Legal recreational cannabis use and binge drinking is on the rise for older adult

Decline in binge drinking among young adults reported in states with recreational cannabis laws

Peer-Reviewed Publication

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

June 15, 2023 --New research at Columbia University Mailman School of Public Health examined changes in binge drinking after the implementation of recreational cannabis laws.

Analysis of national survey data from Americans aged 12 and older showed that past-month binge drinking increased overall among people aged 31 and over from 2008 to 2019. At the same time, binge drinking declined overall among people aged 12-30. The results are published online in the International Journal of Drug Policy.

The most substantial declines in binge drinking were observed among people ages 12-20 (from 17.5 percent in 2008 to 11 percent in 2019), followed by respondents ages 21-30 (from 44 percent to 40 percent). While overall increases in binge drinking were recorded in all U.S. states regardless of cannabis laws among individuals ages 31 and older, the most extensive increases between 2008 and 2019 were noted among people ages 31-40, from 28 percent to 33 percent, followed by those aged 51 and over (from 13 percent to 17 percent).

When investigating binge drinking prevalence before and after implementation of recreational cannabis laws, the authors observed a 4.8 percent decrease in binge drinking among people aged 12-20. However, they also noticed an increase after implementation of recreational cannabis laws among those aged 31 and older (with an increase of 1.7 percent for adults aged 31-40, 2.5 percent for those aged 41-50, and 1.8 percent for those aged 51 and older). Until now, research on the relationship between recreational cannabis laws (RCLs) and binge drinking has been limited to data from just a few states, small study samples, and combined age groups.

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as 5 or more drinks for men or 4 or more drinks for women per drinking session. Binge drinking has been associated with acute adverse outcomes such as motor vehicle crashes and traffic fatalities, criminal legal system exposure, poor academic achievement, and emergency department visits.

 

The study, one of the first to report associations between binge drinking and recreational cannabis laws in adolescents and adults at a national level, builds on existing literature by using nationally representative data to investigate the potential effects of the changing cannabis policy landscape in all age groups also adjusting for a comprehensive measure of state alcohol policies.

“Our earlier research showed the impact of legalizing cannabis on the perception and availability of cannabis use and changes in alcohol use patterns,” said Silvia S. Martins, MD, PhD, professor of epidemiology in the Department of Epidemiology at Columbia Mailman School, and senior author. “The current literature supports two possible hypotheses. The complementary is that both cannabis and alcohol use may increase after cannabis legalization as individuals use these substances together. The substitution hypothesis is that alcohol use may decrease after cannabis legalization, as individuals may use cannabis instead of alcohol when both are readily available. Evidence regarding these hypotheses remains inconclusive, especially regarding how cannabis legalization may impact binge drinking across different age groups,” said Priscila Dib Gonçalves, PhD, post-doctoral fellow in the Substance Abuse Epidemiology program in the Department of Epidemiology at Columbia Mailman School, and first author of the study.   

The researchers make the point, therefore, that more research is needed to understand the incremental change in binge drinking associated with RCLs using nationally representative data across different age groups. “We believe that future studies should examine the relationship of other environmental and individual factors, such as perceived risk, disapproval, availability, peer drinking, alcohol expectancy, among binge drinking and recreational cannabis laws in this age group,” noted Dib Gonçalves. 

“It is worth noting that cannabis legislation is complex, involving multiple policy decisions, including regulations of supply chain and operation: government monopoly, retail sales, legal home cultivation, advertisement, types of products distributed, prices, and taxes, and each state may have different policies when regulating recreational cannabis use,” said Martins. “As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.”

 

Co-authors are Emilie Bruzelius, Natalie S. Levy, Luis E. Segura, Ofir Livne, Sarah Gutkind, Pia M. Mauro, Columbia University Mailman School of Public Health; Anne E. Boustead and Deborah S. Hasin, Department of Psychiatry, Columbia University Irving Medical Center; Diana Silver, New York University School of Global Public Health; and James Macinko, UCLA Fielding School of Public Health.

The study was funded by grants from the U.S. National Institutes of Health, National Institute on

Drug Abuse, R01DA037866, T32DA031099, R01DA048860, and K01DA045224. This research was supported in part by the National Center for Injury Prevention and Control, Centers for Disease

Control and Prevention, 1 R49 CE002096-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors declare having no conflict of interest.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.publichealth.columbia.edu

 

 

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JOURNAL

International Journal of Drug Policy

DOI

10.1016/j.drugpo.2023.104085 

ARTICLE TITLE

Recreational cannabis legislation and binge drinking in U.S. adolescents and adults

Extensive study links cannabis use disorder to mental disorders

A new study suggests that cannabis use disorder leads to an increased risk of developing bipolar disorder and depression

Peer-Reviewed Publication

AARHUS UNIVERSITY

 

IMAGE: "AS FAR AS WE KNOW, WE’VE CONDUCTED THE WORLD'S LARGEST STUDY OF THE LINK BETWEEN CANNABIS USE DISORDER AND AFFECTIVE DISORDERS," SAYS OSKAR HOUGAARD JEFSEN, A PHD STUDENT FROM THE DEPARTMENT OF CLINICAL MEDICINE AT AARHUS UNIVERSITY. HE IS THE FIRST AUTHOR OF THE STUDY, WHICH INCLUDES REGISTER DATA FROM MORE THAN SIX MILLION DANES. PHOTO: SIMON BYRIAL FISCHEL view more 

CREDIT: PHOTO: SIMON BYRIAL FISCHEL

Cannabis is one of the world's most commonly used illegal drugs. New research suggests that cannabis use disorder is more strongly linked with the development of mental disorders than previously assumed.

The study includes register data from more than six million Danes and its findings indicate that cannabis use disorder increases the risk of both psychotic and non-psychotic depression and bipolar disorder.

"When we take differences in gender, age, socioeconomics and family history, and more into account, we see that cannabis use disorder is associated with almost twice the risk of developing depression and a two-to-three-times higher risk of developing bipolar disorder in both men and women," says Oskar Hougaard Jefsen, a PhD student from the Department of Clinical Medicine at Aarhus University. He is the lead author of the study, which has just been published in the scientific journal JAMA Psychiatry.

According to the Danish Health Authority, one in three Danes under the age of 25 has smoked cannabis. However, the new study only focuses on people with a significant consumption of cannabis such that they have been registered with a substance use disorder – e.g. because they have been in contact with the substance abuse treatment system or other parts of the healthcare system.

More countries are legalising cannabis

Several studies have supported the hypothesis that extensive cannabis use is not harmless to human mental health. For example, previous studies suggest that cannabis use disorder can increase the risk of developing schizophrenia. But until now, the risk of other mental disorders has been sparsely studied.

In this study, researchers from Aarhus University and the University of Copenhagen have analysed data from Danish nationwide registers such as the National Patient Register, the Danish Psychiatric Central Research Register and the Danish Register of Pharmaceutical Sales.

"The study is the largest of its kind in the world, and our findings suggests that cannabis use disorder is also associated with an increased risk of developing depression and bipolar disorder. The results recommend caution when it comes to using cannabis. This applies to people with an increased risk of developing mental illness, and to politicians and other decision-makers who are discussing the possibilities of legalising cannabis," says Oskar Hougaard Jefsen.

An increasing number of countries are legalising the production and sale of cannabis for medicinal and recreational use. Since 2018, general practitioners in Denmark have been able to write prescriptions for drugs based on cannabis for patients as part of a trial scheme that also gives companies and individuals the opportunity to produce cannabis for medicinal or industrial use.

Oskar Hougaard Jefsen believes that the results of the study should be considered when it comes to legalising and controlling cannabis use.

"We should conduct more research into whether there are people for whom cannabis is particularly harmful. This could strengthen preventative measures," he says, adding that there is a particular need for more knowledge about the dose-dependent effects of cannabis use on the brain, cognition and behaviour, and for identifying risk factors for the transition from cannabis use disorder to psychiatric disorders.

No conclusive evidence

Oskar Hougaard Jefsen points out that, despite the indications in the study, it does not provide conclusive evidence that cannabis causes these mental disorders.

For example, he cannot rule out that undiagnosed depression or bipolar disorder has led some of the people in the register-based study to develop cannabis use disorder – i.e. the disease resulted in the abuse and not the other way around.

"But when we see an increased disease risk – even ten years after the cannabis use disorder has been registered – I don't think that self-medication can be the only explanation. It seems unlikely that so many people would go undiagnosed for so long," he says.

"Danish register data really gives us a unique opportunity to take into account many of the crucial factors that could affect the results. However, conclusive evidence would require a randomised controlled trial in which a group of people would have to smoke large amounts of cannabis to see if this increased their risk of developing mental illness in the long term, and such a study would of course be unethical," he says.

 

The research results - more information

• The study is a register-based epidemiological cohort study of 6,651,765 people born in Denmark before 2006, and who lived in Denmark between 1995 and 2021. An equal number of men and women appear in the study.
• The partners are Associate Professor Carsten Hjorthøj, Senior Researcher Annette Erlangsen and Clinical Professor Merete Nordentoft – all three from the University of Copenhagen.
• Read more in the scientific article: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2804862

 

Contact

Oskar Hougaard Jefsen, PhD student
Aarhus University, Department of Clinical Medicine - Psychoses Research Unit
Telephone: +45 30 11 20 66
Email: oskar.jefsen@clin.au.dk

Ole Mors, professor and consultant
Aarhus University, Department of Clinical Medicine - Psychoses Research Unit
Telephone: +45 29 47 97 80
Email: ole.mors@clin.au.dk

 

 

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JOURNAL

JAMA Psychiatry

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder

Eating meals earlier improves metabolic health

Meeting Announcement

NYU LANGONE HEALTH / NYU GROSSMAN SCHOOL OF MEDICINE

 

IMAGE: EARLY TIME-RESTRICTED FEEDING (ETRF) IMPROVES GLYCEMIA AND INFLAMMATORY MARKERS EVEN IN THE ABSENCE OF WEIGHT LOSS. view more 

CREDIT: NYU LANGONE HEALTH

Eating more of one’s daily calories earlier in the day may counter weight gain, improve blood sugar fluctuations, and reduce the time that blood sugar is above normal levels, a new study suggests.

“This type of feeding, through its effect on blood sugar, may prevent those with prediabetes or obesity from progressing to type 2 diabetes,” said study lead author Joanne H. Bruno, MD, PhD, an endocrinology fellow at NYU Langone Health.

Presented at the Endocrine Society’s annual meeting on June 15, the new report evaluated early time-restricted feeding (eTRF), which involves restricting calories to the first eight hours of the day. Previous studies have found this form of intermittent fasting may improve cardiometabolic health and blood sugar levels. However, the team wanted to determine whether these improvements are related to weight loss or the fasting strategy.

Led by researchers at NYU Grossman School of Medicine, the work is the first to evaluate the effects of early time-restricted feeding on glycemia and inflammation independent of weight loss.

For their study, the researchers compared eTRF (80 percent of calories consumed before 1PM) to a usual feeding pattern (50 percent of calories consumed after 4PM) among ten participants with prediabetes and obesity.

The patients were randomized to eTRF or usual feeding patterns for the first seven days and were changed over to the alternative arm for the next 7 days. Food was provided to meet the patients’ caloric needs for weight maintenance to determine the weight-independent effects of this strategy. Patients wore continuous glucose (blood sugar) monitors throughout the study.

“We decreased the time these individuals were having high blood sugar levels with just one week of eTRF feeding,” said study senior author Jose O. Aleman, MD, PhD, assistant professor in the Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism at NYU Grossman School of Medicine. “The findings show that eating a majority of one’s calories earlier in the day reduces the time that the blood sugar is elevated, thereby improving metabolic health.”  

Dr. Aleman and colleagues discovered the participants’ weights were stable throughout the study. Early time-restricted feeding led to a decreased mean amplitude of glycemic excursion and decreased time above range (blood glucose > 140mg/dL) compared to the usual eating pattern group. The time in range was similar between the eTRF and usual feeding pattern group.

“Based on this data, eTRF may be a helpful dietary strategy for diabetes prevention,” concluded Dr. Bruno. “Further studies are needed to understand the true overall benefit of these intervention strategies.”

Funding for the study was provided by the National Heart, Lung and Blood Institute Institutional training grant T32HL098129 and National Institutes of Health grant K08 DK117064. Further funding was provided by Rockefeller University’s Shapiro Silverberg Fund for the Advancement of Translational Research.

In addition to Dr. Bruno and Dr. Aleman, other NYU Langone researchers involved in the study were Shabnam Nasserifer, MD; Sally Vanegas, PhD; and Collin Popp, PhD.

Media Inquiries
Katie Ullman

Phone: 646-483-3984

Kathryn.ullman@nyulangone.org

Fewer meals may prevent Type 2 diabetes, obesity

Reducing meals, cutting out midnight snacks may optimize gut health

Peer-Reviewed Publication

UNIVERSITY OF GEORGIA

When intermittent fasting became all the rage among Hollywood celebrities, skeptics balked at the idea of skipping meals. But new research from the University of Georgia suggests the celebs might not have been that far off.

The review found that a specific type of restricted eating may reduce the chances of developing Type 2 diabetes and improve your overall health. Known as time-restricted eating, this type of fasting means having regular but fewer meals, cutting out late-night snacks and not eating for 12 to 14 hours (often overnight).

After a comprehensive review of published, peer-reviewed studies, the researchers found a connection between number of meals and obesity and Type 2 diabetes.

“What we’ve been taught for many decades is that we should eat three meals a day plus snacking in between,” said Krzysztof Czaja, an associate professor of biomedical sciences in UGA’s College of Veterinary Medicine. “Unfortunately, this appears to be one of the causes of obesity.”

The three meals and snacks style of eating prevents insulin levels from going down during the day, and, with the amount of calories and sugars Americans consume on average, that can overload the body’s insulin receptors. That leads to insulin resistance and often Type 2 diabetes.

“That’s why it’s so hard to lose body fat,” Czaja said. “We are not giving our bodies a chance to use it. Having fewer meals a day will allow these fat deposits to be used as an energy source rather than the sugar we keep consuming.”

Modern eating approach disrupts body’s biological clock

The researchers found that time-restricted eating allows the body to relax and lower insulin and glucose levels, which in turn can improve insulin resistance, brain health and glycemic control. It can also reduce calorie intake by around 550 calories per day without the stress of calorie counting.

Previous studies have shown disruptions to sleep and meal schedules can change both the type and amount of bacteria and other microorganisms in the digestive tract. But fasting may positively alter the gut microbiome, potentially staving off inflammation and a variety of metabolic disorders.

Additionally, the review suggests time-restricted eating can help regulate hormones responsible for appetite regulation and energy levels.

Regular meal schedules, eating breakfast and decreasing meals and snacks can help guard against obesity and Type 2 diabetes, according to the publication. And not all breakfasts aren’t created equal. Aim for healthy fats and protein, like eggs, and avoid the sugar-filled breakfast cereals and pastries.

Although time-restricted eating appeared to improve health, the researchers found that other types of restricted eating, such as fasting for days on end, provided few benefits.

Regular but fewer meals can stave off obesity and metabolic disorders

More than four in 10 Americans are clinically obese, meaning their weight is higher than what is considered a healthy range for their height. Almost 10% are severely obese, according to the Centers for Disease Control and Prevention.

Obesity may lead to a variety of health conditions, including Type 2 diabetes, heart disease and even some cancers.

“Obesity is an epidemic right now, especially in the United States,” Czaja said. “It is a preventable disease. When we started looking at the research, we found that ancient humans didn’t eat every day. That means our body evolved not needing food every day.”

The modern approach of three meals plus snacks became popular decades ago, and it’s a hard pattern to break.

“But our gut-brain signaling is not designed for this type of eating,” Czaja said.

The researchers caution that eating is not a one size fits all situation. Smaller, less active people need fewer calories on average than taller athletes, for example. So for some, one meal of nutrient-rich food might be another while others may need more.

But one thing was very clear from the literature they reviewed: Fewer meals of high-quality food is a good guideline for individuals at risk of developing Type 2 diabetes and obesity.

“Also definitely avoid late-night eating,” Czaja said. “Our midnight snacks spike insulin, so instead of us going into a resting state when we sleep, our GI is working on digestion. That’s why we wake up in the morning tired—because we don’t get enough resting sleep.”

Published in Nutrients, the study was co-authored by Carlee Harris, an undergraduate biology major in UGA’s Franklin College of Arts and Sciences.

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JOURNAL

Nutrients

DOI

10.3390/nu15071762 

ARTICLE TITLE

Can Circadian Eating Pattern Adjustments Reduce Risk or Prevent Development of T2D?

NCCN convenes policy summit assessing impact of geography on cancer outcomes, examining rural and urban divide

Speakers explored the challenges that can lead to increased cancer incidence or mortality and possible policy solutions to address access and quality issues, including the use of NCCN Guidelines to establish an equitable standard of care.

Meeting Announcement

NATIONAL COMPREHENSIVE CANCER NETWORK

 

IMAGE: CONGRESSMAN BRIAN HIGGINS (NY-26), CO-CHAIR OF THE CANCER CAUCUS IN THE U.S. HOUSE OF REPRESENTATIVES, SPEAKS DURING NCCN ONCOLOGY POLICY SUMMIT IN WASHINGTON, D.C. VISIT NCCN.ORG/SUMMITS FOR MORE. view more 

CREDIT: NCCN

WASHINGTON, D.C. [June 15, 2023] — Today, the National Comprehensive Cancer Network® (NCCN®)—an alliance of leading cancer centers—convened a policy summit to examine how geography impacts cancer outcomes.

NCCN Chief Executive Officer, Robert W. Carlson, MD, opened the event with a focus on equity.

“NCCN’s work is guided by the idea that where you live should not impact whether you live,” said Dr. Carlson. “NCCN Guidelines are one free resource to make sure everyone, everywhere, has access to cancer care based on the latest evidence and expert consensus. They can be used as guardrails to standardize treatment—preventing under or overtreatment—while still enabling freedom for personalized care.”

Advocates, providers, lawmakers, and others shared diverse perspectives on how location, policies, culture, and built environment can all impact cancer incidences and outcomes.

“Broadly, ‘built environment’ refers to all human-made surroundings, and includes various cancer-relevant factors, such as: reliable internet access; accessible high-quality cancer care and public transportation; level and continuous sidewalks; nearby parks and recreational facilities, nutritious foods, and tree-cover; clean air and water; and safe and supportive housing and neighborhoods,” explained panel member Jesse John Plascak, PhD, MPH, Assistant Professor, Division of Cancer Prevention & Control, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute. “Investing in improving the built environment translates to better health outcomes, including cancer.”

The program featured a fireside chat with Congressman Brian Higgins (NY-26), who shared an overview of the policy landscape and a look at how different regions can be better served.

“Early detection is our best protection against cancer of all types, but many Americans, especially those living in underserved communities, lack access to regular screenings which puts them at a greater risk,” said Congressman Higgins. “As Co-Chair of the Cancer Caucus in the U.S. House of Representatives, I am committed to advancing efforts that address equity in cancer care, improve access to routine screenings, and increase funding leading to breakthroughs and advancements in treatments. Together, we can reach the communities in greatest need and achieve the goals set forth by President Biden’s Cancer Moonshot to end cancer as we know it.”

Elisa Rodriguez, PhD, MS, Vice President & Associate Director of Diversity, Equity and Inclusion (DEI) at Roswell Park Comprehensive Cancer Center, provided the keynote address.

“Our nation’s cancer centers are uniquely positioned to address cancer health disparities and inequity in access to cancer services,” noted Dr. Rodriguez, who also serves as Director of the Community Engagement Resource for Roswell Park and is a Member of the NCCN DEI Directors Forum. “The populations and regions we serve are diverse in many ways—they are rural, urban, and suburban, and the people living in these distinct geographic regions reflect every dimension of humanity and need. Our experiences at Roswell Park can serve as a model for how cancer centers can enlist partners in their work to enhance infrastructure and develop effective strategies to address the cancer burden, increasing access to cancer care for all patients.”

There was a focus on the rural/urban divide throughout the summit, with speakers identifying how various regions can face very different challenges which require thoughtful solutions. They noted that cancer incidence rates tend to be higher in urban areas, but mortality rates are higher in rural communities. In urban areas, there may be more environmental and behavioral stressors contributing to cancer incidences, such as less access to safe places for physical activity or affordable fruits and vegetables. In rural areas, there are numerous barriers to accessing medical care providers—particularly specialists—including staffing shortages and transportation concerns.

“Access to innovative oncology treatments and clinical trials for patients—regardless of where they live—has long been a challenge in oncology and clinical development,” said Sara Kulwicki, MS, Associate Vice President, Clinical Development-Oncology Clinical Design, Delivery & Analytics, Lilly. “In addition to barriers that exist for all patients, those in rural areas face increased obstacles to receiving optimal care. We must continue educating, advocating, and deploying solutions that remove financial, transportation, and other barriers, bringing care closer to patients.”

“A substantial number of rural patients often prefer or need to receive cancer care locally, yet many community hospitals are too under-resourced to offer the continuum of comprehensive and supportive cancer services included in evidence-based standards of care,” agreed Mary Charlton, PhD, Associate Professor, Department of Epidemiology, The University of Iowa, and Director Iowa Cancer Registry. “In order to provide quality care across varying locales, we must develop a multi-faceted, collaborative cancer network approach that extends the resources and expertise from larger cancer centers out to rural hospitals and providers. This must be done in a way that capitalizes on everyone’s strengths while fostering trust and engagement between providers. This strategy has worked well in states like Kentucky and Kansas, and our research aims to develop a rigorous implementation strategy to adapt these network approaches throughout rural America.”  

The speakers offered many insights on leveraging technology to serve more patients. They acknowledged the massive expansion in telehealth was one positive thing to come from the Covid-19 pandemic. However, panel members pointed out that there is still more work to be done to harness technology effectively and equitably. Speakers also spotlighted how interpersonal interactions play an outsized role in finding solutions for the many challenges that prevent rural patients from getting high-quality care.

"The key to delivering specialized cancer care to rural patients is to make that care accessible through a multifaceted approach, collaborating with community oncologists and primary care providers with bidirectional trust and communication," commented Ursa Brown-Glaberman, MD, Associate Professor, Hematology/Oncology, Medical Director, Clinical Research Office, University of New Mexico Cancer Comprehensive (UNM CCC).

“While issues of policy, technology and geography are important, we can’t forget that a community’s culture must be considered and understood when working to increase access to cancer screenings and treatments,” agreed Keith Argenbright, MD, Director, Moncrief Cancer Institute, UT Southwestern Harold C. Simmons Comprehensive Cancer Center. “We must always keep in mind the cultural differences that make our targeted populations unique and work to create policies and partnerships that are embraced by those communities.”

Alma McCormick, BS in Health and Human Performance, Health and Wellness, Executive Director, Messengers for Health, Crow Nation, and Member, PCORI Advisory Panel on Patient Engagement, shared stories of successful community-based participatory research addressing the cancer needs among Crow Indian people. She had a suggestion for one way to gain trust in marginalized communities: “Do what you say you are going to do.”

She continued: “Go to where the people are and let them know you care.”

International radiation oncology head and neck expert Waleed Mourad, MD, Professor of Radiation Oncology, Medical Director, Morehead Cancer Center at The University of Kentucky is doing exactly that on a global scale. Dr Mourad is both the Radiation Oncology physician founder of sub-Saharan Cameroon Oncology Cancer Center and the current medical director of an academic rural practice in Appalachia. He discussed the A to Z challenges of ground up establishment of a cancer treatment facility as well as ongoing challenges in prevention, screening, diagnosis, treatment, and surveillance in both settings..

“Working toward the World Cancer Day goal to ‘Close the Care Gap’ takes a village,” said Dr. Mourad. “With the increased globalization of society, we are all citizens of the world. I cannot underscore enough how important it is to address and mitigate care gaps by delivering culturally-appropriate, team-oriented, competent care.”

Panelists Mei Wa Kwong, JD, Executive Director, Center for Connected Health Policy; Janette Merrill, MS Ed, Senior Director of Policy Programs, American Society of Clinical Oncology (ASCO); and Joette Walters, MSN, MBA, RN, Chief Executive Officer, Tuba City Regional Health Care Corporation, Navajo Nation, also made key contributions to the program. The panel discussions were moderated by Clifford Goodman, PhD, and closing remarks were provided by NCCN Chief Operating Officer Gary Weyhmuller, MBA, SPHR.

The next NCCN policy summit is coming up on September 12, 2023, with a focus on measuring and addressing health-related social needs in cancer. The event will include the launch of a high-impact screening tool to help health care providers meet patient needs and provide better care. Visit NCCN.org/summits to learn more and register.

# # #

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

Historic redlining practices cast a long shadow on cancer screening rates

A new study shows that people who live in historically redlined areas have lower screening rates for breast cancer, cervical cancer, and colorectal cancer

Peer-Reviewed Publication

AMERICAN COLLEGE OF SURGEONS

 

IMAGE: ACCORDING TO A NEW STUDY PUBLISHED IN THE JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, REDLINING WAS ASSOCIATED WITH LOWER ODDS OF HITTING NATIONAL SCREENING TARGETS FOR CERVICAL, COLON, AND BREAST CANCERS. view more 

CREDIT: AMERICAN COLLEGE OF SURGEONS

Key Takeaways

• Banned since 1968, the legacy of redlining persists: There continue to be instances of discrimination affecting people in these historically redlined areas.
• Redlining was associated with lower odds of hitting screening targets for all three types of cancer: 24% lower odds in breast cancer, 64% lower odds in colorectal, and 79% lower odds in cervical cancer, compared with non-redlined areas.
• Actionable initiatives to improve cancer screening rates: Questionnaires to determine barriers to cancer screening, mobile cancer screening efforts, and alternative screening tests, can help address these inequities.

CHICAGO (June 15, 2023): Although redlining was outlawed more than 50 years ago, new research shows that people today who live in historically redlined areas are less likely to be screened for breast, colorectal, and cervical cancer than people who live in areas not associated with redlining practices.

Redlining is a discriminatory practice in which financial institutions refuse to provide loans or insurance to people who live in an area deemed to be a poor financial risk. The practice predominately impacted Black home buyers, contributing to segregation and inequality. Congress banned the practice under the Fair Housing Act of 1968, but people who live in the areas that were once redlined continue to be negatively affected, as evidenced by low rates of cancer screening, according to a study recently published in the Journal of the American College of Surgeons. Until this study, the impact of historical redlining on cancer screening, regardless of contemporary social vulnerability, has been largely unexplored.

“Our study shows that the legacy of redlining has a long historical arc that still persists today due to chronic under investment in these areas,” said the study’s lead author Timothy Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon), a surgical oncologist who is the surgeon-in-chief of The Ohio State University Wexner Medical Center. “Redlining serves as a surrogate for systemic racism, especially as it pertains to those who live in areas that lack adequate investment in education, employment, transportation, and healthcare.”

An example of how redlining persists is the case of a national real estate company that was sued for discrimination by fair housing groups for its policy of not offering real estate services to owners selling homes under a minimum price level, Dr. Pawlik said. In 2022, the company, Redfin, agreed to a $4 million settlement and to expand its services for lower-priced houses.  

Key study findings

Using national 2020 census-tract level data on cancer screening rates and historical redlining grades, the researchers found that:

• Among 11,831 census-tracts, 3,712 tracts were redlined, with the greatest number of redlined tracts in New York and California, particularly in the New York City and Los Angeles metropolitan areas.
• Redlining was associated with lower odds of hitting screening targets in all three types of cancer: 24% lower odds in breast cancer, 64% lower odds in colorectal, and 79% lower odds in cervical cancer, compared with non-redlined areas. This association persisted even after adjusting for contemporary social vulnerability and access to care.
• A large proportion of the total effect of redlining on cancer screening was attributable to poverty, lack of education, and limited English proficiency.

“I find this study on the impact of historic redlining practices on current cancer screening rates to be incredibly important and sobering. The findings clearly demonstrate that the legacy of redlining continues to contribute to significant disparities in breast, colorectal, and cervical cancer screening, highlighting the urgent need for targeted interventions and policy reforms to address underlying structural racism and improve health equity in our historically marginalized communities,” said David Tom Cooke, MD, FACS, professor and chief of the Division of General Thoracic Surgery at UC Davis Health, and president of the Thoracic Surgery Directors Association.

Dr. Cooke, who was not involved with the study, added, “This study underscores the responsibility of healthcare systems, including academic and non-academic medical centers, to proactively tackle social determinants of health, such as redlining, to achieve equitable access to cancer screening and ultimately save lives.”

How to alleviate the impact of redlining on cancer screening rates

By demonstrating the long-term implications of discriminatory practices, the study results can help shape healthcare and social policy reform to reduce health inequities, Dr. Pawlik said.

Those efforts start with specific, actionable initiatives, Dr. Pawlik said. To determine how to improve cancer screening rates in specific areas may require resident questionnaires to determine the potential barriers, he said. For example, if transportation was a barrier, travel vouchers could be provided; or if English proficiency was a barrier, an interpreter could be provided.

Among the approaches that could help improve cancer screening rates in historically redlined areas include:

• Government policies that target the areas with social services aimed at poverty alleviation, affordable housing, and education.
• Initiatives to improve access to preventive cancer care may mitigate cancer screening disparities. One example is the Mobile Mammography Van by the Navajo Breast and Cervical Cancer Prevention Program.
• Alternative methods to make it easier for affected people to get screened. For example, since colonoscopies pose significant barriers, such as bowel prep and devoting most of the day for the exam, tests to detect DNA mutations and blood in the stool may be a more workable approach, Dr. Pawlik said.

“I think the fact that the cancer screening is so disparate in these communities is a real wake up call to all of us,” Dr. Pawlik said.

Study coauthors are Zorays Moazzam, MD; Selamawit Woldesenbet, MS, MPH, PhD; Yutaka Endo, MD, PhD; Laura Alaimo, MD; Henrique A. Lima, MD; Jordan Cloyd, MD, FACS; Mary E. Dillhoff, MD, FACS; and Aslam Ejaz, MD, FACS.

Disclosures: Nothing to disclose.

Citation: Moazzam Z, Woldesenbet S, Endo Y, et al. Association of Historical Redlining and Present-Day Social Vulnerability with Cancer Screening. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000000779.

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 87,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

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JOURNAL

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000000779 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association of Historical Redlining and Present-Day Social Vulnerability with Cancer Screening

ARTICLE PUBLICATION DATE

15-Jun-2023

COI STATEMENT

Nothing to disclose.

FAMU-FSU College of Engineering researchers want drivers to see clearly on the road

Peer-Reviewed Publication

FLORIDA STATE UNIVERSITY

 

IMAGE: MOHAMMADREZA KOLOUSHANI, A DOCTORAL CANDIDATE AT THE FAMU-FSU COLLEGE OF ENGINEERING, SITS IN A CAR. HIS RESEARCH INTO SUN GLARE BLINDNESS IN DRIVERS COULD HELP DELIVER INNOVATIVE SOLUTIONS THAT PREVENT CRASHES. view more 

CREDIT: MARK WALLHEISER/FAMU-FSU COLLEGE OF ENGINEERING

Every year, sun glare contributes to around 3,000 crashes in the United States. FAMU-FSU College of Engineering researchers are helping to mitigate this problem by examining what drivers are likely to do when faced with sun glare. Their work was published in Transportation Research Record.

“We want drivers to be safer on the road,” said study co-author Eren Ozguven, director of the Resilient Infrastructure and Disaster Response Center. “At certain times of day, the sun can be blinding, so as scientists and engineers, we want to find solutions.”

The first step is to understand where problems are most likely to occur. Researchers developed a multinomial logistic regression model to formulate relationships between crash-related factors and alternative actions drivers could adopt to avert a crash.

They found that drivers were most likely to run red lights or stop signs, particularly on local roadways. They also tended to follow vehicles too closely in high-traffic areas.

“There are emerging technologies that could help drivers when sun glare is impacting their driving,” said study co-author Mohammadreza Koloushani, a doctoral candidate in the Department of Civil and Environmental Engineering at the FAMU-FSU College of Engineering. “For example, developing automated avoidance systems that use intelligent transportation technology may prevent crashes when drivers are following other vehicles too closely.”

In-vehicle image processing detectors may enhance eye-tracking accuracy and alert drivers to the presence of sun glare based on their facial expressions. By providing real-time information regarding glare conditions, navigation systems could recommend alternative routes to avoid areas that are prone to sun glare.

Non-automated solutions could also help. By installing anti-glare coatings on pavements, transportation planners can improve roads to enhance driver performance and reduce the hazards posed by sun glare during the daytime.

WHY IT MATTERS:
The findings could help inform the use of emerging intelligent transportation system technologies, such as automated traffic signal performance measures and cooperative intersection collision avoidance systems, to prevent accidents caused by daytime glare.

WHO’S INVOLVED:
Koloushani and Ozguven worked with Mehmet Burak Kaya, a graduate research assistant, and Alican Karaer, doctoral alumnus who now works at the company Iteris. The Florida Department of Transportation Safety Office provided crash data. The authors received no financial support for the research.

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DOI

10.1177/03611981231155419 

ARTICLE TITLE

Investigating the Probability of Potential Actions Performed by Drivers Experiencing Daytime Sun Glare-Induced Blindness