This study examined individual-level determinants of self-reported changes in healthy (diet and physical activity) and addictive (alcohol use, smoking, and vaping) lifestyle behaviors during the initial COVID-19 lockdown period in the USA. A national online survey was administered between May and June 2020 that targeted a representative U.S. sample and yielded data from 1276 respondents, including 58% male and 50% racial/ethnic minorities. We used univariate and multivariable linear regression models to examine the associations of sociodemographic, mental health, and behavioral determinants with self-reported changes in lifestyle behaviors. Some study participants reported increases in healthy lifestyle behaviors since the pandemic (i.e., 36% increased healthy eating behaviors, and 33% increased physical activity). However, they also reported increases in addictive lifestyle behaviors including alcohol use (40%), tobacco use (41%), and vaping (46%). With regard to individual-level determinants, individuals who reported adhering to social distancing guidelines were also more likely to report increases in healthy lifestyle behaviors (β = 0.12, 95% CI 0.04 to 0.21). Conversely, women (β = −0.37, 95% CI −0.62 to −0.12), and unemployed individuals (β = −0.33, 95% CI −0.64 to −0.02) were less likely to report increases in healthy lifestyle behaviors. In addition, individuals reporting anxiety were more likely to report increases in addictive behaviors (β = 0.26, 95% CI 0.09 to 0.43). Taken together, these findings suggest that women and unemployed individuals may benefit from interventions targeting diet and physical activity, and that individuals reporting anxiety may benefit from interventions targeting smoking and alcohol cessation to address lifestyle changes during the pandemic.

This study sought to identify individual-level determinants of COVID-19 vaccine hesitancy based on the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). An online population-based survey was distributed in English and Spanish. Data were derived from 1208 U.S. adults (52% female; 38.7% minorities), 43.5% of whom reported vaccine hesitancy. Multivariable analysis revealed that unemployed individuals were more likely (OR = 1.78, 95% CI: 1.16–2.73, p = 0.009) and married (OR = 0.57, 95% CI: 0.39–0.81, p = 0.002) and higher income individuals (OR = 0.52, 95% CI 0.32–0.84, p = 0.008) were less likely to be hesitant. Individuals with greater perceived susceptibility to COVID-19 (OR = 0.82, 95% CI: 0.71–0.94, p = 0.006), who perceived vaccination as being convenient (OR = 0.86, 95% CI: 0.74–1.00, p = 0.047), and who afforded greater importance to cues to action from government (OR = 0.84, 95% CI: 0.74–0.95, p = 0.005), public health (OR = 0.70, 95% CI: 0.59–0.82, p < 0.001), and healthcare experts (OR = 0.59, 95% CI: 0.50–0.69, p < 0.001) were also less likely to be hesitant. Findings suggest that HBM and TPB constructs may be useful in informing strategies to improve COVID-19 vaccine uptake. Specifically, framing appeals based on perceptions of COVID-19 susceptibility, making vaccination convenient, and rebuilding trust through unified cues to action may help to overcome vaccine hesitancy.

Colorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on complications after surgery for colorectal cancer in our population.

The phenotype of combined heavy alcohol consumption and obesity has the potential to pose as a considerable health burden in the U.S. No studies using nationally representative data in the U.S. have reported their secular joint prevalence trends. We estimated the prevalence and examined the joint trends of heavy alcohol use and obesity over time among adult U.S. men and women in different age groups and according to race/ethnicity. Using data from 10 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020, we examined secular trends in the combined phenotype of heavy drinking and obesity overall and by age-group, sex, and race/ethnicity. The main outcome measures were prevalence of heavy alcohol consumption (>14 drinks/week in men and >7 drinks/week in women) and obesity (BMI ≥30). In 45,292 adults (22,684 men, mean age 49.26 years; and 22,608 women, mean age 49.86), the overall weighted prevalence of combined heavy alcohol drinking and obesity increased from 1.8% (95% CI: 1.2%, 3.1%) in 1999–2000 to 3.1% (95% CI: 2.7%, 3.7%) in 2017–2020 representing an increase of 72% over time. In the joinpoint regression, the combined phenotype of heavy alcohol consumption and obesity increased by 3.25% (95% CI: 1.67%, 4.85%) per year overall from 1999 to 2017. An increasing trend of 9.94% (95% CI: 2.37%, 18.06%) per year was observed among adults aged between 40 and 59 years from 2007 onwards. Prevalence of heavy alcohol consumption in obesity increased at a faster rate among women (APC, 3.96%; 95% CI: 2.14%, 5.82%) than men (APC, 2.47%; 95% CI: 0.63%, 4.35%), and increased among non-Hispanic Whites (APC, 4.12%; 95% CI: 1.50%, 6.82%) and non-Hispanic Blacks (APC, 2.78%; 95% CI: 0.47%, 5.14%), but not Hispanics. The prevalence of combined heavy alcohol consumption and obesity increased overall in the U.S., but the rate of increase differed by age, sex, and race/ethnic groups. Given their independent and potential synergistic effects on premature mortality, public health policies on alcohol consumption need to reflect the background obesity epidemic. 10.13039/100004917 Cancer Prevention & Research Institute of Texas (CPRIT) for the Systems Epidemiology of Cancer Training (SECT) Program (RP210037; PI: A. Thrift).

Background: Esophageal cancer (EC) incidence rates overall have declined in recent decades; however, the two main subtypes, esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), show divergent secular trends. Methods: Age-adjusted EC incidence rates were calculated using data from the Surveillance Epidemiology and End Results (SEER) 12 Program. We examined secular trends from 1992 to 2019 overall and by age group, sex, race/ethnicity, tumor location, and SEER registry. Joinpoint regression was used to compute annual percent changes (APC) and average annual percent changes (AAPC). We used age-period-cohort models to examine the potential impact of period and birth cohort effects on trends. Results: Between 1992 and 2019, overall EC incidence rates declined by 0.54% annually (95% confidence interval [CI]: −0.75%, −0.33%). While ESCC rates declined linearly throughout the study period (AAPC = −2.85; 95%CI: −3.05%, −2.65%), EAC rates increased by over 5% annually from 1992 to 2000 (APC = 5.17; 95%CI: 3.28%, 7.10%), before stabilizing from 2000 to 2019 (APC = 0.22; 95%CI: −0.16%, 0.60%). Trends in ESCC and EAC varied by age group, sex, and race/ethnicity. Relative to ESCC rates among cohorts born circa 1950, the rates were 81% lower in cohorts born circa 1985 (rate ratio, 0.19; 95%CI: 0.04, 0.96). For EAC, rates have remained stable across successive birth cohorts since 1950. Conclusions: We observed linear declines in EC rates overall and for ESCC across age, sex, and race/ethnicity subgroups, but an inconsistent pattern for EAC. The trends in EAC cohorts born after 1955 were stable and suggest that EAC rates may have peaked in the U.S.

Rose's Strategy of Preventive Medicine is critical reading for students and teachers in public health as well as practitioners of family and preventive medicine. In his classic, Geoffrey Rose outlines the prevention paradox that led to a discussion of two main preventive approaches to a disease, the individual- and population-based. This commentary briefly provides historical perspectives and viewpoints on the message of fundamental importance that when the population moves as a whole, the relative differences are the characteristics not of individuals but of populations. The “population as a whole” has been adopted in the lexicon of public health, enriched by Hippocrates' treatise on air, water, and places; Durkheim's collective consciousness; Pickering's continuous unimodal distribution; and Keys' charts of contrasting distributions. These readings should provide the public health professionals with a critical understanding of prevention paradox when they tend to focus only on the expression of the root cause above ground but fail to at the roots beneath the ground.