems and the global economy. | | In this Lancet Commission on diabetes, which embodies 4 years of extensive work on data curation, synthesis, and modelling, we urge policy makers, payers, and planners to collectively change the ecosystem, build capacity, and improve the clinical practice environment. Such actions will enable practitioners to systematically collect data during routine practice and to use these data effectively to diagnose early, stratify risks, define needs, improve care, evaluate solutions, and drive changes at patient, system, and policy levels to prevent and control diabetes and other non-communicable diseases. Emerging evidence regarding the possible damaging effects of severe acute respiratory syndrome coronavirus 2 on pancreatic islets implies the potential worsening of the COVID-19 pandemic and the diabetes epidemic, adding to the urgency of these collective actions. | | Prevention, early detection, prompt diagnosis, and continuing care with regular monitoring and ongoing evaluation are key elements in reducing the growing burden of diabetes. Given the silent and progressive nature of diabetes, it is epidemiological analyses that have provided a framework for identifying populations and subgroups at risk of diabetes and its complications. Although the total prevalence of diabetes reflects disease burden, incidence rates might reflect the effects of interventions among determinant factors that include, but are not limited to, political, socioeconomical, and technological changes within a population, area, or both. | | In 2019, 463 million people had diabetes worldwide, with 80% from low-income and middle-income countries. Over 70% of global deaths are due to non-communicable diseases, including diabetes, cardiovascular disease, cancer, and respiratory disease. On average, diabetes reduces life expectancy in people aged 40–60 years by 4–10 years and independently increases the risk of death from cardiovascular disease, renal disease, and cancer by 1·3–3·0 times. Diabetes is among the leading causes of non-traumatic lower extremity amputation and blindness, especially in people of working age. The co-occurrence of these morbidities severely impairs quality of life, reduces productivity, and causes major suffering. |
Examination of laws allowing sunscreen use in schools in the context of UV levels by state
Patterson B , Holman DM , Qin J , Smith K , Zhou Y . J Adolesc Health 2020 68 (2) 407-410 PURPOSE: Sunscreen use provides ultraviolet radiation (UV) protection but is often limited in school settings because sunscreen is classified as an over-the-counter drug product. Some US states have laws allowing students to carry and self-apply sunscreen. We examined these laws in the context of state UV levels. METHODS: We obtained legislative information through April 2020 from the American Society for Dermatologic Surgery Association website and UV data for years 2005-2015 from Centers for Disease Control and Prevention's National Environmental Public Health Tracking website. RESULTS: Twenty-three states and District of Columbia have sunscreen laws, including 11 states with UV levels above the median UV level across states. There was no significant association between state UV levels and sunscreen laws. CONCLUSIONS: The presence of state sunscreen legislation has increased but is not associated with UV levels. Future research could examine the implementation and public health effects of these laws. |
Incidence and public health burden of sunburn among beachgoers in the United States
DeFlorio-Barker S , Holman D , Landolfi R , Arnold BF , Colford JMJr , Weisberg SB , Schiff KC , Sams EA , Wade TJ . Prev Med 2020 134 106047 The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n=75,614), were pooled to evaluate sunburn incidence 10-12days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending >/=5h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio=0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers. |
Cancer risk among older adults: Time for cancer prevention to go silver
White MC , Holman DM , Goodman RA , Richardson LC . Gerontologist 2019 59 S1-S6 Over two-thirds of all new cancers are diagnosed among adults aged ≥60 years. As the number of adults living to older ages continues to increase, so too will the number of new cancer cases. Can we do more as a society to reduce cancer risk and preserve health as adults enter their 60s, 70s, and beyond? Cancer development is a multi-step process involving a combination of factors. Each cancer risk factor represents a component of cancer causation, and opportunities to prevent cancer may exist at any time up to the final component, even years after the first. The characteristics of the community in which one lives often shape cancer risk-related behaviors and exposures over time, making communities an ideal setting for efforts to reduce cancer risk at a population level. A comprehensive approach to cancer prevention at older ages would lower exposures to known causes of cancer, promote healthy social and physical environments, expand the appropriate use of clinical preventive services, and engage older adults in these efforts. The collection of articles in this supplement provide innovative insights for exciting new directions in research and practice to expand cancer prevention efforts for older adults. This brief commentary sets the stage for the papers that follow. |
Clinical counseling on sun protection and indoor tanning avoidance: A survey of current practices among U.S. health care providers
Holman DM , Qin J , Gottschlich EA , Balk SJ . Prev Med 2019 126 105783 Clinicians can play a role in skin cancer prevention by counseling their patients on use of sun protection and indoor tanning avoidance. We used data from the 2016 DocStyles, a web-based survey of U.S. primary care providers, to examine skin cancer prevention counseling practices among 1506 providers. In 2018, we conducted logistic regression analyses to examine factors associated with regularly providing counseling. Almost half (48.5%) of all providers reported regularly counseling on sun protection, and 27.4% reported regularly counseling on indoor tanning. Provider characteristics associated with regular counseling included having practiced medicine for >/=16years (sun protection: adjusted prevalence ratio [aPR]=1.27, 95% confidence interval [CI]=1.15, 1.41; indoor tanning: aPR=1.38, 95% CI=1.17, 1.63), having treated sunburn in the past year (sun protection: aPR=1.78, 95% CI=1.46, 2.17; indoor tanning: aPR=2.42, 95% CI=1.73, 3.39), and awareness of US Preventive Services Task Force recommendations (sun protection: aPR=1.73, 95% CI=1.51, 2.00; indoor tanning: aPR=2.70, 95% CI=2.09, 3.48). Reporting barriers to counseling was associated with a lower likelihood of regularly counseling on sun protection (1-3 barriers: aPR=0.82, 95% CI=0.71, 0.94; 4+ barriers: aPR=0.80, 95% CI=0.69, 0.93) and indoor tanning (1-3 barriers: aPR=0.72, 95% CI=0.57, 0.91; 4+ barriers: aPR=0.61, 95% CI=0.47, 0.78). Barriers to counseling included lack of time (58.1%), more urgent health concerns (49.1%), and patient disinterest (46.3%). Although many providers report regularly counseling patients on skin cancer prevention, most report serious barriers to providing such counseling. Additional research could explore strategies to integrate compelling and informative skin cancer prevention counseling into current provider practices. |
Prevalence of indoor tanning among U.S. high school students from 2009 to 2017
Holman DM , Jones SE , Qin J , Richardson LC . J Community Health 2019 44 (6) 1086-1089 Indoor tanning exposes users to high levels of ultraviolet radiation, increasing skin cancer risk. The risk is greatest for those who begin indoor tanning at a young age. The objective of this study was to assess changes in indoor tanning prevalence over time among U.S. high school students, by sex, age, and race/ethnicity. We used cross-sectional data from the 2009, 2011, 2013, 2015, and 2017 national Youth Risk Behavior Survey to examine changes in indoor tanning prevalence from 2009 to 2017 and from 2015 to 2017. From 2009 to 2017 indoor tanning declined overall (15.6 to 5.6%; p < 0.001), across all age groups, and among white (37.4 to 10.1%; p < 0.001) and Hispanic (10.5 to 3.0%; p < 0.001) female students, and white (7.0 to 2.8%; p < 0.001) and Hispanic (5.8 to 3.4%; p < 0.001) male students. From 2015 to 2017, indoor tanning declined overall (7.3 to 5.6%; p = 0.04) and among white (15.2 to 10.1%; p = 0.03) and Hispanic (5.8 to 3.0%; p = 0.02) female students, and 16-year-old students (7.2 to 4.7%; p = 0.03). Indoor tanning has continued to decrease, particularly among white and Hispanic female students, dropping well below the Healthy People 2020 target for adolescents. However, continued efforts are needed to further reduce and sustain reductions in adolescent indoor tanning and address remaining research gaps. |
Diabetes care editors' expert forum 2018: Managing big data for diabetes research and care
Riddle MC , Blonde L , Gerstein HC , Gregg EW , Holman RR , Lachin JM , Nichols GA , Turchin A , Cefalu WT . Diabetes Care 2019 42 (6) 1136-1146 Technological progress in the past half century has greatly increased our ability to collect, store, and transmit vast quantities of information, giving rise to the term "big data." This term refers to very large data sets that can be analyzed to identify patterns, trends, and associations. In medicinedincluding diabetes care and researchdbig data come from three main sources: electronic medical records (EMRs), surveys and registries, and randomized controlled trials (RCTs). These systems have evolved in different ways, each with strengths and limitations. EMRs continuously accumulate information about patients and make it readily accessible but are limited by missing data or data that are not quality assured. Because EMRs vary in structure and management, comparisons of data between health systems may be difficult. Registries and surveys provide data that are consistently collected andrepresentativeof broadpopulationsbutare limited in scopeandmaybeupdated only intermittently. RCT databases excel in the specificity, completeness, and accuracy of their data, but rarely include a fully representative sample of the general population. Also, they are costly to build and seldommaintained after a trial's end. To consider these issues, and the challenges andopportunities they present, the editors of Diabetes Care convened a group of experts in management of diabetes related data on 21 June 2018, in conjunction with the American Diabetes Association's 78th Scientific Sessions in Orlando, FL. This article summarizes the discussion and conclusions of that forum, offering a vision of benefits that might be realized from prospectively designed and unified data-management systems to support the collective needs of clinical, surveillance, and research activities related to diabetes. |
Association between sun protection behaviors and sunburn among U.S. older adults
Holman DM , Ding H , Freeman M , Shoemaker ML . Gerontologist 2019 59 S17-s27 BACKGROUND AND OBJECTIVES: Skin cancer incidence rates are highest among U.S. older adults. However, little is known about sun protection behaviors and sunburn among adults aged 65 years and older. RESEARCH DESIGN AND METHODS: We used data from the 2015 National Health Interview Survey to examine the association between sun protection behaviors (sun avoidance, wearing protective clothing, and sunscreen use) and likelihood of having experienced sunburn in the past year. RESULTS: Just over one in ten older adults (13.2%) had experienced sunburn in the past year; sunburn prevalence was nearly twice as high (20.4%) among sun-sensitive older adults. Men, ages 65-69 years, non-Hispanic whites, and those with skin that burns or freckles after repeated sun exposure were more likely to have been sunburned in the past year compared with the respective comparison groups. The only sun protection behavior significantly associated with sunburn was sunscreen use. None of the sun protection behaviors were significantly associated with a decreased risk of sunburn. DISCUSSION AND IMPLICATIONS: The prevalence of sunburn among older adults suggests opportunities to reduce skin cancer risk within this demographic group by preventing overexposure to the sun. The lack of reduced sunburn risk among those who regularly used sun protection may be related to inadequate or inconsistent use of sun protection or the way the sun protection behaviors were measured. Multi-sector approaches to facilitate sun-safety among older adults are warranted and could include targeted efforts focused on those most likely to get sunburned, including men and those with sun-sensitive skin. |
Merkel cell carcinoma incidence, trends, and survival rates among adults aged 50 years from United States Cancer Statistics
Freeman MB , Holman DM , Qin J , Lunsford NB . J Am Acad Dermatol 2019 80 (4) 1154-1156 Merkel cell carcinoma (MCC) is a rare form of skin cancer that frequently metastasizes and is associated with low survival rates.1 A recent examination of data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program—specifically SEER-18 data, which captures 28% of the US population—revealed an increase in MCC incidence rates during 2000–2013.2 For the current study, we used data from the United States Cancer Statistics, which combines state cancer registry data from the Centers for Disease Control and Prevention’s National Program of Cancer Registries and the SEER program (https://www.cdc.gov/cancer/uscs/about/index.htm), to examine patterns in MCC incidence and survival by sex, age, race/ethnicity, tumor stage, and anatomic site. |
Skin cancer prevention behaviors among agricultural and construction workers in the United States, 2015
Ragan KR , Buchanan Lunsford N , Thomas CC , Tai EW , Sussell A , Holman DM . Prev Chronic Dis 2019 16 E15 INTRODUCTION: Nearly 5 million people are treated for skin cancer each year in the United States. Agricultural and construction workers (ACWs) may be at increased risk for skin cancer because of high levels of ultraviolet radiation exposure from the sun. This is the first study that uses nationally representative data to assess sun-protection behaviors among ACWs. METHODS: We analyzed data from the 2015 National Health Interview Survey Cancer Control Supplement to examine the prevalence of sun-protection behaviors among ACWs. We calculated national, weighted, self-reported prevalence estimates. We used chi(2) tests to assess differences between ACWs by industry and occupation. RESULTS: Most of the 2,298 agricultural and construction workers studied were male (by industry, 72.4% in agriculture and 89.3% in construction; by occupation, 66.1% in agriculture and 95.6% in construction) and non-Hispanic white. About one-third had at least 1 sunburn in the past year. The prevalence of sunscreen use and shade seeking was low and did not significantly differ among groups, ranging from 15.1% to 21.4% for sunscreen use and 24.5% to 29.1% for shade seeking. The prevalence of wearing protective clothing was significantly higher among agricultural workers than among construction workers by industry (70.9% vs 50.7%) and occupation (70.5% vs 53.0%). CONCLUSION: Our findings could be used to improve occupational health approaches to reducing skin cancer risk among ACWs and to inform education and prevention initiatives addressing skin cancer. Sun-safety initiatives may include modifying work sites to increase shade and adding sun safety to workplace policies and training. Employers can help reduce occupational health inequities and protect workers by creating workplaces that facilitate sun protection. |
Sunburn prevalence among US adults, National Health Interview Survey 2005, 2010, and 2015
Holman DM , Ding H , Berkowitz Z , Hartman AM , Perna FM . J Am Acad Dermatol 2019 80 (3) 817-820 Sunburn is a biologic indicator of acute overexposure to ultraviolet (UV) radiation, and sunburn at any age is associated with an increased risk for melanoma.1 Tracking changes in the national prevalence of sunburn over time can provide insight to our nation’s progress toward increasing adequate use of sun protection and reducing skin cancer risk at a population level.2 We examined changes over time in sunburn among US adults during 2005–2015. |
Association of HIV pre-exposure prophylaxis awareness, preferred Spanish (vs. English) language use, and sociodemographic variables among Hispanic/Latino men who have sex with men
Mansergh G , Herbst JH , Holman J , Mimiaga MJ . Ann Epidemiol 2019 31 8-10 Men who have sex with men (MSM) continue to be the group at highest risk for HIV infection in the United States, and Hispanic/Latino MSM are at disproportionate risk for HIV infection compared with white MSM [1]. Furthermore, the estimated annual percentage change in the United States from 2008 to 2015 increased for Hispanic/Latino MSM, whereas it decreased for white MSM [2]. | | Pre-exposure prophylaxis (PrEP) is an efficacious tool for preventing the acquisition of HIV [3]. The Centers for Disease Control and Prevention clinical guidelines and recommendations for PrEP use have been available since 2014 and were updated in 2017 [4]. Yet, PrEP awareness and uptake are still lacking among Hispanic/Latino MSM [5]. A recent study of young MSM in Atlanta, Chicago, and New York City found awareness of PrEP to be lower among Latino/Hispanic compared with whites [6]. |
PrEP awareness in the context of HIV/AIDS conspiracy beliefs among black/African American and Hispanic/Latino MSM in three urban US cities
Olansky E , Mansergh G , Pitts N , Mimiaga MJ , Denson DJ , Landers S , Holman J , Herbst JH . J Homosex 2019 67 (6) 1-11 We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18-29 (50%), 30-39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38-0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations. |
Multi-year Study of PAHs in Mainstream Cigarette Smoke
Hearn BA , Ding YS , Watson CH , Johnson TL , Zewdie G , Jeong-Im JH , Walters MJ , Holman MR , Rochester CG . Tob Regul Sci 2018 4 (3) 96-106 OBJECTIVES: Correlations are made between mainstream cigarette smoke deliveries of individual PAHs over multiple years. Average overall PAH deliveries in mainstream cigarette smoke by study year, mentholation, ring size, and manufacturer are compared. METHODS: Mainstream smoke deliveries were determined by GC/MS for 14 polycyclic aromatic hydrocarbons (PAHs) from selected cigarettes on the US market in 2002, 2004, 2007, and 2011. The mainstream smoke PAH emissions were measured under international standardization organization (ISO) smoking conditions. Pearson product-moment correlation was used to examine the linear relationship among the PAHs over multiple years. RESULTS: A number of the PAH analytes were statistically highly correlated with each other. The overall average for mainstream smoke deliveries of PAHs did not change significantly between study years. Similar levels in average PAH deliveries were seen for mentholated and non-mentholated cigarettes. CONCLUSIONS: The strong correlations between PAH compounds over multiple years show that a limited set of PAHs can predict deliveries of others with confidence over multiple years. A more limited panel of analytes may be considered when designing studies involving PAH measurements in mainstream smoke. |
Adverse childhood experiences and the presence of cancer risk factors in adulthood: A scoping review of the literature from 2005 to 2015
Ports KA , Holman DM , Guinn AS , Pampati S , Dyer KE , Merrick MT , Lunsford NB , Metzler M . J Pediatr Nurs 2019 44 81-96 Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention. © 2018 |
Shade as an environmental design tool for skin cancer prevention
Holman DM , Kapelos GT , Shoemaker M , Watson M . Am J Public Health 2018 108 (12) e1-e6 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. (Am J Public Health. Published online ahead of print October 25, 2018: e1-e6. doi:10.2105/AJPH.2018.304700). |
Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and Hispanic men and women
Buchanan Lunsford N , Berktold J , Holman DM , Stein K , Prempeh A , Yerkes A . Prev Med Rep 2018 12 203-209 Black and Hispanic populations perceive their skin cancer risk to be low and are less likely to use sun protection strategies. We conducted formative research to understand knowledge, awareness, beliefs, and behaviors among these groups. In 2017, eighteen focus groups were conducted with black and Hispanic respondents(18-44 years) in four US cities. Groups were segmented by participant characteristics associated with elevated or lower risk for skin cancer, by race/ethnicity, gender, and age. A professional moderator followed a semi-structured discussion guide, and focus group transcripts were analyzed using conventional content analysis and NVIVO 11 Software. Most participants perceived themselves to be at low skin cancer risk due to their "darker skin tone" and/or "lack of family history." Skin cancer signs and symptoms were more inconsistently reported by blacks than Hispanics. Few participants reported regular sun protection behaviors. Those who did used sunscreen, wore protective clothing, and had elevated risk based on sun sensitivity or UV exposure. While most participants recalled family discussions (as youth) about sunscreen and sun protection, the understood intent was to warn against "further skin darkening" or to "prevent aging," not to reduce sun burns or skin cancer risk. Tanning bed use was low across all segments, especially among black respondents. Tailored skin cancer prevention campaigns need to address misperceptions about risks and benefits of skin cancer prevention behaviors among black and Hispanic populations. Families, peer groups, and healthcare providers need to be engaged in the creation of educational interventions and messaging efforts that target these populations. |
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