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Purpose Cancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment. Methods Participants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I–III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months. Results Among 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants. Conclusion In this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP. Trial registration ClinicalTrials.gov identifier: NCT03867916.

BackgroundThere is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups.ObjectiveTo use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 caserates in California.DesignQuasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences.Main measuresAll COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development.Key resultsThe neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego.ConclusionNeighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.

Background: This study uses a novel geographic approach to summarize the distribution of breast cancer in San Francisco and aims to identify the neighborhoods and racial/ethnic groups that are disproportionately affected by this disease. Methods: Nine geographic groupings were newly defined on the basis of racial/ethnic composition and neighborhood socioeconomic status. Distribution of breast cancer cases from the Greater Bay Area Cancer Registry in these zones were examined. Multivariable logistic regression models were used to determine neighborhood associations with stage IIB+ breast cancer at diagnosis. Cox proportional hazards regression was used to estimate the hazard ratios for all-cause and breast cancer–specific mortality. Results: A total of 5,595 invasive primary breast cancers were diagnosed between January 1, 2006 and December 31, 2015. We found neighborhood and racial/ethnic differences in stage of diagnosis, molecular subtype, survival, and mortality. Patients in the Southeast (Bayview/Hunter's Point) and Northeast (Downtown, Civic Center, Chinatown, Nob Hill, Western Addition) areas were more likely to have stage IIB+ breast cancer at diagnosis, and those in the East (North Beach, Financial District, South of Market, Mission Bay, Potrero Hill) and Southeast were more likely to be diagnosed with triple-negative breast cancers (TNBC). Compared with other racial/ethnic groups, Blacks/African Americans (B/AA) experienced the greatest disparities in breast cancer–related outcomes across geographic areas. Conclusions: San Francisco neighborhoods with lower socioeconomic status and larger minority populations experience worse breast cancer outcomes. Impact: Our findings, which reveal breast cancer disparities at sub-county geographic levels, have implications for population-level health interventions.

Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools.

Background Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ACA was subsequently associated with changes in 1-year survival in GBM is not known. Methods A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients with the primary diagnosis of GBM between 2008 and 2016. A multivariable-adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine the main outcome: the 1-year cumulative probability of death by state expansion status. Results A total of 25 784 patients and 14 355 deaths at 1 year were identified and included in the analysis, 49.7% were older than 65 at diagnosis. Overall 1-year cumulative probability of death for GBM patients in non-expansion versus expansion states did not significantly worsen over the 2 time periods (2008–2010: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.04–1.19; 2014–2016: HR 1.18, 95% CI 1.09–1.27). In GBM patients younger than age 65 at diagnosis, there was a nonsignificant trend toward the poorer 1-year cumulative probability of death in non-expansion versus expansion states (2008–2010: HR 1.09, 95% CI 0.97–1.22; 2014–2016: HR 1.23, 95% CI 1.09–1.40). Conclusions No differences were found over time in survival for GBM patients in expansion versus non-expansion states. Further study may reveal whether GBM patients diagnosed younger than age 65 in expansion states experienced improvements in 1-year survival.

Background: Cancer is the leading cause of death for Asian Americans. Patient navigation has shown benefits in enhancing cancer treatment outcomes and quality of life. Navigational needs in accessing cancer supportive care among Asian American cancer patients and how to address such needs, however, remain understudied. Asian Americans face unique language and cultural barriers in cancer care. We designed a culturally and linguistically-tailored pilot patient navigation intervention, Patient COUNTS, to better understand and address the needs of Asian American cancer patients. Objective: To examine cancer supportive care needs and resource use among patients, who participated in a pilot study that aimed to provide culturally and linguistically-tailored navigation for Asian American cancer patients. Methods: We recruited Asian American adults diagnosed with stage I-III colorectal, liver, or lung cancer from the Greater Bay Area Cancer Registry and San Francisco hospitals. Participants spoke English, Chinese, or Vietnamese and had not completed treatment. Participants were assigned a language-concordant patient navigator, who provided support for six months. This study describes participants' cancer supportive care needs and resource use from telephone and self-administered surveys collected at baseline, three, and six months. Participants included 24 Asian Americans with cancer who completed the baseline survey, with 18 (75%) who completed at least one of the follow-up surveys. Results: Of the study sample (n=24), 63% were men, 55% were 65 years or older, and 42% did not complete high school. A majority (75%) spoke limited English; participants' preferred language included Cantonese/Mandarin (61%), Vietnamese (26%) and English (13%). Most participants had stage I (54%) or III (42%) cancer of the lung (42%), colon (37%), or liver (21%). Across the three surveys, the most frequently reported types of needs by the 24 participants were: cancer information (83%), language translation (54%), basic resources such as financial, transportation, legal, housing, and food access resources (50%), access to healthcare (42%), and mental health (33%). Among the 18 participants who completed the three- or six-month surveys, 90% reported using one or more resources that navigators directed them to. Specifically, of the 18 patients, the most frequently used resources included healthcare (77%), basic needs (67%), language translation (56%), and mental health (28%). Conclusions: The Asian American cancer patients enrolled in Patient COUNTS, a pilot patient navigation program, had a variety of cancer supportive care needs. Findings provided preliminary support of Patient COUNTS as a promising approach to assess cancer supportive care needs and assist navigation of resources among Asian American cancer patients. These findings will inform future interventions to improve the care that Asian American cancer patients receive. Citation Format: Katarina Wang, Janice Tsoh, Carmen Ma, Ching Wong, Hoan Bui, Corina Liew, Junlin Chen, Salma Shariff-Marco, Janet N. Chu, Laura Allen, Mei-Chin Kuo, Debora L. Oh, Scarlett L Gomez, Tung T. Nguyen. Cancer supportive care needs and resource use among Asian American cancer patients: Preliminary findings from a pilot patient navigation intervention, “Patient COUNTS” [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-032.

Background: Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time. Methods: Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer–specific survival over three diagnostic time periods: 1997–2002, 2003–2008, and 2009–2014. Analyses included all patients in California with colorectal cancer as a first primary malignancy. Multivariable Cox proportional hazard regression models were used to evaluate the effect of race/ethnicity, insurance status, and neighborhood socioeconomic status (nSES) on 5-year colorectal cancer–specific survival. Results: On the basis of a population-based sample of 197,060 colorectal cancer cases, racial/ethnic survival disparities decreased over time among non-Hispanic Blacks (NHB) compared with non-Hispanic Whites (NHW), after adjusting for demographic, clinical, and treatment characteristics. For cases diagnosed 1997–2002, colorectal cancer–specific hazard rates were higher for NHB [HR, 1.12; 95% confidence interval (CI), 1.06–1.19] and lower for Asians/Pacific Islanders (HR, 0.92; 95% CI, 0.87–0.96) and Hispanics (HR, 0.94; 95% CI, 0.90–0.99) compared with NHW. In 2009–2014, colorectal cancer–specific HR for NHB was not significantly different to the rate observed for NHW (HR, 1.03; 95% CI, 0.97–1.10). There were no changes in disparities in nSES, but increasing disparities by health insurance status. Conclusions: We found a decrease in survival disparities over time by race/ethnicity, but a persistence of disparities by neighborhood socioeconomic status and health insurance status. Impact: Further investigation into the drivers for these disparities can help direct policy and practice toward health equity for all groups.

Introduction Racial/ethnic diversity in prostate cancer (CaP) clinical trials (CTs) is essential to address CaP disparities. California Cancer Registry mandated electronic reporting (e-path) of structured data elements from pathologists diagnosing cancer thereby creating an opportunity to identify and approach patients rapidly. This study tested the utility of an online CT matching tool (called Trial Library) used in combination with e-path to improve matching of underrepresented CaP patients into CTs at time of diagnosis. Methods This was a nonrandomized, single-arm feasibility study among patients with a new pathologic diagnosis of high-risk CaP (Gleason Score ≥8). Eligible patients were sent recruitment materials and enrolled patients were introduced to Trial Library. Results A total of 419 case listings were assessed. Patients were excluded due to physician contraindication, not meeting baseline eligibility, or unable to be reached. Final participants (N = 52) completed a baseline survey. Among study participants, 77% were White, 10% were Black/Hispanic/Missing, and 14% were Asian. The majority of the study participants were over 65 years of age (81%) and Medicare insured (62%). Additionally, 81% of participants reported using the Internet to learn about CaP. The majority (62%) of participants reported that Trial Library increased their interest in CT participation. Conclusions The current study demonstrated that leveraging structured e-path data reporting to a population-based cancer registry to recruit men with high risk CaP to clinical research is feasible and acceptable. We observed that e-path may be linked with an online CT matching tool, Trial Library. Future studies will prioritize recruitment from reporting facilities that serve more racially/ethnically diverse patient populations.

Background: Most men diagnosed with prostate cancers of low grade and low potential for progression are expected to have comparable survival as other men their age without prostate cancer. Thus, active surveillance (i.e., closely monitoring the course of disease with the expectation to intervene given evidence of cancer progression) is universally recommended as a viable management option for men with these tumors. However, men may not be adequately informed about their treatment options; for example, there is evidence that active surveillance is less frequently discussed with underserved men, such as minorities, those of low socioeconomic status, or those with limited English proficiency. Methods: This study is the first (qualitative) phase of a sequential mixed-methods study to explore factors that influence prostate cancer treatment among a diverse group of men with low risk disease. We conducted 43 in-depth interviews with patients diagnosed within the prior 24 months with low-risk prostate cancer recruited from the Greater Bay Area Cancer Registry (13 Asian Americans, 10 African Americans, 10 Latinos, and 10 Non-Hispanic Whites). Interviews were conducted in English, Spanish, Cantonese, or Mandarin. To date, 38 interviews have been transcribed, and coded in Dedoose using 29 codes. Three study staff reviewed all interview excerpts tagged with each code to identify factors that played a role in patients’ decision-making. These factors were then incorporated into an epidemiologic survey being developed for the second (quantitative) phase of the study. Results: Themes related to treatment decision-making include: concern for and obligation to partner/family, others’ experiences with treatment, clinical factors (grade/stage), health insurance, medical mistrust, cancer-related anxiety, comorbidities, race/ethnicity/culture, and religion/spirituality. We incorporated these themes into the quantitative survey by drafting survey items on: burden on family members, experiences of family/friends with cancer, avoidance of repeated tests, anxiety related to anticipation of test results, preference for immediate action rather than waiting to see whether the cancer progresses, personality and coping preferences, cultural factors (e.g., stigma regarding cancer, norms/expectations regarding manhood), and life stage and lifestyle. Most of these items have not been included in prior surveys of prostate cancer treatment decision-making. Conclusions: We identified many novel factors influencing treatment decisions among a diverse group of prostate cancer patients in the Greater San Francisco Bay Area, illustrating how a mixed-method approach can be used to augment knowledge regarding treatment decision-making in diverse populations. Ongoing quantitative work will examine the importance of these factors among a larger study population. This work will assist providers to better support patients with low risk prostate cancer as they go through the treatment decision-making process. Citation Format: Salma Shariff-Marco, Janet Shim, Laura Allen, Mei-Chin Kuo, Kathie Lau, Todd Golden, Zinnia Loya, Alice Guan, Mindy C. DeRouen, Debora Oh, Daphne Lichtensztajn, TAP Study Team, Scarlett Lin Gomez. Factors that influence prostate cancer treatment decisions: A qualitative study among a diverse, population-based sample of men with low-risk prostate cancer in Northern California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B053.

Background: While cancer is the most common cause of death for Asian Americans, many Asian American cancer patients do not receive appropriate treatment nor supportive care. The Patient COUNTS project aims to provide these patients and their caregivers with accessible, culturally-relevant, and linguistically-appropriate navigation resources that utilize technology to reduce disparities and improve quality of life. Methods: With feedback from a Patient Advisory Council and focus groups with cancer patients and caregivers, we developed a patient navigation program for Asian Americans that is currently being pilot tested with patients in Northern California. We are also developing an online patient portal that will enable newly diagnosed colorectal, liver, and lung cancer patients to access appropriate resources and virtual navigation. The portal and navigation will be available in English, Chinese (Cantonese/Mandarin), and Vietnamese, with ability to collect patient-generated health data (e.g., quality of life) and provide tailored resources and navigation. Results: We conducted 4 focus groups and 3 individual interviews with 17 participants in 4 languages (English, Mandarin, Cantonese, or Vietnamese). Key emerging themes include: 1) information unawareness or overload; 2) emotional support; 3) navigation needs; and 4) resource access. Participants with limited English proficiency often did not know to ask or what to ask for regarding their diagnosis or treatment. Some, however, were confused and overwhelmed by the amount of information from many sources. Receiving encouragement to fight cancer was described as crucial in their cancer care; family, friends, doctors, nurses or hospital staff were the primary sources of such emotional support. Although most participants were unfamiliar with navigation, they thought it was very desirable once an explanation was provided. Participants wanted information on symptoms and side effects management. They recommended providing information on sensitive topics (e.g., stigma, dying) only when asked by the patient. Access to information in both their native language and English are important for their comprehensive and communication with others. For participants with end-stage disease, information on palliative care and clinical trials should be provided. These findings guided the development of our patient navigation program to provide information on cancer, treatment, living with cancer, emotional well-being, resources (access to health care, financial, transportation, housing, food and nutrition, child/adult care). Conclusions: Our formative research found significant needs among Asian American cancer patients and suggestions for how to address those needs. Implementing the in-person pilot and online portal will enable us to identify key elements of an effective, sustainable, and disseminable navigation program for Asian American cancer patients and their caregivers. Citation Format: Salma Shariff-Marco, Debora Oh, Janice Tsoh, Ching Wong, Laura Allen, Janet Chu, Hoan Bui, Corina Liew, Angela Sun, Joyce Cheng, Lei Chun Fung, Scarlett Lin Gomez, Tung Nguyen. The Patient COUNTS Study: Patient Cancer OUtreach, Navigation, Technology, and Support [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C017.

Objectives To estimate the adult health burden and costs in California during 2013 associated with adults’ prior Adverse Childhood Experiences (ACEs). Methods We analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008–2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY. Results Among adults in California, 61% reported ACEs. Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars. During 2013, the estimated health burden per exposed adult included $589 in personal healthcare expenses and 0.0224 DALYs valued at $5,769. Conclusions Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts.

Background Early detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. A systematic review was conducted to better understand the pediatric health outcomes associated with childhood adversity. Methods PubMed, PsycArticles, and CINAHL were searched for relevant articles. Longitudinal studies examining various adverse childhood experiences and biological health outcomes occurring prior to age 20 were selected. Mental and behavioral health outcomes were excluded, as were physical health outcomes that were a direct result of adversity (i.e. abusive head trauma). Data were extracted and risk of bias was assessed by 2 independent reviewers. Results After identifying 15940 records, 35 studies were included in this review. Selected studies indicated that exposure to childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption. Studies on household dysfunction reported an effect on weight during early childhood, and studies on maltreatment reported an effect on weight during adolescence. Maternal mental health issues were associated with elevated cortisol levels, and maltreatment was associated with blunted cortisol levels in childhood. Furthermore, exposure to childhood adversity was associated with alterations of immune and inflammatory response and stress-related accelerated telomere erosion. Conclusion Childhood adversity affects brain development and multiple body systems, and the physiologic manifestations can be detectable in childhood. A history of childhood adversity should be considered in the differential diagnosis of developmental delay, asthma, recurrent infections requiring hospitalization, somatic complaints, and sleep disruption. The variability in children’s response to adversity suggests complex underlying mechanisms and poses a challenge in the development of uniform diagnostic guidelines. More large longitudinal studies are needed to better understand how adversity, its timing and severity, and the presence of individual genetic, epigenetic, and protective factors affects children’s health and development.

Purpose When children are exposed to Adverse Childhood Experiences (ACEs), their biological stress response is chronically triggered, altering brain architecture and causing long-term harm to their developing bodies. Left unaddressed, this toxic stress response can have serious long-term health effects on children as well as impact educational, social, and economic outcomes. Early detection, therefore, has powerful potential to improve the health and wellbeing of children. Identification and diagnosis are currently limited, however, by gaps in understanding …

Childhood adversity negatively impacts the biological development of children and has been linked to poor health outcomes across the life course. The purpose of this literature review is to explore and evaluate the effectiveness of interventions that have addressed an array of biological markers and physical health outcomes in children and adolescents affected by adversity. PubMed, CINAHL, PsychInfo, Sociological Abstracts databases and additional sources (Cochrane, WHO, NIH trial registries) were searched for English language studies published between January 2007 and September 2017. Articles with a childhood adversity exposure, biological health outcome, and evaluation of intervention using a randomized controlled trial study design were selected. The resulting 40 intervention studies addressed cortisol outcomes (n = 20) and a range of neurological, epigenetic, immune, and other outcomes (n = 22). Across institutional, foster care, and community settings, intervention programs demonstrated success overall for improving or normalizing morning and diurnal cortisol levels, and ameliorating the impacts of adversity on brain development, epigenetic regulation, and additional outcomes in children. Factors such as earlier timing of intervention, high quality and nurturant parenting traits, and greater intervention engagement played a role in intervention success. This study underlines progress and promise in addressing the health impacts of adversity in children. Ongoing research efforts should collect baseline data, improve retention, replicate studies in additional samples and settings, and evaluate additional variables, resilience factors, mediators, and long-term implications of results. Clinicians should integrate lessons from the intervention sciences for preventing and treating the health effects of adversity in children and adolescents.

Early life adversity, also referred to as adverse childhood experiences (ACEs), includes stressful or traumatic experiences in childhood and abuse, neglect, and household dysfunction. ACEs put children at risk of negative physical, mental, and behavioral health outcomes. When a child is exposed to stressors, such as early life adversity, the body’s natural stress response can become maladaptive or toxic to the body. The toxic stress response results from a disruption of the circuitry between neuroendocrine and immune systems, and it affects multiple biological systems, laying the foundation for long-term health outcomes.

This study investigated levels of adherence to antiretroviral therapy in white, Hispanic, and black men and isolated factors associated with adherence among each racial group.Data were collected from 1102 men enrolled in the Multicenter AIDS Cohort Study followed between April 2002 and October 2006. Self-reported 100% adherence was defined as taking all doses and pills over the previous 4-day period, reporting not typically skipping any medications, and reporting always following the medication schedule. Variables associated with adherence were determined by multilevel logistic regression for each racial group. Adherence was also analyzed by ethnicity within racial groups.After controlling for confounders, we found that Hispanics were 2.16 times and blacks were 1.37 times more likely than whites to not report 100% adherence (95% confidence interval 1.47 to 3.18 and 1.05 to 1.79, respectively). Hispanics with ethnic backgrounds from Central and South America and the Caribbean had lower rates of adherence. Blacks with ethnic backgrounds from the Caribbean had lower rates of adherence than those from other regions.

Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are common functional bowel disorders. Patients with IBS-C or CIC often present with ≥ 1 comorbidity that coincides with either of these conditions. These comorbidities may make underappreciated contributions to the patient's overall disease burden.To identify the comorbidities that are the most frequently reported in patients with IBS-C or CIC in the medical literature.A literature search (January 2001-March 2012) was performed using the Medline and Medline In-Process databases. Studies of adult patients with IBS-C or CIC were selected, and the prevalence rates of the comorbidities were extracted and analyzed according to the body system affected.A total of 70 distinct comorbidities were identified from 35 published studies. These comorbidities involved several body systems, including the gastrointestinal, genitourinary, psychiatric, endocrine, and allergic or immunologic systems. Functional dyspepsia and depression were the most common comorbidities in patients with IBS-C, whereas functional dyspepsia, diabetes, and depression were the most common comorbidities in patients with CIC.Patients with IBS-C or CIC frequently experience a wide range of comorbidities that contribute to their disease burden. Thus, we believe that medical professionals should consider common comorbidities when diagnosing and treating patients with IBS-C or CIC.

Background The rate of smoking and lung cancer among women is rising in Europe. The primary aim of this study was to determine why women begin smoking in five different European countries at different stages of the tobacco epidemic and to determine if smoking is associated with certain characteristics and/or beliefs about smoking. Methods A cross-sectional telephone survey on knowledge and beliefs about tobacco was conducted as part of the Women in Europe Against Lung Cancer and Smoking (WELAS) Project. A total of 5 000 adult women from France, Ireland, Italy, Czech Republic, and Sweden were interviewed, with 1 000 from each participating country. All participants were asked questions about demographics, knowledge and beliefs about smoking, and their tobacco use background. Current and former smokers also were asked questions about smoking initiation. Basic statistics on the cross-sectional data was reported with chi-squared and ANOVA p-values. Logistic regression was used to analyze ever versus never smokers. Linear regression analyses were used to analyze age of smoking initiation. Results Being older, being divorced, having friends/family who smoke, and having parents who smoke were all significantly associated with ever smoking, though the strength of the associations varied by country. The most frequently reported reason for initiation smoking was friend smoking, with 62.3% of ever smokers reporting friends as one of the reasons why they began smoking. Mean age of smoking initiation was 18.2 years and over 80% of participants started smoking by the age of 20. The highest levels of young initiators were in Sweden with 29.3% of women initiating smoking at age 14-15 and 12.0% initiating smoking younger than age 14. The lowest level of young initiators was in the Czech Republic with 13.7% of women initiating smoking at age 14-15 and 1.4% of women initiating smoking younger than age 14. Women who started smoking because their friends smoked or to look 'cool' were more likely to start smoking at a younger age. Women who started smoking to manage stress or to feel less depressed were more likely to start smoking at an older age. Conclusions In all five participating countries, friends were the primary factor influencing ever smoking, especially among younger women. The majority of participants began smoking in adolescence and the average reported age of smoking initiation was youngest in Sweden and oldest in the Czech Republic.