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BACKGROUND: Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer. METHODS: This study examined the association between prediagnosis cardiovascular health and total and cause-specific mortality among 12,076 postmenopausal women who developed local- or regional-stage invasive cancer in the Womens Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity-related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non-Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival. RESULTS: After a median follow-up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all-cause mortality (HR, 1.99; 95% CI, 1.73-2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88-5.57), cancer-specific mortality (HR, 1.37; 95% CI, 1.1-1.72), and other-cause mortality (HR, 2.14; 95% CI, 1.70-2.69). A higher waist circumference was associated with greater all-cause mortality (HR, 1.17; 95% CI, 1.06-1.30) and cancer-specific mortality (HR, 1.22; 95% CI, 1.04-1.42). CONCLUSIONS: Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all-cause, CVD, cancer-specific, and other-cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation. LAY SUMMARY: This study uses information from the Womens Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country. The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors. It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.

Background: Black women with epithelial ovarian cancer (EOC) have worse survival and a higher burden of comorbid conditions compared with other racial groups. This study examines the association of comorbid conditions and medication use for these conditions with survival among Black women with EOC. Methods: In a prospective study of 592 Black women with EOC, the Charlson comorbidity index (CCI) based on self‐reported data, three cardiometabolic comorbidities (type 2 diabetes, hypertension, and hyperlipidemia), and medication use for each cardiometabolic comorbidity were evaluated. Cox proportional hazards regression models were used to examine the association of comorbid conditions and related medication use with all‐cause mortality while adjusting for relevant covariates overall and by histotype (high‐grade serous [HGS]/carcinosarcoma vs. non‐HGS/carcinosarcoma) and stage (I/II vs. III/IV). Results: A CCI of ≥2 was observed in 42% of the cohort, and 21%, 67%, and 34% of women had a history of type 2 diabetes, hypertension, and hyperlipidemia, respectively. After adjusting for prognostic factors, a CCI ≥2 (vs. 0; hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04–1.71) and type 2 diabetes (HR, 1.42; 95% CI, 1.10–1.84) were associated with an increased risk of mortality. The increased risk of mortality for type 2 diabetes was present specifically among women with HGS/carcinosarcoma (HR, 1.47; 95% CI, 1.10–1.97) and among women with stage III/IV disease (HR, 1.47; 95% CI, 1.10–1.98). The authors did not find evidence that hypertension, hyperlipidemia, or medication use for the cardiometabolic comorbidities meaningfully impacted survival. Conclusion: Comorbid conditions, especially type 2 diabetes, had a significant adverse impact on survival among Black women with EOC. In a population‐based study of Black women with ovarian cancer, a higher Charlson comorbidity index based on self‐reported data and type 2 diabetes were associated with an increased risk of mortality, but no association was observed for hypertension or hyperlipidemia. Medication use for comorbid conditions did not meaningfully impact survival in this patient population. [ABSTRACT FROM AUTHOR]

Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.

Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of selected modifiable risk factors (diet, alcohol, physical activity, BMI, and smoking) with risk of invasive breast cancer in the Women's Health Initiative (WHI). This study comprised 131,833 postmenopausal women, of whom 8,168 had breast cancer, who were enrolled in the WHI Observational Study or the WHI clinical trials. Cox proportional hazards regression was used to estimate the HRs and 95% confidence intervals (CI) for the association of the score with the risk of developing breast cancer overall and according to specific breast cancer clinicopathologic characteristics. There was a 4% reduction in the risk of breast cancer per unit increase in the HLI score. Compared with those with an HLI score in the lowest quintile level, those in the highest quintile level had 30%, 37%, and 30% lower risk for overall, ER+/PR+, and HER2+ breast cancer, respectively (HR = 0.70; 95% CI, 0.64-0.76; 0.63, 0.57-0.69; and 0.70; 0.55-0.90, respectively). We also observed inverse associations between the score and risk of breast cancer irrespective of nodal status, tumor grade, and stage of the disease. Most individual lifestyle factors were independently associated with the risk of breast cancer. Our findings support the view that promoting healthy lifestyle practices may be beneficial with respect to lowering risk of breast cancer among postmenopausal women. Cancer Prev Res; 11(6); 317-26. ©2018 AACRSee related editorial by Friedenreich and McTiernan, p. 313.

Background: Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors' relatively low incomes and wealth. Methods: The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self‐reported several forms of social risks, including food insecurity, housing instability, utility shut‐offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer‐related factors. Results: Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20–39 years (47%) followed by those aged 40–54 years (43%), 55–64 years (38%), and 65 years and older (24%; p for trend <.001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42–2.16) for survivors aged 20–39 years, 1.76 (95% CI, 1.52–2.03) for survivors aged 40–54 years, and 1.41 (95% CI, 1.23–1.60) for survivors aged 55‐64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks. Conclusions: In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors. This report evaluates associations between age at diagnosis and the prevalence of social risks, such as food insecurity, housing instability, and forgoing care because of lack of transportation in a population‐based cohort of Black cancer survivors. Age at diagnosis was inversely associated with social risks, and young adult survivors reported the highest prevalence of any social risks, multiple social risks, and several individual social risks. [ABSTRACT FROM AUTHOR]

In this policy brief, the authors examine why low-income teenagers are almost three times more likely to be obese than teens from more affluent households. Specifically, persistent barriers to health were found, including high numbers of neighborhood fast food restaurants, high sugary soda consumption and television viewing and low numbers of parks and other opportunities for physical activity. Among their recommendations, the authors urged city planners to consider zoning ordinances to regulate the number of fast–food restaurants while providing incentives to attract grocery and other stores that stock fresh fruits and vegetables. The authors also called for greater opportunities for physical activity and education, as well as campaigns to promote family dinners and discourage excessive television viewing.

This report examines important health concerns of nonelderly women (ages 18-64) in California, including their health status, selected health behaviors, health insurance coverage, usual source of care and access to health care. The authors examine how these health measures vary among women by family income and by race/ethnicity, with a focus on women often disproportionately affected by lack of consistent policies that promote health and access to health care. They also look at difference by age group, to examine the changing health care issues and needs of women at different points in their lives. Using data from the 2005 and 2001 California Health Interview Survey, the first section of the report examines women's self-reported health status, activity limitations and health condition prevalence. The second section of the report looks at selected health behaviors -- physical activity level, smoking and alcohol use. The third section covers the current state of health insurance coverage for women, including the characteristics of uninsured women. Finally, the report addresses issues of access to care: where women receive care; their use of safety-net providers; and their use of physician services and preventive screenings.

Despite advances in therapy, asthma remains a disease that is not optimally controlled in many Californians. This policy brief examines the economic and social burden of the poor control of asthma and recommends policy changes to reduce those costs. Using data from the California Health Interview Survey (CHIS), the authors found that California's children missed 1.9 million days of school and the state's adult workers missed 2 million days of work due to asthma. As many as 475,000 children and adults in California reported that they went at least once to the emergency room or urgent care center because of asthma. The number is likely to be much higher due to repeat visits. The research adds to a growing body of knowledge about the debilitating personal and economic effects of asthma, a condition linked to pollution, lack of insurance and medical care as well as to risk factors such as smoking.

People living in neighborhoods crowded with fast-food and convenience stores but relatively few grocery or produce outlets are at significantly higher risk of suffering from obesity and diabetes. The authors of this report correlated the responses of nearly 40,000 Californians surveyed in the 2005 California Health Interview Survey (CHIS) with the Retail Food Environment Index (RFEI) to determine the prevalence of obesity and diabetes. The Retail Food Environment Index (RFEI) is a ratio of the total number of fast-food restaurants and convenience stores compared to grocery stores and produce vendors near a person's home. The authors found that Californians living in communities with many fast food restaurants ­ rather than grocery stores and other outlets providing more nutritious choices ­ were more likely to have diabetes and/or be obese. The authors also found that although low-income communities are often hit hardest by this phenomenon, the health correlation is seen across all geographic regions, income levels and ethnicities. The report was authored by The UCLA Center for Health Policy Research, the California Center for Public Health Advocacy (CCPHA) and PolicyLink. The findings draw upon The UCLA Center for Health Policy Research's California Health Interview Survey (CHIS), a biennial statewide survey of more than 40,000 Californians used by legislators, policy makers, local health departments, state agencies, community organizations, advocacy groups, foundations, researchers, and many others.

The prevalence of diabetes in California continues to rise. Over 1.8 million adults age 18 and over (7%) have been diagnosed with diabetes, up from 1.5 million (6.2%) in 2001. This policy brief examines the prevalence and management of diabetes in California based on data from the 2005 California Health Interview Survey (CHIS 2005). It also describes how the prevalence has changed since 2001 based on data from CHIS 2001. The brief concludes with public policy recommendations intended to reduce the risk of diabetes and its related complications.

Teens living in neighborhoods with high concentrations of low-income households are unlikely to have a safe park near their home and are more likely to get less physical activity, according to this policy brief from the UCLA Center for Health Policy Research. The policy brief finds the same trends among teens in neighborhoods with higher unemployment rates, lower levels of education and higher levels of household crowding. Based on data from the 2003 California Health Interview Survey, the U.S. Census and park location information, this policy brief examines adolescent physical activity and access to parks as a function of the characteristics of the neighborhoods in which they live. Specifically, this brief shows that physical activity and access to parks vary with neighborhood characteristics, including concentration of low-income households, crowding, unemployment rates and level of education. These neighborhood characteristics serve as indicators of neighborhood disadvantage and point to neighborhoods that are likely to have limited resources.

In California, 2.8 million children and adults (900,000 children and 1.9 million adults) suffer from active asthma. One out of six of these Californians (16%) lives below the poverty level.1 Low-income adults and children with active asthma disproportionately bear the burden of asthma. They experience more frequent symptoms, go to the emergency department (ED) more often for asthma care, miss more school and have poorer health status. They also are more likely to lack access to health care and to live in conditions associated with asthma exacerbations.

Using data from the 2003 California Health Interview Survey (CHIS), this policy brief examines the racial/ethnic disparities in the burden of asthma among those with active asthma. In addition, the study focuses on disparities in access to care and exposure to indoor environmental triggers that may contribute to the asthma burden experienced by racial and ethnic minorities.

Many Californians are exposed to environmental conditions in the home -- such as the presence of tobacco smoke and furry pets -- which can trigger asthma symptoms. In addition, many who have not been diagnosed with asthma experience asthma-like breathing problems when exposed to these same indoor conditions. Using results from the 2003 California Health Interview Survey (CHIS), this policy brief examines the association of asthma symptoms and asthma-like breathing problems with smoking and the presence of tobacco smoke in the home, and with the presence of dogs and cats in the home. This brief presents the prevalence of monthly asthma symptoms among adults and children with active asthma and the prevalence of wheezing and other asthma-like symptoms in the previous year among those not diagnosed with asthma.

In California, 2.8 million children and adults (900,000 children and 1.9 million adults) suffer from active asthma. One out of six of these Californians (16%) lives below the poverty level.1 Low-income adults and children with active asthma disproportionately bear the burden of asthma. They experience more frequent symptoms, go to the emergency department (ED) more often for asthma care, miss more school and have poorer health status. They also are more likely to lack access to health care and to live in conditions associated with asthma exacerbations. Using data from the 2003 California Health Interview Survey (CHIS 2003), this policy brief examines the burden of asthma among low-income asthma sufferers as well as some opportunities to reduce the burden for these asthma sufferers. Active asthma refers to people who have been diagnosed with asthma and who reported they still have asthma and/or experienced an asthma attack in the past year

Less than one-fourth of California adults -- 5.5 million -- walk on a regular basis, while significantly more than that -- 6.8 million -- do not walk at all, according to this policy brief by the UCLA Center for Health Policy Research that analyzes the differences in the walking habits of Californians. San Francisco (at 38 percent) leads other counties in the percentage of residents who walk regularly, while San Joaquin and San Bernardino have the highest percentage of residents (34 percent) who don't walk at all. American Indian/Alaska Natives have the highest prevalence of regular walking (27 percent), compared to Latinos (23 percent), Whites (21 percent) and African Americans (19 percent). The differences among racial/ethnic groups can be partially explained by differences in the amount of time spent walking for transportation and for leisure. Perceived neighborhood safety and availability of parks are also associated with higher rates of regular walking. For the purposes of the brief, regular walking is defined as walking on at least five separate occasions for a combined total of at least 150 minutes in the previous seven days. This is based on the recommendation that adults engage in moderate physical activity for at least 30 minutes on five or more days per week. Based on data from the 2003 California Health Interview Survey, this new policy brief offers valuable information to those interested in creating new policies and/or conditions to promote healthier lifestyles.

Nearly 1.7 million California adults age 18 and over (6.6%) have been diagnosed with diabetes, up from 1.5 million (6.2%) in 2001. The prevalence of diabetes nationally (6.6%) is similar to that in California. This policy brief examines the prevalence of diagnosed diabetes in California based on data from the 2003 California Health Interview Survey (CHIS 2003). It also describes how the prevalence has changed since 2001 based on data from CHIS 2001. The brief concludes with public policy recommendations intended to reduce the risk of diabetes and its related complications.

More than one in four California adolescents -- nearly one million in all -- get less than the recommended levels of physical activity, but neighborhood characteristics and access to safe parks have an important effect on whether teens meet activity recommendations, and whether they get any activity at all reports this new health policy research brief using data from the 2003 California Health Interview Survey (CHIS 2003). More teens with access to a safe park get regular physical activity and fewer who have access to a safe park are inactive compared to those who do not have access to a safe park. Access to parks is particularly important for the activity levels of adolescents living in urban areas and for those from low-income families, those living in multi-unit apartment buildings, and those living in neighborhoods perceived as unsafe. This brief presents policy recommendations aimed at improving neighborhood environments and access to parks to encourage physical activity by California adolescents.

One in four California adults does not walk at all for transportation or leisure in an average week and half of California adults walk for a combined total of less than one hour each week as reported in this new health policy research brief that uses data from the 2003 California Health Interview Survey (CHIS 2003). Walking behaviors vary by sociodemographic and neighborhood characteristics. Adults with the highest family incomes walk the most for leisure, but those from lower-income households walk the most for transportation and the most overall. Access to safe parks and neighborhood crime prevention programs increase the amount adults walk for leisure, but do not affect walking for transportation. Adults in neighborhoods with high social cohesion walk more for leisure and less for transportation than those in neighborhoods with lower social cohesion. This brief presents policy recommendations aimed at improving neighborhood environments to encourage walking by California adults.

Each day two-thirds of California teens drink soda, nearly half eat fast food, and only a quarter eat at least five servings of fruits and vegetables, as reported in this new health policy research brief that uses data from the 2003 California Health Interview Survey (CHIS 2003). Older teens, boys, Latinos, African Americans and those from low-income households drink the most soda. Latinos, African Americans, Asians and the least affluent eat the most fast food. Soda consumption is associated with the presence of sodas in school vending machines, as well as with fast food consumption. Greater fast food consumption is also associated with eating fewer fruits and vegetables. This brief presents policy recommendations aimed at improving the school food environment as a way to improve the eating behaviors of California teens.

This policy brief describes physical activity among California's adolescents based primarily on data from the 2003 California Health Interview Survey (CHIS 2003). The number of California adolescents who are physically inactive is increasing. Teenage girls, teens from low-income families, teens with no access to safe parks or open spaces, teens whose schools do not require physical education, and Latino, Asian, and African American teens are particularly at risk. The policy brief recommends that efforts to increase physical activity among California's youth should focus on assuring increased opportunities for activity at school and more safe environments for activity out of school.