David J. Lee

Background: Cigarette smoking remains a major public health concern among people living with HIV (PLWH), particularly those from under-resourced communities. Digital health may improve access to cessation support, yet its potential among this population remains understudied. Objective: This study explored barriers to quitting smoking and evaluated the potential of digital health for tobacco treatment among PWLH smokers. Methods: We surveyed 205 PLWH who smoked cigarettes (45.4% female; mean age 51.2 years; response rate 92.3%) to examine smoking behaviors, cessation barriers, technology access, use pattern, and interest in digital health for tobacco treatment. Multivariable logistic regression models were employed to assess how demographics and smoking behaviors influence interest in using digital health (phone calls, text messages, smartphone applications, or combinations) for tobacco treatment. Results: Participants were primarily racial and ethnic minorities, including 55.1% non-Hispanic Black and 34.2% Hispanic individuals, with 74.4% earning less than $10,000 annually. Most participants reported previous quit attempts (76.5%). Common barriers to quitting included difficulty managing cravings (45.4%), cost of treatment (28.8%), and limited access to care (25.9%), while depression (58.9%) and risky alcohol use (39.6%) were also prevalent. Access to technology was high: 91.7% owned a cell phone, 61.0% owned a smartphone, and 63.9% reported internet access. Among smartphone owners, 74.0% used mobile applications. Phone calls were the most preferred single digital health modality for tobacco treatment (51.7%), followed by text messaging (43.9%), smartphone applications (39.0%), and video conferencing (38.5%). Preferred intervention methods included mindfulness strategies (73.0%), nicotine replacement therapy (71.1%), and counseling (63–65%). Non-Hispanic Black and non-heterosexual participants showed significantly higher interest in digital health for tobacco treatment, with aOR 5.49 (1.44 – 20.90) and 6.02 (1.46 – 24.82), respectively. Practice Implications: Despite barriers, PLWH smokers are interested in digital health for tobacco treatment. Incorporating digital tools could improve access and reduce disparities in this population.

Background: Firefighters display increased risk of colorectal cancer (CRC). The distribution for CRC stage at diagnosis among firefighters compared to other occupational groups is unknown. Methods: Colorectal cancer cases from the Florida Cancer Data System cancer registry (2001-2014) for males ≥20 years were ascertained. Firefighters were identified through either direct linkage with Florida Fire Marshal’s Office employment and certification records or Standard Occupation Codes annotated at diagnosis. White-collar, blue-collar, and service workers were also identified according to these codes. Stage at diagnosis was classified as localized, regional, or distant. Bivariate tabulations of occupational groups and clinicodemographic covariates were conducted using contingency tables. The association between occupational group and stage at diagnosis was assessed by multivariable multinomial logistic regression adjusting for year of diagnosis, age, race and ethnicity, tobacco use and cancer diagnosis sequence. Adjusted odds ratios (aORs) are reported. Results: In total, 13 813 CRC cases, including 346 cases among firefighters, were analyzed. Firefighters were more likely to be non-Hispanic white and be diagnosed with a single primary cancer. One hundred and forty (40.5%) firefighter CRC cases were localized. Using firefighters as the referent group, only blue-collar workers approached 50% increased odds of later-stage diagnoses (aORRegional = 1.44; 95% CI = 1.12 to 1.84; P = .004; aORDistant =1.49; 95% CI = 1.11 to 2.01; P = .008). Individuals ≥50 years and the first among multiple primary cancers were more likely to have localized CRC (P < .001). Conclusion: Although firefighters have increased CRC risk, they tend to be diagnosed more localized. Improved screening across worker groups can increase the percentage of localized CRCs.

Introduction: Low-income people living with HIV (PLWH) in the United States encounter several behavioral challenges. Multiple-behavior interventions targeting multiple risks are promising. Cigarette smoking remains high among PLWH (47%), and smokers have low adherence to antiretroviral therapy (ART). This study explores the feasibility of a smartphone app-based intervention combining mindfulness training (MT) for smoking cessation with video directly observed therapy (vDOT) for ART monitoring among minority and low-income PLWH. Methods: We conducted a proof-of-concept feasibility three-arm randomized controlled trial among PLWH (n = 39; 53.8% males) to test three treatment groups (Gs): (G1) usual care (UC; brief advice to quit and ART adherence); (G2) MT app plus brief advice to ART adherence; and (G3) MT plus vDOT apps. The primary outcomes were intervention feasibility, acceptability, app usability, smoking cessation, and ART adherence improvement. Results: Enrollment rate was low (37%) due to low access to technology and language barriers. Retention rates were high (UC: 92.3%, G2: 84.6%, G3: 100.0%). The MT app usability was higher (G2: 72.8%, G3: 69.2%) than the vDOT app (G3: 23.1%). G2 participants were more satisfied with treatment than G3 (p < .04). Smoking abstinence rates in G2 and G3 were double that in UC (UC: 25.0%, G2: 45.5%, G3: 53.8%). ART adherence improved by 53.0% in G2 and G3 compared to 30.7% in UC. Conclusions: The combined intervention was promising. However, the app-based intervention feasibility was low, and vDOT for ART monitoring was unacceptable. These results will inform the optimization and further testing of the multi-component intervention. Implications: Disparities in HIV persist among minority and low-income groups who face several behavioral challenges. The current proof-of-concept trial indicated that the multiple-behavior intervention targeting smoking cessation and adherence to ART in minority and low-income PLWH is promising. However, given the low access to technology and the language barrier in this group, the feasibility of the app-based intervention was low. Video-based strategy to monitor ART adherence was not acceptable due to privacy concerns. As healthcare becomes more reliant on technology-based tools, research is needed to address the digital divide among this group to prevent the exacerbation of existing healthcare access disparities.

Objective: There is limited information on the risk of multiple primary cancers (MPCs) among firefighters. We evaluated the distribution and relative risk of MPC for male career firefighters versus nonfirefighters for the second, third, or fourth diagnosed cancers. Methods: This population-based study employed linked data (1981–2014) from three sources in Florida to report the distribution and relative risk of MPC. Results: There are 290,624 (20.81%) MPCs (n = 1054 career firefighters, n = 289,570 nonfirefighters). Firefighters have 1.14 times (95% CI, 1.00–1.30; P = 0.047) greater number of MPC compared to nonfirefighters. The distribution of MPC sites was relatively similar. Compared to nonfirefighters, firefighters had a higher risk of melanoma of the skin, all melanomas for both the first and second MPCs. Conclusion: Future research is warranted to investigate melanoma risk as MPC and to identify associated occupational hazards.

Studies examining occupational exposures and cancer risk frequently report mixed findings; it is thus imperative for researchers to synthesize study results and identify any potential sources that explain such variabilities in study findings. However, when synthesizing study results using meta-analytic techniques, researchers often encounter a number of practical and methodological challenges. These challenges include (1) an incomparability of effect size measures due to large variations in research methodology; (2) a violation of the independence assumption for meta-analysis; (3) a violation of the normality assumption of effect size measures; and (4) a variation in cancer definitions across studies and changes in coding standards over time. In this paper, we first demonstrate these challenges by providing examples from a real dataset collected for a large meta-analysis project that synthesizes cancer mortality and incidence rates among firefighters. We summarize how each of these challenges has been handled in our meta-analysis. We conclude this paper by providing practical guidelines for handling challenges when synthesizing study findings from occupational cancer literature.

Introduction: Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied. Methods: We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal’s Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n = 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities. Results: Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7–97.1%) than the general population (94.2%, 95%CI: 94.1–94.3%). Overall, firefighters’ diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34–0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18–2.86) than the general population. Conclusion: Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters’ lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters’ quality of life.

All-cause mortality among diverse Hispanic/Latino groups in the United States and factors underlying mortality differences have not been examined prospectively. To describe cumulative all-cause mortality (and factors underlying differences) by Hispanic/Latino background, before and during the COVID-19 pandemic. Prospective, multicenter cohort study. Hispanic Community Health Study/Study of Latinos. 15 568 adults aged 18 to 74 years at baseline (2008 to 2011) of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other backgrounds from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California. Sociodemographic, acculturation-related, lifestyle, and clinical factors were assessed at baseline, and vital status was ascertained through December 2021 (969 deaths; 173 444 person-years of follow-up). Marginally adjusted cumulative all-cause mortality risks (11-year before the pandemic and 2-year during the pandemic) were examined using progressively adjusted Cox regression. Before the pandemic, 11-year cumulative mortality risks adjusted for age and sex were higher in the Puerto Rican and Cuban groups (6.3% [95% CI, 5.2% to 7.6%] and 5.7% [CI, 5.0% to 6.6%], respectively) and lowest in the South American group (2.4% [CI, 1.7% to 3.5%]). Differences were attenuated with adjustment for lifestyle and clinical factors. During the pandemic, 2-year cumulative mortality risks adjusted for age and sex ranged from 1.1% (CI, 0.6% to 2.0%; South American) to 2.0% (CI, 1.4% to 3.0%; Central American); CIs overlapped across groups. With adjustment for lifestyle factors, 2-year cumulative mortality risks were highest in persons of Central American and Mexican backgrounds and lowest among those of Puerto Rican and Cuban backgrounds. Lack of data on race and baseline citizenship status; correlation between Hispanic/Latino background and site. Differences in prepandemic mortality risks across Hispanic/Latino groups were explained by lifestyle and clinical factors. Mortality patterns changed during the pandemic, with higher risks in persons of Central American and Mexican backgrounds than in those of Puerto Rican and Cuban backgrounds. National Institutes of Health.

그동안 리질리언스 연구는 주로 단기간 제한된 지역에 피해를 주는 재난을 대상으로 수행되었다. 본고에서는 향후 감염병 재난과 기후위기 등 중장기적, 점진적 재난이 계속될 것으로 예상되는 상황에서 리질리언스 개념과 프레임워크 구성에 있어 재난의 특성을 고려할 필요가 있음을 제안했다. 우선 지역사회 단위 재난관리 중요성과 사회생태학적 리질리언스, 지역사회 재난 리질리언스 프레임워크 구성요소 중 자본과 속성을 개관했다. 그리고 코로나19 재난상황에서 해당프레임워크의 적용가능성에 대해 검토 후 다음과 같은 주요 시사점을 도출하였다. 첫째, 향후 연구에서는 자본, 속성의 특성뿐만 아니라 시간의 흐름에 따른 이들 간 관계 변화가능성에 주목할 필요가 있다. 둘째, 기존에 단일한 지역사회 단위로 이해되었던 프레임워크 내에서 정부와 비영리부문의 고유의 역할이 달라질 수 있음을 주지하고 이에 대한 이론화 연구가 필요하다.