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Cancer is rapidly increasing worldwide and urgent global action towards cancer control is required. Consistent with global trends, Canada is expected to experience a near doubling in new cases and cancer deaths between 2020–2040; population growth and ageing being the primary drivers. The projected increased cancer incidence and its associated costs is expected to further exacerbate socioeconomic inequities. Focused actions to prevent cancer, to detect it earlier when more treatable, and, to lower the risk of recurrence, must be prioritized. Almost half of all cancers are preventable, caused by risk factors that are potentially avoidable and modifiable. Integrating cancer prevention with care-based models is necessary and represents the most cost-effective and sustainable approach to control cancer. To be effective, prevention efforts must consider the cancers impacting local populations and understand how community and individual factors interact within the spatial and temporal contexts in which people live. This study is part of the Nova Scotia Community Cancer Matrix project which profiles the cancers impacting communities over time; measuring associations between cancer and socioeconomic status (SES); and determining how the joint spatial distribution of cancers can be used to address inequities, identify priority populations and strengthen prevention efforts. Using Bayesian inference to model spatio-temporal variations in 58,206 cases diagnosed in 301 communities between 2001–2017, across 10 preventable cancer types, we report significant disparities in cancer risk across communities based on sex and community SES. The work highlights the utility of small-area mapping to identify at-risk communities and understand how community-SES impacts risk. It also uncovers significant inequities rooted in the differential distribution of material and social capacity, operating beyond the control of individuals. The approach is implementable to other regions to inform and strengthen prevention efforts aiming at reducing the burden of cancer or that of other diseases.

Despite public health efforts, use of legal substances such as cigarettes, cannabis and e-cigarettes are common in Canada. Most policies focus on individual level factors, which do not account for possible influences of the environments to which people belong (i.e., neighborhoods). This study aimed to identify neighborhood-level risk factors for use of cigarettes, cannabis and e-cigarettes in the Canadian Partnership for Tomorrow’s Health cohort. Participants completed questionnaires on demographics and health behaviors including recent (30-day) use of cigarettes, cannabis and e-cigarettes. Geospatial neighborhood-level measures: deprivation, gentrification, household security, labor force participation, immigration and visible minority proportion were linked via postal codes. Regression models were built to understand associations between substance use and neighborhood factors. Neighborhood material deprivation, social deprivation, and household insecurity were positively associated with odds of using cigarettes, cannabis, and e-cigarettes. Odds of using these substances was higher for participants living in gentrified neighborhoods. Lower odds of cigarette, cannabis, and e-cigarette use were found for participants living in neighborhoods with a high proportion of recent immigrants and/or visible minorities. Evidence from this study suggests interventions aimed at reducing or preventing substance use should be multidimensional, encompassing strategies directed at both individuals and neighborhoods.

PurposeIndividuals living with cancer have been shown to have a higher burden of comorbid disease and multimorbidity in comparison to their cancer-free counterparts consequently, leaving them at risk of polypharmacy (i.e., ≥ 5 medications) and its potential negative effects. The primary aim of the current study was to examine the self-reported prevalence of and association between multimorbidity and prescription medication use in a population-based sample of adult cancer survivors (CS).MethodsThis retrospective, nested case–control study drew participant data from the Atlantic Partnership for Tomorrow’s Health cohort. CS (n = 1708) were matched to 4 non-cancer controls (n = 6832) by age and sex. Prevalence of polypharmacy by number of chronic conditions and age was estimated with 95% CI. Logistic regression was used to examine the association between multimorbidity and polypharmacy while adjusting for sociodemographic and lifestyle factors. The comorbidity–polypharmacy score was also calculated as an estimate of disease burden.ResultsMultimorbidity was common in both CS (53%) and non-cancer controls (43%); however, a significantly higher percentage of CS reported multimorbidity (p < 0.001). Prescription medication use was also found to be significantly higher among CS (2.3 ± 2.6) compared to non-cancer controls (1.8 ± 2.3; p < 0.0001). Exploratory comorbidity–polypharmacy score analyses indicated that CS had a significantly higher overall disease burden than the age/sex-matched non-cancer controls.ConclusionsAs CS appear to be at a higher risk of multimorbidity and polypharmacy and by extension, increased healthcare burden, ongoing education on the prevention of medication-related harm, and interventions to reduce the occurrence of both co-morbid disease and unnecessary medications are warranted.

The concept of the social determinants of health was born out of the recognition that, although disease is a biomedical outcome, socioeconomic inequities are important drivers of disease variation globally, nationally and locally. Through a social determinants lens, it is inequities in power, money and resources that are important contributors to inequities in health, disease and mortality. Or more bluntly: \"social injustice is killing on a grand scale\". Importantly, mapping social inequities onto health variations supports upstream disease prevention and control by providing a focus for multi-sector interventions. However, there are limitations to the application of the concept of social determinants globally, within countries and locally. Acting on social determinants of health and their pathways, to prevent ill health, requires more than just epidemiological data on the factors underlying these determinants.

Background Arsenic in drinking water is a public health issue affecting hundreds of millions of people worldwide. This review summarizes 30 years of epidemiological studies on arsenic exposure in drinking water and the risk of bladder or kidney cancer, quantifying these risks using a meta-analytical framework. Methods Forty studies met the selection criteria. Seventeen provided point estimates of arsenic concentrations in drinking water and were used in a meta-analysis of bladder cancer incidence (7 studies) and mortality (10 studies) and kidney cancer mortality (2 studies). Risk estimates for incidence and mortality were analyzed separately using Generalized Linear Models. Predicted risks for bladder cancer incidence were estimated at 10, 50 and 150 μg/L arsenic in drinking water. Bootstrap randomizations were used to assess robustness of effect size. Results Twenty-eight studies observed an association between arsenic in drinking water and bladder cancer. Ten studies showed an association with kidney cancer, although of lower magnitude than that for bladder cancer. The meta-analyses showed the predicted risks for bladder cancer incidence were 2.7 [1.2–4.1]; 4.2 [2.1–6.3] and; 5.8 [2.9–8.7] for drinking water arsenic levels of 10, 50, and 150 μg/L, respectively. Bootstrapped randomizations confirmed this increased risk, but, lowering the effect size to 1.4 [0.35–4.0], 2.3 [0.59–6.4], and 3.1 [0.80–8.9]. The latter suggests that with exposures to 50 μg/L, there was an 83% probability for elevated incidence of bladder cancer; and a 74% probability for elevated mortality. For both bladder and kidney cancers, mortality rates at 150 ug/L were about 30% greater than those at 10 μg/L. Conclusion Arsenic in drinking water is associated with an increased risk of bladder and kidney cancers, although at lower levels (<150 μg/L), there is uncertainty due to the increased likelihood of exposure misclassification at the lower end of the exposure curve. Meta-analyses suggest exposure to 10 μg/L of arsenic in drinking water may double the risk of bladder cancer, or at the very least, increase it by about 40%. With the large number of people exposed to these arsenic concentrations worldwide the public health consequences of arsenic in drinking water are substantial.

The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.

Health geography is a subdiscipline of human geography, which deals with the interaction between people and the environment. Health geography views health from a holistic perspective encompassing society and space, and it conceptualizes the role of place, location and geography in health, well-being and disease.2,3 Although health geography is closely aligned with epidemiology, its distinct primary emphasis is on spatial relations and patterns. Whereas epidemiology is predicated on the biomedical model and focuses on the biology of disease, health geography seeks to explore the social, cultural and political contexts for health within a framework of spatial organization. Traditionally, research in health geography spans 2 distinct avenues: the patterns, causes and spread of disease, and the planning and provision of health services. Research in these interlinked areas supports policy development. For example, disease epidemiology is in part related to the geography of health service provision.4 Geographic research in health is often dichotomized between quantitative and qualitative methodologies, with quantitative studies closely aligned with epidemiology and qualitative studies aligned with medical sociology and social sciences. Although differences in approach are important for the assessment of complex problems, these methodologies share a common theme: the role of place and space in health. For example, a quantitative study of an outbreak of an infectious disease such as mumps might focus on spatial modelling of disease diffusion, whereas a qualitative investigation might focus on socio-cultural influences on vaccination uptake within communities, the characteristics of which have been defined within an epidemiology-health geography framework. Often, health geographers will combine quantitative and qualitative methods in complimentary mixed-methods approaches. Geographers contribute to methodologic developments that are useful in health research, including multi-level statistical models, cluster analysis and geographically weighted regression analysis.22 Limitations aside, place and geographic context are recognized as important influences on health.25,26 Although ecologic fallacy has been used to dismiss ecologic (aggregate) studies as unreliable and blunt instruments useful only for showing broad patterns, it is now recognized that many risk factors do operate at the population or community level.25 These risks may modify effects, such as interaction between genes and chemical pollutants, or directly influence health. Dismissing ecologic studies neglects the geographic context within which health outcomes occur.25 Advances in multilevel modelling, geographic information systems and spatial analysis further supports research investigating the relative influence of individual- and community-level health risks within a unified framework.

Problem: There remains uncertainty around cancer risk at lower levels of arsenic in drinking water. This study updates evidence from our previous review on the relationship between arsenic in drinking water and urinary bladder and kidney cancers (updated search January 2013 to February 2023). Method: Thirty-four studies were retained for review; six met criteria for inclusion in meta-analysis. Risk estimates for bladder and kidney cancer incidence and mortality were analyzed separately using Bayesian multilevel linear models. Results: For bladder cancer incidence, the estimated posterior mean relative risks (RRs) were 1.25 (0.92–1.73), 2.11 (1.18–4.22) and 3.01 (1.31–8.17) at arsenic concentrations of 10, 50 and 150 μg/L, respectively, with posterior probabilities of 92%, 99% and 100%, respectively, for the RRs to be >1. The corresponding RRs for kidney cancer were 1.37 (1.07–1.77), 1.95 (1.44–2.65) and 2.47 (1.74–3.52), with posterior probabilities of 100%. For bladder cancer, the posterior mean mortality ratios were 1.36 (0.35–6.39), 2.92 (1.24–7.82) and 4.88 (2.83–9.03) with posterior probabilities of 72%, 99% and 100%, respectively. Conclusions: The findings show increased bladder and kidney cancer risks at lower levels of arsenic in drinking water. Given that many people worldwide are exposed to lower levels of arsenic in drinking water, the public health impacts are substantial.

Most oropharyngeal and anogenital cancers are caused by human papillomavirus (HPV). Although HPV vaccines showed high efficacy against oropharyngeal and anogenital HPV infections, and cancer precursors in randomized clinical trials, there are limited data on the effectiveness of HPV vaccination against HPV-related cancers. We aimed to evaluate the association of HPV vaccination with HPV-related cancers among a nationally representative sample of United States adults, aged 20–59 years. In a cross-sectional study combining four cycles from the National Health and Nutrition Examination Survey, from 2011 through 2018, we used a survey-weighted logistic regression model, propensity score matching and multiple imputations by chained equations to explore the association of HPV vaccination with HPV-related cancers. Among 9891 participants, we did not find an association of HPV vaccination with HPV-related cancers (adjusted OR = 0.58, 95% CI 0.19; 1.75). Despite no statistically significant association between HPV vaccination and HPV-related cancers, our study findings suggest that HPV-vaccinated adults might have lower odds of developing HPV-related cancers than those who were not vaccinated. Given the importance of determining the impact of vaccination on HPV-related cancers, there is a need to conduct future research by linking cancer registry data with vaccination records, to obtain more robust results.

Background Although smoking is the primary risk factor for lung cancer, 15–25% of lung cancers occur in never smokers. Emerging evidence suggests lifestyle factors are associated with lung cancer risk, but few studies among never smokers exist. Methods A case–control study of never smokers within the Canadian Partnership for Tomorrow’s Health was conducted. At recruitment, participants provided data on lifestyle, health history and sociodemographic factors. Incident lung cancers were identified through linkage with administrative health records. Cases ( n  = 190) were matched to controls ( n  = 760) on age, sex, and follow-up time. Logistic regression analyses, adjusted for matching factors and annual income, were used to identify associations between lifestyle factors and lung cancer risk. Results Consumption of < 5 servings of fruits and vegetables/day was associated with higher risk of lung cancer (OR  1.50, 95% CI 1.03–2.17). Short or long sleep (≤ 6 or > 9 h/night) was also associated with increased risk of lung cancer (OR 1.52, 95% CI 1.01–2.29). No associations were observed for obesity measures, alcohol consumption, or physical activity. Conclusion Our findings provide evidence of a potential role between sleep, fruits and vegetable consumption, and lung cancer risk in a pan-Canadian, non-smoking population. However, the sample size is modest, and further investigation is needed.