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Annual screening with low dose chest tomography has been adopted for those at high risk to aid in the early detection of lung cancer. In addition to screening, it is recommended that such persons receive evidence-based smoking-cessation. However, both lung cancer screening and evidence-based smoking-cessation strategies are underutilized in the US. We review the impact of a dedicated Tobacco Treatment Clinic (TTC), delivering evidence-based smoking cessation strategies, on lung cancer screening enrollment. Patients of the TTC, aged 50 years or older, having a minimum 20-pack-year smoking history were included. All patients had records reviewed to see if they had received lung cancer screening; if their lung cancer screening was achieved through the TTC, this was documented as "initial screening" versus "continued screening or surveillance". Sociodemographic variables were collected as well. As for results, between January 2019 to February 2020, 92 patients enrolled in the TTC and fulfilled criteria for lung cancer screening. The mean age was 65.7 ± 8.3 years old, with 58 (63.0%) of the patients being female. Seventy-five (81.5%) patients were African American. Of the 92, 68 (73.9%) patients had lung cancer screening, with 51 patients receiving their first lung cancer screening scan through the TTC. In conclusion, through enrollment in a dedicated TTC, a significant proportion of patients were able to access lung cancer screening for the first time. Further, many of these patients were of minority status. Having a dedicated TTC may improve current health equity gaps in lung cancer screenings in certain US populations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Community resilience is a community's ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community's disaster-specific functioning over time. We explored COPEWELL's usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.

Introduction: Cancer clinical trial (CCT) enrollment is low potentially threatening the generalizability of trial results and expedited regulatory approvals. We assessed whether type of initial patient appointment for non-small cell lung cancer (NSCLC) is associated with CCT eligibility., Methods: Using a patient-to-accrual framework, we conducted a quasi-retrospective cohort pilot study at Sidney Kimmel Comprehensive Cancer Center (SKCCC), Baltimore, Maryland. 153 NSCLC patients new to SKCCC were categorized based on type of initial appointment: patients diagnosed or treated and patients seen for a consultation. CCT eligibility was determined by comparing eligibility criteria for each open trial to the electronic medical record (EMR) of each patient at every office visit occurring within 6-months of initial visit., Results: We found no association between type of initial appointment and CCT eligibility (OR, 1.15; 95% CI, 0.49-2.73). Analyses did suggest current smokers were less likely to be eligible for trials compared to never smokers (OR, 0.15; 95% CI, 0.03-0.64), and stage 4 patients with second line therapy or greater were more likely to be eligible than stage 1 or 2 patients (OR, 5.18; 95% CI, 1.08-24.75). Additional analyses suggested most current smokers and stage 1 or 2 patients had trials available but were still ineligible., Conclusions: SKCCC has a diverse portfolio of trials available for NSCLC patients and should consider research strategies to re-examine eligibility criteria for future trials to ensure increased enrollment of current smokers and stage 1 or 2 patients. We could not confirm whether type of initial visit was related to eligibility.

Purpose: Health promotion and disease prevention among people with disabilities are often overlooked. The objective of this article is to determine if working age adults with disabilities differ in healthy behaviours from those without disabilities., Method: Behavioural Risk Factor Surveillance System data (2003) were used to assess healthy behaviours among 201,840 community dwelling working age adults., Results: People who reported activity limitation irrespective of assistive device use were more likely to be overweight and to smoke than people without a disability. The prevalence of heavy alcohol and insufficient fruit and vegetable consumption was significantly lower among those who used an assistive device irrespective of activity limitation compared to the No Disability Group. Adults in all disability groups were significantly more likely to report physical inactivity compared to the No Disability Group. Lower alcohol consumption and physical inactivity findings were accentuated when the disabled were not working., Conclusions: There is evidence that people with a disability report poor lifestyle behaviours that increase disease risk and may need assistance with smoking cessation, weight loss and adoption of a physical activity routine. Screening for unhealthy behaviours and advice should be incorporated into routine health care visits for working age adults with disabilities.

Objective: We determined the frequency of deaths associated with histiocytosis in the United States (US) for which incidence data are lacking and could be potentially important in understanding outcomes for patients with these disorders., Methods: National death data collected by the US Vital Statistics Reporting System and aggregated using wonder.cdc.gov were analyzed for underlying cause of death due to malignant histiocytosis (MH), Langerhans cell histiocytosis (LCH) and Letterer-Siwe disease (LS, a form of LCH) for 3 periods: 1979-1988, 1989-1998, and 1999-2006. To capture histiocytosis, International Classification of Diseases (ICD)-9 codes 202.3, 202.5, and 277.8 and ICD-10 codes C96.1, C96.0, and D76.0-76.1 were used. Deaths were calculated for US residents stratified according to sex, race, region, and age. Other listed contributing causes of death with a histiocytosis diagnosis were also examined., Results: A total of 2,416 deaths primarily due to histiocytosis as underlying cause occurred between 1979 and 2006. On comparison of the underlying and contributory cause for the period 1999-2006, histiocytosis mentioned on the death certificate as a contributory cause (N=562) occurs nearly as often as does underlying cause alone (N=648). The age-adjusted (year 2000) death rate was highest for MH (2.62 deaths per 10 million, 95% CI: 2.40-2.83) and for LCH and LS disease (2.17, 95% CI: 1.98-2.36) during the period 1979-1988. Death rates of each type of histiocytosis dropped significantly from 1979 to 1988 to 1999-2006 (p-value <0.0001). Distribution of the conditions showed the majority of deaths were due to LCH and LS (67%) across all time periods. LCH/LS was significantly more common in persons younger than 5 years of age irrespective of gender (p-value <0.0001) whereas death rates from MH were significantly greater in ages >54 years (p-value <0.00001). There were more MH deaths among males than females whereas no gender differences were seen for LCH/LS., Conclusions/discussion: Death due to histiocytosis or histiocytosis-related causes is a rare event that is trackable in the US by person, place and time characteristics. However, a population-based, disease incidence registry has begun to accurately ascertain incidence cases, which will facilitate study of these conditions.

The Community Health Status Indicators Project (CHSI) 2008 provides 16-page reports for the 3141 counties in the United States, each of which includes more than 300 county-specific data items related to chronic and infectious diseases, birth characteristics or outcomes, causes of death, environmental health, availability of health services, behavioral risk factors, health-related quality of life, vulnerable populations, summary measures of health, and health disparities. The CHSI, originally initiated in 2000, provides county-level health profiles for all U.S. counties so that programs addressing community health can readily access community health indicators. Each county report also permits comparisons of a county's health status with similar "peer counties," with all counties, and with national Healthy People 2010 objectives. Under the leadership of a public-private partnership, the CHSI Steering Committee updated each county report and added new information and features to create CHSI 2008. This new CHSI version includes data for 1994 through 2006 from multiple surveillance systems. New features include an enhanced Web site, an Internet mapping application, and a downloadable database of the indicators for all counties.