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Background: Particulate matter consisting of fine particles measuring 2.5 microns or less in diameter (PM2.5), a component of air pollution, has been linked to adverse health outcomes. The objective of this study was to assess the association between ambient PM2.5 exposure and survival in children with cancer in the United States. Methods: Individuals aged birth to 19 years who were diagnosed with cancer between January 1, 2004, and December 31, 2019, were selected from the National Cancer Database. The association between the annual PM2.5 level at the patient's zip code of residence at the time of diagnosis and overall survival was evaluated using time‐varying Cox proportional hazards models (crude and adjusted for diagnosis year and age). To address concerns that exposure to air pollution is correlated with other social determinants of health, the authors tested the association between PM2.5 levels and survival among sociodemographic subgroups. Results: Of the 172,550 patients included, 27,456 (15.9%) resided in areas with annual PM2.5 concentrations above the US Environmental Protection Agency (EPA) annual PM2.5 standard of 12 μg/m3. Residing in these high‐pollution areas was associated with worse overall survival (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 1.012–1.10). Similarly, when PM2.5 was evaluated as a linear measure, each unit increase in PM2.5 exposure was associated with worse survival (aHR, 1.011; CI, 1.005–1.017). Exposure to PM2.5 at levels above the EPA standards was also significantly associated with worse overall survival among sociodemographic subgroups. Conclusions: Exposure to PM2.5 was significantly associated with worse overall survival among children with cancer, even at levels below EPA air quality standards. These results underscore the importance of setting appropriate air quality standards to protect the health of this sensitive population. Plain Language Summary: The authors investigated how living in areas with high air pollution (defined as particulate matter consisting of fine particles measuring 2.5 microns or less in diameter; PM2.5) affects the overall survival of children with cancer in the United States.The results indicated that children living in areas with higher PM2.5 levels, and even at levels below prior and current US Environmental Protection Agency standards, had lower survival rates than children living in areas with lower levels of PM2.5.This finding emphasizes the need for stricter air quality standards to better protect children, particularly those with serious health conditions like childhood cancer. Exposure to particulate matter consisting of fine particles less than or equal to 2.5 microns in diameter was significantly associated with worse overall survival in children with cancer, even at levels below US Environmental Protection Agency air quality standards. These findings highlight the need for stricter air quality regulations to protect vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors. Methods: This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21‐item measure of a consumer's ability to select and use health insurance (HIL self‐efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0–4 (low knowledge), 5–6 (moderate knowledge), and 7–10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self‐efficacy. Results: Nearly three‐quarters of patients had high HIL self‐efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out‐of‐pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (

Background: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health‐related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. Methods: Adult cancer survivors were identified from the 2013–2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2‐3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. Results: Among cancer survivors 18–64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65–79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18–64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36–2.93, p <.001; reference = minor/none) in adjusted analyses. Among cancer survivors 65–79 years old, 2‐3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13–2.20, p =.007; reference = 0 domain). Conclusions: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer. Health‐related social needs (HRSNs), including food insecurity and nonmedical financial worries, are associated with higher mortality risk among younger adult cancer survivors. Standardized and comprehensive assessment of HRSNs and medical financial hardship is essential to identify and mitigate adverse economic impacts of cancer. [ABSTRACT FROM AUTHOR]

The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working‐age adults not yet age‐eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working‐age adults with a history of cancer and compare them with estimates among working‐age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019–2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer. [ABSTRACT FROM AUTHOR]

Background: Cancer patients and survivors have high care needs, often provided by a spouse or partner. The purpose of this study was to elucidate how employment and work loss patterns differed across cancer history/treatment status and gender. Methods: Using nationally representative data from the Medical Expenditure Panel Survey (2011, 2016, and 2017), the authors linked data across married participants and categorized them by spouses' cancer treatment status (no cancer history, on treatment for cancer, off treatment for cancer). Multivariable logistic and zero‐inflated negative binomial regressions were used to assess the associations among cancer history/treatment status, gender, and employment outcomes (employment status and workdays lost to care for self or others). Results: For men, employment did not differ significantly by cancer history/treatment status (on treatment: odds ratio [OR], 0.58; 95% confidence interval [CI], 0.33–1.02, off treatment: OR, 0.84; 95% CI, 0.62–1.14 vs. no cancer history). For women, employment was not significantly different when the spouse was on treatment for cancer compared to no cancer history (OR, 0.78; 95% CI, 0.33–1.86]) but was significantly increased for women whose spouse was off treatment (OR, 1.39; 95% CI, 1.05–1.84). Among employed participants, women whose spouse was on cancer treatment were nine times more likely to take days off work to provide care (OR, 9.52; 95% CI, 3.94–23.03) and took more than three times as many days off to care for others (OR, 3.21; 95% CI, 2.07–4.97) as men whose spouse had no cancer history. Conclusions: Wives of cancer survivors are at increased risk of work loss, with implications for their financial and psychological well‐being. Employers, policymakers, and clinicians have opportunities to support working caregivers. Employment and productivity loss patterns differed by cancer treatment status for men and women. Wives of cancer survivors are at increased risk of work loss with implications for employers, policymakers, and health care professionals. [ABSTRACT FROM AUTHOR]

State‐specific information on lost earnings due to smoking‐attributable cancer deaths to inform and advocate for tobacco control policies is lacking. We estimated person‐years of life lost (PYLL) and lost earnings due to cigarette smoking‐attributable cancer deaths in the United States nationally and by state. Proportions and numbers of cigarette smoking‐attributable cancer deaths and associated PYLL among individuals aged 25 to 79 years in 2019 were calculated and combined with annual median earnings to estimate lost earnings attributable to cigarette smoking. In 2019, estimated total PYLL and lost earnings associated with cigarette smoking‐attributable cancer deaths in ages 25 to 79 years in the United States were 2 188 195 (95% CI, 2 148 707‐2 231 538) PYLL and $20.9 billion ($20.0 billion‐$21.7 billion), respectively. States with the highest overall age‐standardized PYLL and lost earning rates generally were in the South and Midwest. The estimated rate per 100 000 population ranged from 352 (339‐366) in Utah to 1337 (1310‐1367) in West Virginia for PYLL and from $4.3 million ($3.5 million‐$5.2 million) in Idaho to $14.8 million ($10.6 million‐$20.7 million) in Missouri for lost earnings. If age‐specific PYLL and lost earning rates in Utah had been achieved by all states, 58.2% (57.0%‐59.5%) of the estimated total PYLL (1 274 178; 1 242 218‐1 306 685 PYLL) and 50.5% (34.2%‐62.4%) of lost earnings ($10.5 billion; $7.1 billion‐$13.1 billion) in 2019 nationally would have been avoided. Lost earnings due to smoking‐attributable cancer deaths are substantial in the United States and are highest in states with weaker tobacco control policies. [ABSTRACT FROM AUTHOR]

The rapid development of the world economy and industry brings us a higher standard of living and also causes severe water pollution at the same time. Herein, pH‐responsive 1‐allyl‐3‐methylimidazole acetate grafted poly(vinylidene fluoride) membranes (PVDF‐g‐IL) were prepared by high‐energy electron irradiation grafting and non‐solvent‐induced microphase separation technology. The corresponding pH‐responsive membranes can be used to separate dye wastewater with different charges by converting the positive and negative nature of the membrane surface charge. Moreover, the grafted 1‐allyl‐3‐methylimidazole acetate offers a reversible wettability switching ability in different acidic and alkaline environments. The results showed that membrane porosity and average pore size become more prominent, and the pure water flux increases from 121 to 622 Lm−2 h−1. The functionalized membranes exhibited excellent filtration performance of cationic and anionic dyes wastewater by transforming the positive and negative surface charge. The optimum PVDF‐g‐IL membrane displayed a nearly 100% rejection and flux recovery rate. Furthermore, PVDF‐g‐IL membranes exhibited both adsorption and desorption properties for dyes with high adsorption and desorption rates at different pH values. The present research provides a practical and straightforward preparation method of pH‐responsive PVDF‐g‐IL membranes and can apply in the field of dye wastewater purification. [ABSTRACT FROM AUTHOR]

Previous studies using data from the early 2000s demonstrated that patients who were uninsured were more likely to present with late‐stage disease and had worse short‐term survival after cancer diagnosis in the United States. In this report, the authors provide comprehensive data on the associations of health insurance coverage type with stage at diagnosis and long‐term survival in individuals aged 18–64 years who were diagnosed between 2010 and 2013 with 19 common cancers from the National Cancer Database, with survival follow‐up through December 31, 2019. Compared with privately insured patients, Medicaid‐insured and uninsured patients were significantly more likely to be diagnosed with late‐stage (III/IV) cancer for all stageable cancers combined and separately. For all stageable cancers combined and for six cancer sites—prostate, colorectal, non‐Hodgkin lymphoma, oral cavity, liver, and esophagus—uninsured patients with Stage I disease had worse survival than privately insured patients with Stage II disease. Patients without private insurance coverage had worse short‐term and long‐term survival at each stage for all cancers combined; patients who were uninsured had worse stage‐specific survival for 12 of 17 stageable cancers and had worse survival for leukemia and brain tumors. Expanding access to comprehensive health insurance coverage is crucial for improving access to cancer care and outcomes, including stage at diagnosis and survival. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown.Methods: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years).Results: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years.Conclusions: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted. [ABSTRACT FROM AUTHOR]

Recently, the rational design and development of efficient faradaic deionization electrodes with high theoretical capacitance, natural abundance, and attractive conductivity have shown great promise for outstanding capacitive deionization (CDI)‐based desalination applications. Herein, the construction of novel FeOOH hybrid heterostructures with Na and Cl dopants (e.g., Na‐FeOOH and Cl‐FeOOH) via a robust hydrothermal strategy is reported, and an asymmetric CDI cell (Na‐FeOOH//Cl‐FeOOH) comprising Na‐FeOOH and Cl‐FeOOH working as the cathode and anode, respectively, is assembled. The multiple coupling effects of the specific structural features (e.g., enriched porosity, hierarchical pore alignment, and highly open crystalline framework), enhanced electrochemical conductivity, and optimized ion‐transfer property endow the FeOOH hybrid electrode with improved electrochemical performance. Impressively, the Na‐FeOOH//Cl‐FeOOH cell demonstrates a superior salt adsorption capacity (SACNaCl) of 35.12 mg g−1 in a 500 mg L−1 NaCl solution, a faster removal rate, and remarkable cycling stability. Moreover, the pseudocapacitive removal mechanism from the synergetic contribution of the Na‐FeOOH cathode and Cl‐FeOOH anode account for the significant desalination promotion of the Na‐FeOOH//Cl‐FeOOH cell. [ABSTRACT FROM AUTHOR]

Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well-designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigated the associations of health insurance coverage disruptions, also known as coverage churn, and receipt of breast and colorectal cancer screening.Adults who were age‐eligible and younger than 65 years (range, 50–64 years) for breast (n = 17,128 women) and colorectal (n = 32,562 individuals) cancer screening were identified from 5 years of the National Health Interview Survey. Adults were categorized into five groups based on insurance type at survey (private, public, none) and prior coverage disruptions within the past year. Screening outcomes included: (1) ever‐screened, (2) past‐year screening, and (3) guideline‐concordant screening. Separate multivariate logistic regression models were used to evaluate the associations between insurance coverage disruptions and cancer screening.Among adults who had coverage at the time of the survey, 3.1% with private insurance and 6.5% with public insurance reported prior coverage disruptions. Individuals without health insurance coverage had the lowest level of screening. Among individuals who had private coverage, prior disruptions were associated with lower guideline‐concordant screening in adjusted analyses (breast cancer screening: adjusted prevalence ratio [aPR], 0.82; 95% confidence interval [CI], 0.75–0.89; colorectal cancer screening: aPR, 0.78; 95% CI, 0.72–0.86); among those who had public coverage, prior disruptions were also associated with lower guideline‐concordant breast cancer screening (aPR, 0.73; 95% CI, 0.60–0.89) and colorectal cancer screening (aPR, 0.84; 95% CI, 0.72–0.99).Health insurance coverage disruptions were associated with lower past‐year and guideline‐concordant breast and colorectal cancer screening. The current findings underscore the importance of stable health insurance coverage to improve cancer screening and early detection when treatment is most effective. [ABSTRACT FROM AUTHOR]