As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated “opt-out” referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.

BackgroundModifiable lifestyle factors are known to impact survival. It is less clear whether this differs between postmenopausal women ever diagnosed with breast cancer and unaffected women.MethodsWomen diagnosed with breast cancer and unaffected women of comparable age were recruited from 2002 to 2005 and followed up until 2020. Using baseline information, a lifestyle adherence score (range 0-8; categorized as low [0-3.74], moderate [3.75-4.74], and high [>= 4.75]) was created based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. Cox regression and competing risks analysis were used to analyze the association of adherence to WCRF/AICR lifestyle recommendations with overall mortality and with death due to cardiovascular diseases and cancer, respectively.ResultsA total of 8584 women were included (2785 with breast cancer and 5799 without). With a median follow-up of 16.1 years there were 2006 total deaths. Among the deaths of known causes (98.6%), 445 were cardiovascular-related and 1004 were cancer-related. The average lifestyle score was 4.2. There was no differential effect of lifestyle score by case-control status on mortality. After adjusting for covariates, moderate (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.57-0.76) and high (HR, 0.54; 95% CI, 0.47-0.63) adherence to WCRF/AICR lifestyle recommendations were significantly associated with a decrease in overall mortality. Similarly, in competing risks analysis, moderate and high adherence were associated with decreased mortality from cardiovascular diseases and from cancer.ConclusionsA healthy lifestyle can substantially reduce mortality risk in women. With low adherence to all WCRF/AICR guidelines in about a third of study participants, health interventions are warranted. There was no differential effect of a breast cancer diagnosis on the association between healthy lifestyle score and lower mortality in postmenopausal women.

Background: Tobacco consumption remains a leading cause of global morbidity and mortality and is a significant preventable health concern. Despite the known benefits of smoking cessation, many smokers face difficulties in maintaining abstinence and preventing relapse. In Germany, approximately 30% of individuals aged 14 and older are smokers, which reflects low smoking cessation rates and limited use of evidence-based smoking cessation interventions. Purpose: This qualitative study aimed to explore experts’ views on smoking cessation through interviews with health practitioners. Methods: Fifteen semi-structured in-depth interviews were conducted with professionals from diverse fields, including medical doctors, psychologists, and addiction therapists, from July to November 2022. The data were analyzed using qualitative content analysis. A deductively developed categorization system was applied to identify sub-themes within categories and to systematically code the data. All data were thencategorized under two main categories: facilitators and barriers to smoking cessation. Results: Key facilitators included the self-motivation of participants, the communication skills of the intervention leader, and the provision of knowledge about addiction mechanisms. Important barriers were smokers’ fears of quitting, external environmental pressures, and inadequate counseling structures. Conclusion: The findings suggest that improving smoking cessation interventions in Germany require comprehensive strategies involving both structural adjustments in health care settings and enhanced training for tobacco treatment specialists.

Background: Non-adherence to medical guidelines is associated with suboptimal health outcomes and increased healthcare costs, and yet adherence to preventive therapies is often difficult to achieve. Understanding which factors can improve adherence is a public health priority. In this study, we examined the association of psychosocial factors and adherence of preventive behaviors within the context of the COVID-19 pandemic. Methods: Panel data from the European COvid Survey (ECOS), a representative sample of residents aged 18+ from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy collected from April 2020 (wave 1) to May 2022 (wave 10) was used to examine trends and determinants of COVID-19 preventive behaviors (i.e., mask wearing, hand washing). Results: With a total of 27,095 participants, 53.5% were female, and 15.9% were aged 18-24, 67.9% 25-64, and 16.3% 65+. The trends in adherence decreased over time except in wave 5 where a spike in adherence levels matched wave 1 levels and a surge in reported COVID-19 infections. In multivariable logistic regression models, worry about overloading the health system (OR = 1.26, 95%CI: 1.22-1.31), perceived risk to one's own health (OR = 1.13, 95%CI: 1.08-1.18) and others (OR = 1.16, 95%CI: 1.10-1.22), and trust in institutions (OR = 1.20, 95%CI: 1.12-1.26), traditional news media (OR = 1.05, 95%CI: 1.01-1.10), and health providers (OR = 1.31, 95%CI: 1.26-1.37) increased the likelihood of engaging in COVID-19 preventive behaviors. However, those with high trust in social media were less likely to follow prevention guidelines (OR = 0.78, 95%CI: 0.75-0.80). Conclusions: Psychosocial factors (risk perceptions, worry, and trust variables) were associated with adhering to COVID-19 prevention guidelines. Findings that high trust in social media was related to low adherence suggests more research is needed to understand how public health can improve health communications via social media, a popular information resource. Key messages: • Health risk perceptions and worry about overloading the health system were associated with adhering to COVID-19 prevention guidelines. • Trust in social media was related to low adherence to COVID-19 prevention guidelines.