Monday, June 20, 2016

Making Strides Against Cervical Cancer While Reducing Burden - HPV Vaccination and HPV Testing

By Sydney Philpott

Human papillomavirus (HPV) is a very common sexually transmitted infection. According to the World Health Organization (WHO), most sexually active women and men will have an HPV infection at some point in their lives. While HPV infections usually go away on their own, certain types persist and then serve as the primary cause of cervical cancer. Globally, HPV leads to about 600,000 new cases of cervical and genitourinary cancer each year, with about 26,900 cases in the United States alone.

In 2006, HPV vaccination became available worldwide and was recommended by the WHO and the Centers for Disease Control and Prevention (CDC) for girls age 9-26 and recommended for boys of the same age group in 2011. After just 5-6 years, studies in the United States found that HPV infections in girls age 14-19 dropped 64 percent, risk of cervical pre-cancer was lowered by 47 percent, and there was a 61 percent reduction in treatment for genital warts (infographic). The WHO estimates that two-thirds of new cases of cervical cancer could be prevented if 80 percent of those age-eligible were vaccinated worldwide.

Despite these improvements, vaccination rates in the United States have remained low. On average, only 60 percent of girls age 13-17 initiate the HPV vaccination series and 39.7 percent receive all three recommended doses, while only 41.7 percent of boys initiate and 21.6 percent complete the series. Additionally, there are clear racial and socioeconomic disparities for vaccination in the United States – but these often move in a direction opposite from many health behaviors. Among adolescent girls age 13-17 in 2014, 66 percent of blacks and Hispanics had at least one dose of the HPV vaccine, while 56 percent of whites did. Similarly, 67 percent of those below the poverty line started the series, while only 58 percent above did.

These numbers, though, change a bit when looking at the percentage of girls completing the full three-dose series once they start it, suggesting that efforts that drive initiation of the vaccine fall off in certain groups when it comes to completing the entire series. Of girls who started the series, 68 percent of those living below the poverty level and 69 percent of those living above went on to complete the 3 doses – nearly identical numbers. Similarly, over 70 percent of Hispanics and whites completed the series once they started, whereas only 62 percent of blacks did.

While the relatively high vaccination initiation rate in African Americans is heartening, it's also important to ensure that as many girls as possible get subsequent doses so they are as protected as possible in the future. Currently, African American women are more likely to be diagnosed with cervical cancer at later disease stages and die at almost twice the rate compared with non-Hispanic white women. Improving rates of HPV vaccination and completion across all groups can help narrow such cancer disparities.

Furthermore, recent systematic reviews examining efforts to increase HPV vaccination use in the U.S. have conflicting conclusions, and the relative success of these interventions fell short of national averages and stated vaccination goals.

Compared to the United States, other countries have had considerably more success achieving high HPV vaccination rates. Through implementation of school-based vaccination programs, Scotland reported 81 percent three-dose vaccination in 2011, England reported 76 percent in 2010 and Australia 73 percent in 2014. In 2013, the United States reported that only 37.6 percent of adolescent girls age 13-17 had all three vaccine doses.

These discrepancies may be due to the three-dose requirement remaining a substantial barrier to successful HPV vaccination in the United States. However, recent evidence indicates that fewer than three doses may be protective. Brotherton et al. found that less than three doses provides some protection against cervical disease in Australian women, even when measured within 5 years in a population including those who were sexually active at the time of vaccination. Therefore, adolescents in the United States, and other regions with low vaccination rates, may benefit from even partial vaccination. Updated recommendations for less than three doses could also lead to reduced costs for developing countries as well as broader uptake and access to vaccination. In the United States, nearly half of girls age 13-17 have received two doses of the HPV vaccine.

The ability to also test women for HPV is changing the approach to screening for cervical cancer, especially as more and more women are being vaccinated against HPV.

Since HPV is the direct cause of nearly all cervical cancers, women who are found to have HPV can be followed more closely to see if they clear the infection, or if they have or develop cancer or pre-cancer.

In the United States, the HPV test is most often recommended along with a standard Pap test in women 30 and older. This is called co-testing. In 2014, however, the FDA approved the stand-alone HPV test as a method of cervical cancer screening, and certain professional organizations now strongly suggest that the HPV test can be used on its own as an effective alternative to standard Pap tests in most women being screened for cervical cancer.

In Australia, the National Cervical Screening Program will implement a switch in 2017 from Pap testing every two years for those age 18-69, to HPV screening alone every five years for those between the ages of 25-74. This screening transition is expected to continue to reduce cervical cancer mortality while vastly reducing the burden on women.

Fewer numbers of doctor visits and stressful, time-consuming follow-ups for positive screening tests will be a major saving for women. Improving our ways of summarizing such benefits of HPV vaccination across life from 18 to 69 could help frame vaccination as a benefit to women far beyond just reducing cervical cancer incidence.

Tuesday, June 14, 2016

Large-Scale Problem: Obesity Rates Still Increasing in Certain Groups


by Hank Dart

The course of the obesity epidemic in the United States has been so bad for so many years that even minor victories have been cause for celebration. But despite some bright spots in the most recent Centers for Disease Control and Prevention reports on national rates of obesity (on adults, on youth), there's little celebrating going on.  The reason?  Some striking milestones in the rates of obesity in both women and teenagers.

The rate of obesity in US women -- which for most of the past decade rested around 35 percent -- has now surpassed 40 percent -- rising from 35.7 percent in 2005/6 to 40.5 percent in 2013/14, the most recent years for which there are data. And this overall number doesn't tell the complete picture, as the burden of obesity isn't shared equally across all groups.  The rate of obesity is around 38.2 percent in white women, 46.9 percent in Hispanic women, and 57.2 percent in black women.  Asian women have the lowest rate, at around 12.4 percent.

While the numbers in men are concerning as well, they've stabilized somewhat over the past decade, bouncing around the mid-30s, with the most recent report finding that 35 percent of men in the United States are obese. As with women, the numbers for men vary by age, with Asians having the lowest rate (12.6%) and blacks the highest (38%).

The new numbers for youth are not quite as striking - but remain concerning as well.  They show that over the past 25 years the rate of obesity in adolescents and teenagers has nearly doubled -- from 10.5 percent to 20.6 percent -- with the overall rate of obesity in youth ages 2 - 19 years old now at 17 percent, up from 10 percent in 1988.

There are, however, two positive trends in younger kids, with rates of obesity dropping since 2004 in 2 - 5 year olds and leveling off since 2008 in 6 - 11 year olds.

The overall picture of obesity in America, however, can be quite discouraging, even for the optimists who tend to work in public health. The epidemic began over two decades ago, and no efforts so far have been able to make real strides in reversing it. And the health, quality of life, and fiscal implications are enormous.

In a recent Viewpoint in the Journal of the American Medical Association, David Ludwig, MD of Harvard Medical School and the New Balance Foundation Obesity Prevention Center writes that the latest evidence may support predictions that the obesity epidemic and its health consequences may begin to shorten life expectancy in coming generations. While advances in the treatment of obesity-related chronic diseases like heart disease, diabetes, stroke, and cancer have kept mortality rates of these disease relatively stable or on the decline, a new provisional report on death rates suggests that mortality rates may now be increasing for some diseases.  The obesity epidemic could be creating more disease, and more serious disease, that advances in treatment can no longer keep up with.

Making progress against the epidemic is going to be essential if we are to help prevent growing rates of disease in the years and decades ahead.

In addition to bolstering research on the causes and prevention of weight gain, we need to support efforts that help people make and maintain healthy food and activity choices.  As with the fight against tobacco, this means multi-pronged, multi-layered approaches - such as improved food and activity offerings in schools and workplaces, taxes on unhealthy foods, subsides for healthy foods, widespread communication campaigns, and infrastructure that allows people to easily and safely fit activity into their days.  The social, financial, and structural environment that surrounds us is key to making and sustaining healthy behaviors.

Stemming the tied of weight gain in the US will not be easy, but it's essential that as a society we garner the will to put in place a concerted effort that will benefit current and future generations.

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See also:

Other Cancer News in Context posts addressing cancer, chronic disease, and weight.

Wednesday, May 25, 2016

Universal Needs: The Role of Universal Health Coverage in Reducing Cancer Deaths and Disparities


By Graham Colditz, MD, DrPH

In the British journal, The Lancet, this week Dr. Karen Emmons and I comment on an analysis of health insurance, cancer mortality and the impact of the great recession 1. This note expands slightly on our comment and adds focus on the Vice-President's Moonshot options to improve access to cancer treatment and outcomes for cancer patients. We note that with over 14 million new cases diagnosed worldwide and over 8 million cancer deaths in 2012 2, there has been renewed focus on the accumulating global burden of cancer. A growing emphasis is now on how to increase the availability of evidence-based prevention and treatment strategies 3. In the US there has also been interest in the role of government-funded health insurance, and the rapidly increasing cost of cancer care. Globally, as of 2009 only 75 of 194 countries had legislation that provided am mandate for Universal Health Coverage (UHC) and only 58 were attaining UHC 4. In the Lancet this week, Majhiben Maruthappu et al draw on data regarding the global economic downturn to evaluate the relation between public sector expenditures on health care, change in unemployment, and cancer mortality 5. Changes in economic status, investment in cancer care and outcomes are complex and difficult to study, but critical if we are to understand the impact of different policy approaches on cancer morbidity and mortality at a population level.

Using the natural experiment created by the global economic downturn, the authors show strong relationships between unemployment and increased mortality from treatable cancers. To evaluate change in unemployment (or in public expenditure on health) in relation to change in cancer mortality, they use multivariable regression analysis assessing change within each country. They draw on detailed cancer mortality data for more than 70 countries from the World Bank and the World Health Organization mortality data from 1990 to 2010. They chose mortality from 6 cancers (prostate, female breast, male and female colorectal cancer and male and female lung cancer) as the primary outcome for assessment of the relation to unemployment changes, and assessed time lags from the recession to account for treatment impact (or lack of treatment) to emerge in the mortality data. They also evaluated changes in relation to an aggregate measure of treatable cancers (breast, prostate, colorectal) and untreatable cancers with 5-year survival less than 10% (lung and pancreas). This focus on cancer mortality avoids the long delays between many prevention or lifestyle changes and cancer incidence 6 more directly addressing the timing of, and access to, treatment and cancer outcomes. A 1% increase in unemployment was associated with a significant increase in the age-standardized mortality from treatable cancer, but no significant relation was observed for untreatable cancers. Grouping countries by health development index did not show important differences. Supplementary Figure S2 plots the unemployment and the trend in cancer mortality demonstrating this significant relationship. The authors conclude that the primary means by which increased unemployment likely has an adverse impact upon cancer mortality is through reduced access to effective care, which universal healthcare coverage can directly address. Further they show that increases in public health expenditure as a percentage of GDP was significantly associated with mortality reductions using these same cancer endpoints and that the results persisted for up to 5 years after increases in public health expenditures.

Studies of unemployment have previously shown relationships with cancer mortality, for example following the Great Depression 7. These new data bring the evidence to contemporary health care delivery and health systems. Furthermore, studies within the US show that cancer patients are more than twice as likely as their same aged peers to file for bankruptcy 8. This risk is particularly higher among those under age 65, who do not yet have access to the only universal health care mechanism in the US (Medicare) and social security (income) protection 8. Socioeconomic gradients have been reported for survival after colorectal cancer in Australia 9 and Sweden 10. Hence, even these broad social programs are not sufficient to buffer the impact of the cost of care. Higher expenditures on cancer care per case is related to lower excess cancer mortality 11. Here the added protection of universal health systems against the adverse effect of recession-induced unemployment adds further weight to the arguments for standards of care being available to all cancer patients, regardless of their personal economic or insurance resources.

These data make a strong case for universal healthcare coverage and its protective effect on cancer mortality, especially during economic downturns. Disparities in cancer outcomes between countries are likely a function of such policies on coverage and allocation of health resources 3,12. Many countries provide such coverage, but many do not, or do so in ways that issues of affordability have not been addressed. Importantly, the current study does not include data from China or India, which together have almost 37% of the world’s population 13. These two countries, each with relatively low percentage of GDP spent on health and limited access to cancer care,14 will no doubt see a dramatic rise in cancer burden in the coming years due to the population age structure and economic development, and the impact will likely be felt worldwide.

There are also persistent disparities in cancer outcomes within countries, and attention is also needed to models of care and coverage. Data examining the impact of cancer treatability on racial/ethnic disparities underscores the importance of policy-focused approaches to close the access gap. Tehranifar, et al., found that there are few disparities in survival rates for cancers that are largely untreatable 15. However, social disparities emerge in situations where the knowledge, technology, and effective medical interventions for controlling a disease exist, allowing individuals with greater access to important social and economic resources (e.g. knowledge, income, and beneficial social relations) to delay and avoid death from that disease 15. Within the United States, integrated healthcare systems demonstrate the ability to eliminate disparities between race / ethnic groups in cancer mortality that have persisted in the general population 16. As the authors note, against a background of rising health care costs, spending restrictions must be accompanied by improvements in efficiency, or it is likely that poorer quality of care will lead to higher mortality levels. Integrated health systems, which provide multi-disciplinary care pathways and focus on quality improvement, are one means of addressing quality and efficiency concerns 17.

In the US, Vice-President Biden has called for renewed efforts to address the burden and growing impact of cancer in the US and worldwide. The new data here add to the evidence that implementing universal healthcare coverage would further reduce the toll of cancer by making it possible to implement evidence-based treatments and prevention strategies that are already in hand. Universal coverage is a key United Nations Development Program Sustainable Development Goal (SDG 3), which has been described as the single most powerful concept that public health has to offer 18.

Although in many countries universal health care coverage overall is seen as an important societal investment, this has not to date been the case in the US. However, it may be very difficult to achieve the promise of improving treatments for cancer without providing coverage to those impacted by cancer. Universal coverage specifically for all cancer patients would meet the IOM recommendation to reduce disparities in access to cancer care for vulnerable and underserved populations 19. Further, universal cancer coverage would likely generate a far faster return on investment than through discovery and development of new therapies that are decades away from being implemented.


References

1. Colditz GA EK. The role of universal health coverage in reducing cancer deaths and disparities. Lancet 2016; http://dx.doi.org/10.1016/ S0140-6736(16)30376-2.

2. Ferlay J SI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F,. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer, 2013.

3. Sullivan R, Peppercorn J, Sikora K, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol 2011; 12(10): 933-80.

4. Stuckler D FA, Basu S, McKee M,. The political economy of universal health coverage. Montreux, switzerland, 2010.

5. Maruthappu M, Watkins J, Noor MA, et al. Economic downturns, universal healthcare coverage, and cancer mortality in high- and middle-income countries, 1990–2010. Lancet 2016; published online May 25. http://dx.doi.org/10.1016/S0140-6736(16)00577-8.

6. Wei EK, Wolin KY, Colditz GA. Time course of risk factors in cancer etiology and progression. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2010; 28(26): 4052-7.

7. Stuckler D, Meissner C, Fishback P, Basu S, McKee M. Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929-1937. J Epidemiol Community Health 2012; 66(5): 410-9.

8. Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013; 32(6): 1143-52.

9. Beckmann KR, Bennett A, Young GP, et al. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res 2016; 16(1): 24.

10. Eloranta S, Lambert PC, Cavalli-Bjorkman N, Andersson TM, Glimelius B, Dickman PW. Does socioeconomic status influence the prospect of cure from colon cancer--a population-based study in Sweden 1965-2000. Eur J Cancer 2010; 46(16): 2965-72.

11. Stevens W, Philipson TJ, Khan ZM, MacEwan JP, Linthicum MT, Goldman DP. Cancer mortality reductions were greatest among countries where cancer care spending rose the most, 1995-2007. Health Aff (Millwood) 2015; 34(4): 562-70.

12. Berrino F, De Angelis R, Sant M, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007; 8(9): 773-83.

13. United Nations Department of Economic and Social Affairs PD. World Population Propsects. The 2015 revision. Key findings and advance tables. Working Paper No. ESA/P/WP.241. New York: United Nations, 2015.

14. Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014; 15(5): 489-538.

15. Tehranifar P, Neugut AI, Phelan JC, et al. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev 2009; 18(10): 2701-8.

16. Rhoads KF, Patel MI, Ma Y, Schmidt LA. How do integrated health care systems address racial and ethnic disparities in colon cancer? J Clin Oncol 2015; 33(8): 854-60.

17. Shortell SM, McCurdy RK. Integrated health systems. Stud Health Technol Inform 2010; 153: 369-82.

18. United Nations. Gaol 3. Ensure healthy lives and promote well-being for all at all ages. 2015. https://sustainabledevelopment.un.org/sdg3 (accessed March 20 2016).

19. IOM (Institute of Medicine). Delivering high-quality cancer care: Charting a new course for a system in crisis. Washington, DC, 2013.

Monday, May 2, 2016

Be Less Refined: Eat More Whole Grains

Editor's note: This post originally appeared as a Health Beyond Barriers podcast on Minds Eye Radio. It was produced in English, Spanish, Bosnian, Vietnamese, and Arabic through a collaboration with LAMP, Language Access Metro Project.
By Hank Dart

Whole grains. For something so often recommended as part of a healthy diet, they can seem pretty elusive.

We sort of know what they are - but not really.

We know we should be eating more of them - but don't really know how best to do that.

Well, the good news is that whole grains are pretty easy to get a grasp on with just a handful of helpful tips.

But, first, let's try to answer the question:
Why should we even care about whole grains?
As with most diet recommendations, the quick answer to this question is: for your health.

Whole grains are packed with fiber and other key nutrients and have been found to lower the risk of diabetes, heart disease, and certain cancers. They can also help keep weight in check and the digestive system running like clockwork.

On top of this, research has found that whole grains can lower the risk of dying prematurely. Results from a study that followed over 74,000 women and 43,000 men for around 25 years showed that those who ate the most whole grains over that time had a nearly 10 percent lower risk of dying from any cause than those who ate the least.

So, whole grains aren't just an out-of-the-blue recommendation put together by disgruntled dieticians. They can have a real impact on many of the most important - and preventable - diseases.

With that in mind, let's move on to the next big question:
What are whole grains?
Most of us know what grains are. They are things like wheat, oats, rice, bulgur, and millet. This is an incomplete list, but you get the idea.

In their natural state, grain kernels have three key parts - bran, germ, and endosperm. When a grain contains all three of these it is considered a whole grain.

This is different from "refined" or "enriched" grains - like white rice and white flour - that have the bran and germ removed during processing. Bran and germ are rich in many healthy compounds, like fiber, vitamins, minerals, and phytoestrogens.

So, now that what we know what they are, we need to ask:
What amount of whole grains should we eat?
The latest Dietary Guidelines for Americans recommends that at least half of the grains we eat each day should be whole grains. While that's a little ambiguous - for most adults, it translates to about 3 - 4 ounces of whole grains every day. That's the equivalent of around 3 - 4 slices of whole grain bread, or 1½ to 2 cups of cooked brown rice. Every day.

It's not a huge amount, but it's enough that it's important to make sure you have enough healthy whole grain foods on hand. Which begs the question:
What's the best ways to find healthy whole grain foods at the store?
Luckily, we're all probably familiar with a number of healthy whole grains, like - 100% whole wheat bread, brown rice, bulgur, rolled oats, and even whole-grain pasta. So to buy more whole grains, all we need to do is take the extra step of actually putting them in our shopping carts more often.

After these easy-to-find foods, it can get a little trickier to identify healthy whole grain foods, but it's not really that hard.

First, and most important: Let the label be your guide.

Choose foods that have as the first ingredient on the food label a grain that starts with words like "whole grain" or "whole." The first ingredient in the list is the most common ingredient in the food. So, if the label on your breakfast cereal starts with "whole grain oats," then whole grain oats are the main ingredient.

This isn't a perfect system because some foods can have whole grains as a first ingredient but also have a lot of added sugar. Sugary breakfast cereals can be a good example of this. So it's best to choose whole grain foods that also have little or no added sugar.

It's also important not to let the color of a food be your only guide. Some dark breads, for example, may seem to have a lot of whole grains in them, but in fact, may have little in any - getting their color from things like molasses.

Now that we know how to find healthy whole grains, let's ask one final question:
What's the best way to fit more whole grains into our diet?
The one word answer: slowly.

If you've been eating a lot of refined grain foods, moving to whole grains can take some getting used to. Whole grains have an appealing and complex taste, but they do taste different than refined grains. So making the transition slowly gives you time to adjust and build up habits for long term success.

Start by mixing half-and-half white rice and brown rice. Do the same with white pasta and whole-grain pasta - and other grain foods you regularly eat.

Then slowly increase the amount of the whole grain foods. Over time, you may not even miss the refined grain options.

Making healthy whole grain choices doesn't mean giving up completely on the refined grain foods we like. With a little effort, though, we can add more whole grains into our day and give our diets, and our health, a real boost.

And don't we all deserve that?


Additional resources

The Nutrition Source - Harvard School of Public Health
http://www.hsph.harvard.edu/nutritionsource/whole-grains/

Choose My Plate - USDA
http://www.choosemyplate.gov/grains-tips

Dietary Guidelines for Americans 2015 - 2020
http://health.gov/dietaryguidelines/2015/guidelines/

Your Disease Risk - Siteman Cancer Center
http://www.yourdiseaserisk.wustl.edu


References

1. Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 2003;98:1790-6.

2. Ye EQ, Chacko SA, Chou EL, Kugizaki M, Liu S. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr 2012;142:1304-13.

3. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617.

4. Huang T, Xu M, Lee A, Cho S, Qi L. Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Med 2015;13:59.

5. Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA internal medicine 2015;175:373-84.

6. US Departments of Agriculture and Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services; 2015.




Monday, April 25, 2016

Tailoring Smoking Cessation Outreach: Specialty Tools of Smokefree.gov and an Innovative Study in American Indian/Alaska Native Communities

by Katy Henke

A new study sheds some light on strategies that may help smokers in under-researched communities take steps to quit. Recently, researchers from Washington University in St. Louis led a study that looked at the potential impact that graphic cigarette labels might have in sparking social interaction around smoking cessation in American Indian/Alaska Natives communities. Published in BMJ Open, the study focused on how individuals perceived graphic warning labels on cigarettes and found that participants who saw graphic images were more likely to approach a friend or family member and discuss the idea of quitting smoking. Images that portrayed children or the physical harms of smoking drew the most reaction from participants.
Sample graphic warning labels (Used with author permission) 

This was the first study of its kind to focus on cigarette labels and their potential impact within the American Indian/Alaska Natives communities, where rates of smoking are around double that of the general population. Future research will be able to build on these findings and further explore ways to bolster cessation efforts and help lower rates of smoking in these communities.

Quitting smoking is still the number one way to improve overall health, and, increasingly, efforts that promote prevention and cessation can now be effectively tailored to meet the needs and concerns of specific populations.

A number of tailored cessation programs are offered through the federal government's site, Smokefree.gov. In addition to the site's free telephone counseling at 1-800-QUIT-NOW and text message program, smokefreetxt, it offers a number of specialty websites, including:

smokefreeVET: Focuses on why many veterans begin smoking, how and why to quit smoking, and how to transition back into the civilian lifestyle while quitting. 
smokefreeWomen: Addresses the unique concerns of women who are considering or trying to quit smoking. The smokefreeMOM text messaging specifically helps pregnant women with quitting. 
smokefreeTeen: Provides information to teenagers about the importance of choosing to quit and/or staying smoke free. The site focuses on both the immediate and long term impact of smoking on the health and lifestyle of teens.  
smokefreeEspa├▒ol: Provides culturally appropriate tips and advice in Spanish on how to prepare for and begin quitting smoking.

Smokefree.gov also has a strong presence on social media that continually offers advice and education information about the benefits of quitting.

Other health resources with information on smoking and its impact on health and wellness: 
8 Ways to Prevent Cancer and Stay Healthy: This website highlights ways to lower your risk of certain cancers, including advice for quitting smoking.

Your Disease Risk: An interactive online tool designed to estimate your risk of important chronic diseases, which also offers personalized information about reducing your risk.

Thursday, April 14, 2016

Keeping "Your Disease Risk" Up to Date: Cancer Science Review and Plans for a Responsive Design

Since January of 2000, our website, Your Disease Risk, has reached millions of visitors with
personalized risk estimates and prevention messages for the most important preventable chronic diseases, including cancer, heart disease, osteoporosis, and others.

Based on feedback from both health professionals and the public, much of the appeal of the the Your Disease Risk site is its unique approach that  successfully meshes up-to-date science with engaging messages and an easy-to-navigate interface.

To maintain this important balance, the site has been through a number of programming updates and science reviews since its launch -- the most recent of which looked at the Heart Disease, Stroke, and Diabetes tools and saw the launch of a new chronic bronchitis and emphysema tool.

Starting in 2015, we began the large task of reviewing and updating the science that drives the 12 different cancer tools on the site.   With a science panel consisting of leaders in cancer and nutritional epidemiology, a consensus-based approach will be adopted to identify any necessary changes to the risk factors used in each cancer risk estimate -- as well as to the prevention messages that go along with them.

Among others, a sample of risk factor and messaging issues that will be reviewed in detail in this science update include:
Breast cancer risk
  • Weight/adiposity in youth/young adulthood
  • Mammographic density
  • Alcohol use in youth/young adulthood 
Cervical cancer risk 
    • HPV vaccination
     Colon cancer risk 
      • Processed meat 
      Ovarian cancer risk 
        • Talc use
        Prostate cancer risk 
        • New focus on advanced prostate cancer

        In concert with this science review are plans to optimize the site for mobile viewing by updating the appearance and overall design of Your Disease Risk so that it works seamlessly across all platforms - notebooks, tablets, and smartphones.

        The science review is expected to be completed by summer 2016, with updates to the site launched later in the year or early 2017.