The Association of Sleep Trouble and Physical Inactivity with Breast Cancer Risk in Nova Scotia: Evidence from the Atlantic PATH Cohort

Authors: Cindy Feng, Ellen Sweeney Journal: International Journal of Environmental Research and Public Health Abstract: Breast cancer is a major public health concern, and modifiable health behaviors such as sleep quality and physical activity may influence risk. This study examined the associations between self-reported sleep trouble, sleep duration, and physical activity with breast cancer incidence in a prospective longitudinal cohort of 10,305 females from Nova Scotia. Breast cancer cases were identified through record linkage to the Nova Scotia Cancer Registry. Multivariable logistic regression models were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs), accounting for sociodemographic factors, reproductive history, comorbidities, and other health behaviors. Frequent sleep trouble (“all of the time”) was significantly associated with increased odds of breast cancer (AOR = 2.41, 95% CI = 1.09–5.34, p = 0.03), while no significant associations were observed between sleep duration and breast cancer risk. High physical activity was significantly associated with a lower risk of breast cancer (AOR = 0.58, 95% CI = 0.39–0.86, p < 0.01). These findings suggest that frequent sleep disturbances may be associated with an increased risk of breast cancer, while high physical activity appears to be linked to a lower risk of breast cancer. Further research is needed to explore these relationships and their underlying mechanisms. doi: https://doi.org/10.3390/ijerph22040471

Quality of Non‐Surgical and Non‐Pharmacological Knee Osteoarthritis Care in the Maritimes

Authors: Aleksandra Budarick, Cheryl Hubley-Kozey, Linda Li, Olga Theou, William Stanish Journal: Musculoskeletal Care Objectives: To evaluate the quality and types of care individuals with mild‐to‐moderate knee osteoarthritis receive in the Canadian Maritime provinces, and determine associations with demographic, social, and patient‐reported factors. Methods: Individuals with knee osteoarthritis were invited to complete a healthcare quality survey based on the British Columbia Osteoarthritis (BC OA) survey. The cross‐sectional descriptive observational survey assessed four healthcare quality indicators: advice to exercise, advice to lose weight, assessment of ambulatory function, and assessment of non‐ambulatory function. Pass‐rates were calculated overall and for each quality indicator. Binary logistic regressions determined associations between quality indicators and demographic, social, and patient‐reported outcomes. Patient‐reported use of exercise and diet as arthritis treatments were added to the quality indicator eligibility criteria as a sensitivity analysis. Results: Participants (n = 241) had a mean age of 67 (7) years, body mass index of 30.7 (7.5) kg/m2 and were 77% female. The overall pass rate was 42.9% using the BC OA criteria, and 49.3% in the sensitivity analysis. Individual quality indicator pass‐rates ranged from 4.3% for non‐ambulatory function to 85.7% for ambulatory function assessments. The sensitivity analysis increased pass‐rates for advice to exercise (61.9%–69.3%) and advice to lose weight (27.9%–35.1%). Pass‐rates were not driven by demographic, social, or patient‐reported factors. Conclusions: Over half of individuals with mild‐to‐moderate knee osteoarthritis did not receive recommended core treatments in the Maritimes, highlighting a need to improve care for this patient group. Quality indicators should be routinely evaluated to determine whether clinical care aligns with best practice guidelines. doi: 10.1002/msc.70047

Investigating Skin Cancer Risk and Sun Safety Practices Among LGBTQ+ Communities in Canada

Authors: François Lagacé, Farhan Mahmood, Santina Conte, Lorena Mija, Amina Moustaquim-Barrette, Jonathan LeBeau, Alyson McKenna, Mahan Maazi, Johnny Hanna, Alexandra Kelly, Raquel Lazarowitz, Elham Rahme, Travis Hrubeniuk, Ellen Sweeney, Ivan Litvinov. Journal: Current Oncology Background: Skin cancer prevention relies on effective sun safety practices. Previous studies have shown that LGBTQ+ individuals exhibit lower sunscreen use and higher tanning bed usage compared to their non-LGBTQ+ counterparts. This study is the first to assess skin cancer risk factors, sun-protective behaviors, and skin cancer concerns among LGBTQ+ individuals across Canada. Methods: A national survey study was conducted between July 2020 and March 2024 and included LGBTQ+ respondents aged ≥ 16 years who had completed the survey. Responses were summarized using frequency counts/percentages for categorical variables and means/standard deviations for continuous variables. Logistic regression models were used to calculate age- and gender-adjusted odds ratios for subgroup analyses. Results: Of the 700 LGBTQ+ participants included (59.3% women; median age 38 years), the majority had a Fitzpatrick skin phototype (FSP) I–III (76.4%). Concerningly, 60% reported >10 lifetime sunburns, 58% reported ≥1 blistering sunburn, 34% had used a tanning bed ≥1 time in their lifetime, and 69% reported having a tan in the last 12 months. Sunscreen was worn regularly by only half of the respondents, and half of the participants agreed or strongly agreed with “I look better and/or healthier with a tan”. Additional comparisons are presented based on gender, FSP, education, and income. Conclusion: The findings of this study highlight the need for public health campaigns tailored to the LGBTQ+ community, emphasizing culturally sensitive sun safety education, particularly for LGBTQ+ men, individuals with FSP IV–VI, and those with lower education levels, to help reduce future skin cancer risk. doi: https://doi.org/10.3390/curroncol31120593  

Estimating Additive Interaction in Two-Stage Individual Participant Data Meta-Analysis

Authors: Maartje Basten, Lonneke A van Tuijl, Kuan-Yu Pan, Adriaan W Hoogendoorn, Femke Lamers, Adelita V Ranchor, Joost Dekker, Philipp Frank, Henrike Galenkamp, Mirjam J Knol, Nolwenn Noisel, Yves Payette, Erik R Sund, Aeilko H Zwinderman, Lützen Portengen, Mirjam I Geerlings Journal: American Journal of Epidemiology Abstract: Individual participant data (IPD) meta-analysis provides important opportunities to study interaction and effect modification for which individual studies often lack power. While previous meta-analyses have commonly focused on multiplicative interaction, additive interaction holds greater relevance for public health and may in certain contexts better reflect biological interaction. Methodological literature on interaction in IPD meta-analysis does not cover additive interaction for models including binary or time-to-event outcomes. We aimed to describe how the Relative Excess Risk due to Interaction (RERI) and other measures of additive interaction or effect modification can be validly estimated within two-stage IPD meta-analysis. First, we explain why direct pooling of study-level RERI estimates may lead to invalid results. Next, we propose a three-step procedure to estimate additive interaction: 1) estimate effects of both exposures and their product term on the outcome within each individual study; 2) pool study-specific estimates using multivariate meta-analysis; 3) estimate an overall RERI and 95% confidence interval based on the pooled effect estimates. We illustrate this procedure by investigating interaction between depression and smoking and risk of smoking-related cancers using data from the PSYchosocial factors and Cancer (PSY-CA) consortium. We discuss implications of this procedure, including the application in meta-analysis based on published data. doi: https://doi.org/10.1093/aje/kwae325

Oral microbial signatures associated with age and frailty in Canadian adults

Authors: Vanessa DeClercq, Robyn J. Wright, Jacob Nearing, and Morgan G.I. Langille Journal: Scientific Reports Abstract: This study aimed to assess the association between the oral microbiome, age, and frailty. Data and saliva samples were obtained from male and female participants aged 35–70 years (n = 1357). Saliva samples were analysed by 16S rRNA gene sequencing and differences in microbial diversity and community compositions were examined in relation to chronological age and the frailty index (FI). Most alpha diversity measures (Richness, Shannon Diversity, Faith’s Phylogenetic Diversity) showed an inverse association with frailty, whereas a positive association was observed with age and Shannon Diversity and Evenness. A further sex-stratified analysis revealed differences in measures of microbial diversity and composition. Multiple genera were detected as significantly differentially abundant with increasing frailty and age by at least two methods. With age, the relative abundance of Veillonella was reduced in both males and females, whereas increases in Corynebacterium appeared specific to males and Aggregatibacter, Fusobacterium, Neisseria, Stomatobaculum, and Porphyromonas specific to females. Beta diversity was significantly associated with multiple mental health components of the FI. This study shows age and frailty are differentially associated with measures of microbial diversity and composition, suggesting the oral microbiome may be a useful indicator of increased risk of frailty or a potential target for improving health in ageing adults. doi: | https://doi.org/10.1038/s41598-024-60409-8

The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis

Authors: Kuan-Yu Pan , Lonneke van Tuijl, Maartje Basten, Judith J. M. Rijnhart, Alexander de Graeff, Joost Dekker, Mirjam I. Geerlings, Adriaan Hoogendoorn, Adelita V. Ranchor, Roel Vermeulen, Lützen Portengen, Adri C. Voogd, Jessica Abell, Philip Awadalla, Aartjan T. F. Beekman, Ottar Bjerkese, Andy Boyd, Yunsong Cui, Philipp Frank, Henrike Galenkamp, Bert Garssen, Sean Hellingman, Monika Hollander, Martijn Huisman, Anke Huss, Melanie R. Keats, Almar A. L. Kok, Steinar Krokstad, Flora E. van Leeuwen, Annemarie I. Luik, Nolwenn Noisel, Yves Payette, Brenda W. J. H. Penninx, Susan Picavet, Ina Rissanen, Annelieke M. Roest, Judith G. M. Rosmalen, Rikje Ruiter, Robert A. Schoevers, David Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R. Sund, Ellen Sweeney, Alison Teyhan, Emma L. Twait, Kimberly D. van der Willik and Femke Lamers. Journal: Psychological Medicine Abstract: Background – Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers). Methods – Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs). Results – Smoking (HRs range 1.04–1.10) and physical inactivity (HRs range 1.01–1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03–1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01). Conclusions  – Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.   doi: DOI: https://doi.org/10.1017/S0033291724000850  

Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis

Authors: Maartje Basten, Kuan-Yu Pan, Lonneke A. vanTuijl, Alexander deGraeff, Joost Dekker, Adriaan W.Hoogendoorn, Femke Lamers, Adelita V. Ranchor, Roel Vermeulen, Lützen Portengen, Adri C. Voogd, Jessica Abell, Philip Awadalla, Aartjan T.F. Beekman, Ottar Bjerkeset, Andy Boyd, Yunsong Cui, Philipp Frank, Henrike Galenkamp, Bert Garssen, Sean Hellingman, Martijn Huisman, Anke Huss, Melanie R. Keats, Almar A.L. Kok, Steinar Krokstad, Flora E. vanLeeuwen, Annemarie I. Luik, NolwennNoisel, Yves Payette, Brenda W.J.H. Penninx, Ina Rissanen, Annelieke M. Roest, Judith G.M. Rosmalen, Rikje Ruiter, Robert A. Schoevers, David Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R. Sund, Ellen Sweeney, Emma L. Twait, Alison Teyhan, W.M. Monique Verschuren, Kimberly D. vanderWillik, Mirjam I. Geerlings Journal: International Journal of Cancer Abstract: Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects o fhealth behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration)and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress. doi: 10.1002/ijc.34852

Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder

Authors: Megan Wiseman, Megan Hinks, Darcy Hallett, Jaqueline Blundell, Ellen Sweeney, Christina Thorpe, Susan Walling, Ashlyn Swift-Gallant Journal: Journal of Psychiatric Research, 168. Abstract: Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow’s Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis. doi: https://doi.org/10.1016/j.jpsychires.2023.10.048

Depression, Anxiety, and the Risk of Cancer: An Individual Participant Data Meta-Analysis

Authors: LonnekeA. van Tuijl, Maartje Basten, Kuan‐Yu Pan, Roel Vermeulen, Lützen Portengen, Alexander de Graeff, Joost Dekker, Mirjam I. Geerlings, Adriaan Hoogendoorn, Femke Lamers, Adri C. Voogd, Jessica Abell, Philip Awadalla, Aartjan T.F. Beekman, Ottar Bjerkeset, Andy Boyd, |Yunsong Cui, Philipp Frank, Henrike Galenkamp, Bert Garssen, Sean Hellingman, Martijn Huisman, Anke Huss, Trynke R. de Jong, Melanie R. Keats, Almar A. L. Kok, Steinar Krokstad, Flora E. van Leeuwen, Annemarie I. Luik, Nolwenn Noisel, N. Charlotte Onland‐Moret, Yves Payette, Brenda W. J. H. Penninx, Ina Rissanen, Annelieke M. Roest, Rikje Ruiter, Robert A. Schoevers, David Soave, Mandy Spaan, Andrew Steptoe, Karien Stronks, Erik R. Sund, Ellen Sweeney, Emma L. Twait, Alison Teyhan, W. M. Monique Verschuren, Kimberly D. van der Willik, Judith G. M. Rosmalen, Adelita V. Ranchor. Journal: Cancer Abstract: Background: Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium. Methods: The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2). Results: No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06–1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04–1.23). Conclusions: Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. doi: https://doi.org/10.1002/cncr.34853

Assessing Skin Cancer Risk Factors, Sun Safety Behaviors and Melanoma Concern in Atlantic Canada: A Comprehensive Survey Study

Authors: François Lagacé, Bibi Nuzha Noorah, Santina Conte, Lorena Alexandra Mija, Jasmine Chang, Leila Cattelan, Jonathan LeBeau, Joël Claveau, Irina Turchin, Wayne Gulliver, Robert Gniadecki, Elena Netchiporouk, Wilson H. Miller Jr., Thomas G. Salopek, Elham Rahme, Sandra Peláez, and Ivan V. Litvinov. Journal: Cancers Abstract Background: The incidence of cutaneous melanoma (CM) is increasing at an alarming rate in Canada and elsewhere around the world. Significant regional differences in CM incidence have been identified in Atlantic provinces. The goal of this study is to compare ultraviolet exposure, sun protective behaviours, level of worry and baseline CM knowledge in provinces with a high versus low incidence of CM as well, as between various demographic groups. Methods: A cross-sectional survey study was conducted in Atlantic provinces between July 2020 and August 2022. All participants aged ≥ 16 years with a completed survey were eligible. Survey responses were summarized using frequency counts, percentages, and means. Two-sided Z-tests for equality of proportions and logistic regression models were used to compare the survey results between geographic and demographic groups. Results: In total, 7861 participants were included (28.0% men; mean age 61.3 years; response rate 28%). Our results (gender- and age-adjusted odds ratio, 95% confidence interval) show that high-incidence provinces for CM (Prince Edward Island and Nova Scotia) had significantly more sunburns (OR 2.00, 1.72–2.31), total sun exposure (OR 2.05, 1.68–2.50), recreational sun exposure (OR 1.95, 1.61–2.35) and tans (OR 1.77, 1.53–2.05) than individuals in low-incidence provinces (Newfoundland and Labrador). However, individuals in high-incidence provinces displayed more protective behaviors: there were less tanning bed users (OR 0.82, 0.71–0.95), they checked their skin more frequently for new moles (OR 1.26, 1.06–1.51) and practiced more sun protection overall. Additional analyses are presented based on education, income, sexual orientation and gender. Discussion: These findings suggest that future efforts aimed at reducing the CM burden in Atlantic Canada should be tailored for target geographic and/or demographic groups. https://doi.org/10.3390/cancers15153753