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Red meat and processed meat consumption has been hypothesized to increase risk of cancer, but the evidence is inconsistent. We performed a systematic review and meta-analysis of prospective studies to summarize the evidence of associations between consumption of red meat (unprocessed), processed meat, and total red and processed meat with the incidence of various cancer types. We searched in MEDLINE and EMBASE databases through December 2020. Using a random-effect meta-analysis, we calculated the pooled relative risk (RR) and 95% confidence intervals (CI) of the highest versus the lowest category of red meat, processed meat, and total red and processed meat consumption in relation to incidence of various cancers. We identified 148 published articles. Red meat consumption was significantly associated with greater risk of breast cancer (RR = 1.09; 95% CI = 1.03–1.15), endometrial cancer (RR = 1.25; 95% CI = 1.01-1.56), colorectal cancer (RR = 1.10; 95% CI = 1.03–1.17), colon cancer (RR = 1.17; 95% CI = 1.09-1.25), rectal cancer (RR = 1.22; 95% CI = 1.01-1.46), lung cancer (RR = 1.26; 95% CI = 1.09–1.44), and hepatocellular carcinoma (RR = 1.22; 95% CI = 1.01-1.46). Processed meat consumption was significantly associated with a 6% greater breast cancer risk, an 18% greater colorectal cancer risk, a 21% greater colon cancer risk, a 22% greater rectal cancer risk, and a 12% greater lung cancer risk. Total red and processed meat consumption was significantly associated with greater risk of colorectal cancer (RR = 1.17; 95% CI = 1.08–1.26), colon cancer (RR = 1.21; 95% CI = 1.09–1.34), rectal cancer (RR = 1.26; 95% CI = 1.09–1.45), lung cancer (RR = 1.20; 95% CI = 1.09-1.33), and renal cell cancer (RR = 1.19; 95% CI = 1.04–1.37). This comprehensive systematic review and meta-analysis study showed that high red meat intake was positively associated with risk of breast cancer, endometrial cancer, colorectal cancer, colon cancer, rectal cancer, lung cancer, and hepatocellular carcinoma, and high processed meat intake was positively associated with risk of breast, colorectal, colon, rectal, and lung cancers. Higher risk of colorectal, colon, rectal, lung, and renal cell cancers were also observed with high total red and processed meat consumption.

The COVID-19 pandemic has had wide-ranging impacts on communities worldwide, with Indigenous communities in southern Ontario, Canada, being no exception. Partnering with Aamjiwnaang First Nation, we explored the multifaceted impacts of the pandemic and learnings for the future. This study utilized semi-structured interviews with the community’s pandemic committee and other front line essential services (N = 12) to explore the nuanced dimensions of the pandemic’s effects. Data were analysed using a template approach to codebook thematic analysis to examine various aspects of the pandemic response. Five main themes were identified, including: (i) Wellbeing and mental health, (ii) Work-life balance, (iii) Community and social factors, (iv) Organizational dynamics, and (v) Lessons learned and future planning. Our findings unveiled a multifaceted spectrum of challenges, encompassing socioeconomic, psychological, and organizational aspects, which the First Nations community encountered amidst the pandemic. Despite these challenges, the commitment to community adaptation and collaboration highlighted the resilience cultivated through strong Indigenous leadership, trusting partnerships, and transparent communication, contributing to an effective response. This research stresses the need for future pandemic preparedness efforts to prioritize Indigenous leadership and address the social and cultural determinants of Indigenous health. Additionally, to effectively address future environmental and health emergencies, there is a pressing need to adopt an all-hazards approach and develop comprehensive, yet adaptable plans tailored to meet the diverse needs of communities.

The COVID-19 pandemic exacerbated food insecurity issues in geographically isolated communities, including Fort Albany First Nation (FAFN). This research examines FAFN’s adaptive strategies to improve food security, highlighting community resilience and leadership. Data were gathered through semi-structured interviews with 20 community members who were involved in the pandemic response, either as members of the pandemic committee or as managers of community programs. Thematic analysis revealed significant adaptation of existing programs and the establishment of new initiatives to address food security during the pandemic. Initiatives, such as the community garden and the Fort Albany Farmers Market were food security programs that existed prior to the pandemic, and despite labor shortages during the pandemic, logistical hurdles were addressed to maintain operations and enhance food distribution efficiency. New emergency food initiatives, backed by government support and community efforts, successfully delivered food to vulnerable households. Traditional subsistence activities, such as hunting and fishing, were essential for providing sustenance and strengthening community resilience. These adaptive strategies highlight the critical role of local leadership, community participation and ingenuity, and the utilization of Indigenous knowledge in overcoming food security challenges during crises. This paper underscores the need to support Indigenous food sovereignty and build resilient local food systems tailored to the unique needs of First Nations communities. The experiences of FAFN during the COVID-19 pandemic provide invaluable insights into the resilience and innovation required to improve food security in remote and vulnerable populations, emphasizing the need for sustained investment and policy support in these communities.

We examined whether abuse in childhood and/or adolescence was associated with shorter telomere length in a pooled analysis of 3,232 participants from five diverse cohorts. We also assessed whether religion or spirituality (R/S) could buffer deleterious effects of abuse. Physical and sexual abuse in childhood (age <12) and adolescence (age 12-18) was assessed using the Revised Conflict Tactics Scale and questions from a 1995 Gallup survey. We measured relative leukocyte telomere lengths (RTL) using quantitative real time polymerase chain reaction. We used generalized estimating equations to assess associations of physical and sexual abuse with log-transformed RTL z-scores. Analyses were conducted in each cohort, overall, and stratified by extent of religiosity or spirituality and religious coping in adulthood. We pooled study-specific estimates using random-effects models and assessed between-study heterogeneity. Compared to no abuse, severe sexual abuse was associated with lower RTL z-scores, in childhood: -15.6%, 95% CI: -25.9, -4.9; p-trend = 0.04; p-heterogeneity = 0.58 and in adolescence: -16.5%, 95% CI: -28.1, -3.0; p-trend = 0.08; p-heterogeneity = 0.68. Sexual abuse experienced in both childhood and adolescence was associated with 11.3% lower RTL z-scores after adjustment for childhood and demographic covariates (95% CI: -20.5%, -2.0%; p-trend = 0.03; p-heterogeneity = 0.62). There was no evidence of effect modification by R/S. Physical abuse was not associated with telomere length. Sexual abuse in childhood or adolescence was associated with a marker of accelerated biological aging, decreased telomere length. The lack of moderation by R/S may be due to inability to capture the appropriate time period for those beliefs and practices.

Indigenous communities worldwide continue to disproportionately bear the burden during pandemics due to ongoing health inequities and systemic exclusion from pandemic decision-making processes. As the global community prepares for the next pandemic, it is critical to prioritise Indigenous leadership and governance within public health responses. This commentary highlights successful models of Indigenous-led pandemic responses during COVID-19 in Canada and Australia. It introduces the EPIC (Equity, Partnerships, Intelligences, and Change) framework, that emphasises equity, leadership and local and cultural intelligence as critical components to improve pandemic preparedness and response for Indigenous communities. This international collaboration calls on governments and health authorities to uphold Indigenous sovereignty, self-determination, and leadership in pandemic planning and response efforts.

Background We conducted a systematic review and meta-analysis of prospective studies to clarify the relation of fruit and vegetable consumption with incident breast cancer. Methods We searched systematically PubMed and EMBASE databases up to November 2020 to include prospective studies that reported the association of fruit and vegetable consumption with incident breast cancer. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest category of total fruit and vegetable, total fruit and total vegetable consumption, as well as fruit juice and subgroups of vegetables in relation to breast cancer incidence, using a random-effect model. Results Total fruit and vegetable consumption was associated with lower overall (RR = 0.91, 95% CI = 0.87–0.95) and postmenopausal breast cancer risk (RR = 0.88, 95% CI = 0.79–0.99). Total fruit consumption was associated with lower overall (RR = 0.93, 95% CI = 0.88–0.99) and postmenopausal breast cancer risk (RR = 0.93, 95% CI = 0.87–0.99). Total fruit and vegetable intake were associated with 11% and 26% lower risk of oestrogen- and progesterone-receptor-positive (ER+/PR+) and -negative (ER−/PR−) breast cancer, respectively. Total vegetable consumption was associated with 27% lower risk of ER−/PR− breast cancer. Fruit juice consumption was associated with increased overall breast cancer risk (RR = 1.04, 95% CI = 1.01–1.07). We did not find significant associations for subgroups of vegetable intake and breast cancer risk. Conclusions These findings suggest that high total fruit and vegetable consumption are associated with reduced risk of overall, postmenopausal, ER+/PR+ and ER−/PR− breast cancer.

ObjectivesThe COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research.DesignThis study took the form of a scoping review.Data sourcesMedline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024.Eligibility criteriaAll citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA.Data extraction and synthesisData extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis.ResultsOf the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively.ConclusionsBy overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.

Objective: Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome). Methods: Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression. Results: The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R2 = 0.21 and adjusted R2 = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively. Conclusions: In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.

Background Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. Methods From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13–17 years old; n  = 250) and their parents ( n  = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children’s hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. Discussion As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families’ needs.

Background We examined the role of post-diagnostic coffee and tea consumption in relation to breast cancer-specific and all-cause mortality among women with breast cancer in prospective cohort studies. Methods We identified 8900 women with stage I–III breast cancer from 1980 through 2010 in the Nurses’ Health Study (NHS) and from 1991 through 2011 in the NHSII. Post-diagnostic coffee and tea consumption was assessed by a validated food frequency questionnaire every 4 years after diagnosis. Results During up to 30 years of follow-up, we documented 1054 breast cancer-specific deaths and 2501 total deaths. Higher post-diagnostic coffee consumption was associated with a lower breast cancer-specific mortality: compared with non-drinkers, >3 cups/day of coffee was associated with a 25% lower risk (hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.59–0.96; P trend  = 0.002). We also observed a lower all-cause mortality with coffee consumption: compared with non-drinkers, >2 to 3 cups/day was associated with a 24% lower risk (HR = 0.76, 95% CI = 0.66–0.87) and >3 cups/day was associated with a 26% lower risk (HR = 0.74, 95% CI = 0.63–0.87, P trend  < 0.0001). Post-diagnostic tea consumption was associated with a lower all-cause mortality: compared with non-drinkers, >3 cups/day was associated with a 26% lower risk (HR = 0.74, 95% CI = 0.58–0.95; P trend  = 0.04). Conclusions Among breast cancer survivors, higher post-diagnostic coffee consumption was associated with better breast cancer and overall survival. Higher post-diagnostic tea consumption may be related to better overall survival.