Pub Date : 2026-03-01Epub Date: 2026-01-14DOI: 10.1016/j.lana.2026.101372
Tiange P. Zhang , Jennifer L. Dodge , Norah A. Terrault , Brian P. Lee
Background
Asians and Native Hawaiians/Pacific Islanders (NHPIs) comprise 8% of the U.S. population with over 40 subgroups. Health data often aggregate these subpopulations, limiting group-specific estimates. In 2018, modifications to death certificates allowed for the disaggregation of NHPIs from Asians. This study examines differences in gastrointestinal-related mortality between NHPI and Asian adults across all major gastrointestinal disease categories.
Methods
We analyzed mortality data for adults aged ≥25 years from the National Center for Health Statistics 2018–2023. Established definitions classified NHPI and Asian individuals based on single or multi-race listings. Gastrointestinal-related deaths were identified using validated ICD-10 codes and categorized into liver diseases, colorectal cancer, upper gastrointestinal cancers, and non-cancer digestive diseases. Age-standardized mortality rates (ASMRs) per 100,000 and rate ratios were calculated.
Findings
Between 2018 and 2023, there were 3322 gastrointestinal-related deaths among NHPI adults (mean age 63.9 years, standard deviation 14.4; 1373 [41.3%] female decedents) and 47,275 among Asian adults (mean age 70.2 years, standard deviation 14.6; 20,892 [44.2%] female decedents). Overall gastrointestinal-related ASMR for NHPIs was 66.8 (95% CI: 64.5–69.2) per 100,000 adults. NHPIs exhibited higher mortality rates than Asians in all gastrointestinal disease categories. NHPIs had 24% higher overall gastrointestinal-related mortality rate than Asians (RR: 1.24; 95% CI: 1.20–1.29), with 33% higher for liver diseases (RR: 1.33; 95% CI: 1.24–1.44) and 63% higher for non-cancer digestive diseases (RR: 1.63; 95% CI: 1.49–1.77).
Interpretation
NHPIs (vs. Asians) have higher gastrointestinal-related mortality rates, with the greatest disparities observed in liver diseases and non-cancer digestive diseases. By disaggregating data across the full spectrum of gastrointestinal diseases, this study provides a clearer understanding of NHPI-specific disparities and highlights critical areas for targeted public health efforts.
Funding
U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
{"title":"Differential gastrointestinal mortality in Native Hawaiian/Pacific Islander and Asian subgroups in the U.S.: a cross-sectional analysis of national mortality surveillance data 2018–2023","authors":"Tiange P. Zhang , Jennifer L. Dodge , Norah A. Terrault , Brian P. Lee","doi":"10.1016/j.lana.2026.101372","DOIUrl":"10.1016/j.lana.2026.101372","url":null,"abstract":"<div><h3>Background</h3><div>Asians and Native Hawaiians/Pacific Islanders (NHPIs) comprise 8% of the U.S. population with over 40 subgroups. Health data often aggregate these subpopulations, limiting group-specific estimates. In 2018, modifications to death certificates allowed for the disaggregation of NHPIs from Asians. This study examines differences in gastrointestinal-related mortality between NHPI and Asian adults across all major gastrointestinal disease categories.</div></div><div><h3>Methods</h3><div>We analyzed mortality data for adults aged ≥25 years from the National Center for Health Statistics 2018–2023. Established definitions classified NHPI and Asian individuals based on single or multi-race listings. Gastrointestinal-related deaths were identified using validated ICD-10 codes and categorized into liver diseases, colorectal cancer, upper gastrointestinal cancers, and non-cancer digestive diseases. Age-standardized mortality rates (ASMRs) per 100,000 and rate ratios were calculated.</div></div><div><h3>Findings</h3><div>Between 2018 and 2023, there were 3322 gastrointestinal-related deaths among NHPI adults (mean age 63.9 years, standard deviation 14.4; 1373 [41.3%] female decedents) and 47,275 among Asian adults (mean age 70.2 years, standard deviation 14.6; 20,892 [44.2%] female decedents). Overall gastrointestinal-related ASMR for NHPIs was 66.8 (95% CI: 64.5–69.2) per 100,000 adults. NHPIs exhibited higher mortality rates than Asians in all gastrointestinal disease categories. NHPIs had 24% higher overall gastrointestinal-related mortality rate than Asians (RR: 1.24; 95% CI: 1.20–1.29), with 33% higher for liver diseases (RR: 1.33; 95% CI: 1.24–1.44) and 63% higher for non-cancer digestive diseases (RR: 1.63; 95% CI: 1.49–1.77).</div></div><div><h3>Interpretation</h3><div>NHPIs (vs. Asians) have higher gastrointestinal-related mortality rates, with the greatest disparities observed in liver diseases and non-cancer digestive diseases. By disaggregating data across the full spectrum of gastrointestinal diseases, this study provides a clearer understanding of NHPI-specific disparities and highlights critical areas for targeted public health efforts.</div></div><div><h3>Funding</h3><div><span>U.S. National Institute of Diabetes</span> and <span>Digestive and Kidney Diseases</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101372"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-12DOI: 10.1016/j.lana.2026.101393
Hannah Melchinger , Krutika Kuppalli , Jad A. Elharake , Saad B. Omer , Amyn A. Malik
<div><h3>Background</h3><div>The United States is currently experiencing the largest surge of measles cases since 2000, with over 2855 cases reported across the country since January 2025. Though the measles, mumps, and rubella (MMR) vaccine is recognized as the most effective protection against measles, rates of MMR coverage among children under the age of five have declined in several US states. Across the US, attitudes towards measles and intention to vaccinate are not well understood.</div></div><div><h3>Methods</h3><div>We conducted a nationally representative survey assessing measles knowledge, attitudes, and intention to vaccinate among US adults (18+). Our primary outcome was assessing whether respondents would be willing to vaccinate a child under the age of five against measles if recommended to do so by a health professional. We also assessed participant knowledge of measles, their perception of measles risk, the degree to which they believed the threat of measles was being exaggerated, and whether participants indicated they would be willing to receive the MMR vaccine as an adult if recommended to do so by a healthcare professional. Respondents were stratified by whether they had children of any age, and analyses were weighted based on age, sex, and race estimations sourced from the American Community Survey 2022. Proportions, means, and 95% confidence intervals (CI) were calculated for intention to vaccinate, trust in sources of information, self-assessed knowledge, risk perception, perceived exaggeration of threat, self-efficacy, and measles and influenza vaccination status, and adjusted according to survey weights.</div></div><div><h3>Findings</h3><div>A total of 1166 respondents completed the survey. Of those who completed the survey, 53% (weighted percentage, unweighted n = 620) were male, 70% (850) were over the age of 36, 16% (182) were Black or African American, 14% (164) were Hispanic, and 85% (1105) had some college education. Half (50%, 95% CI: 47–53) reported an average knowledge of measles and 81% were aware of the MMR vaccine. Overall, 79% (95% CI: 76–81, 914) were willing to vaccinate a child under five against measles, including 82% of parents with children of any age, and 75% of non-parent respondents. Respondents without children were significantly less likely to vaccinate a child against measles (aOR: 0.67, 95% CI: 0.36–0.98), as were those who believed the threat of measles was being exaggerated (aOR: 0.19, 95% CI: 0.12–0.31). Respondents who reported a higher perceived risk of measles were more likely to vaccinate children against measles (aOR: 1.5, 95% CI: 1.1–2.0) Intention to vaccinate also varied geographically.</div></div><div><h3>Interpretation</h3><div>These results show that while childhood measles vaccination remains the social norm with close to 80% intention, there is an important minority of US adults who are not willing to vaccinate children against measles even if recommended to do so. Measles requir
{"title":"Intention to vaccinate children against measles: findings from a national survey in the United States","authors":"Hannah Melchinger , Krutika Kuppalli , Jad A. Elharake , Saad B. Omer , Amyn A. Malik","doi":"10.1016/j.lana.2026.101393","DOIUrl":"10.1016/j.lana.2026.101393","url":null,"abstract":"<div><h3>Background</h3><div>The United States is currently experiencing the largest surge of measles cases since 2000, with over 2855 cases reported across the country since January 2025. Though the measles, mumps, and rubella (MMR) vaccine is recognized as the most effective protection against measles, rates of MMR coverage among children under the age of five have declined in several US states. Across the US, attitudes towards measles and intention to vaccinate are not well understood.</div></div><div><h3>Methods</h3><div>We conducted a nationally representative survey assessing measles knowledge, attitudes, and intention to vaccinate among US adults (18+). Our primary outcome was assessing whether respondents would be willing to vaccinate a child under the age of five against measles if recommended to do so by a health professional. We also assessed participant knowledge of measles, their perception of measles risk, the degree to which they believed the threat of measles was being exaggerated, and whether participants indicated they would be willing to receive the MMR vaccine as an adult if recommended to do so by a healthcare professional. Respondents were stratified by whether they had children of any age, and analyses were weighted based on age, sex, and race estimations sourced from the American Community Survey 2022. Proportions, means, and 95% confidence intervals (CI) were calculated for intention to vaccinate, trust in sources of information, self-assessed knowledge, risk perception, perceived exaggeration of threat, self-efficacy, and measles and influenza vaccination status, and adjusted according to survey weights.</div></div><div><h3>Findings</h3><div>A total of 1166 respondents completed the survey. Of those who completed the survey, 53% (weighted percentage, unweighted n = 620) were male, 70% (850) were over the age of 36, 16% (182) were Black or African American, 14% (164) were Hispanic, and 85% (1105) had some college education. Half (50%, 95% CI: 47–53) reported an average knowledge of measles and 81% were aware of the MMR vaccine. Overall, 79% (95% CI: 76–81, 914) were willing to vaccinate a child under five against measles, including 82% of parents with children of any age, and 75% of non-parent respondents. Respondents without children were significantly less likely to vaccinate a child against measles (aOR: 0.67, 95% CI: 0.36–0.98), as were those who believed the threat of measles was being exaggerated (aOR: 0.19, 95% CI: 0.12–0.31). Respondents who reported a higher perceived risk of measles were more likely to vaccinate children against measles (aOR: 1.5, 95% CI: 1.1–2.0) Intention to vaccinate also varied geographically.</div></div><div><h3>Interpretation</h3><div>These results show that while childhood measles vaccination remains the social norm with close to 80% intention, there is an important minority of US adults who are not willing to vaccinate children against measles even if recommended to do so. Measles requir","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101393"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-09DOI: 10.1016/j.lana.2026.101383
Jonas Eduardo Monteiro dos Santos , Alison Pearce , Arn Migowski , Dyego Leandro Bezerra de Souza , Isabelle Soerjomataram , Leonardo Borges Lopes de Souza , Linda Sharp , Luís Felipe Leite Martins , Paul Hanly , Marianna De Camargo Cancela
Background
Brazil contributes to 41% of colorectal cancer (CRC) deaths in Latin America. CRC is the second most incident cancer among males and females in Brazil, with wide regional variation. We aimed to estimate the years of potential life lost (YPLL) and the productivity lost due to mortality from CRC by region, between 2001 and 2030.
Methods
We estimated the indirect costs of mortality from CRC using the Human Capital Approach. Mortality data (2001–2016) were obtained from the national Mortality Information System. Economic data were obtained from the Continuous National Household Sample Survey. Productivity lost was calculated for those aged over 15. Results for 2016–2030 were estimated based on the observed data (2001–2015).
Findings
We estimated 635,253 deaths from CRC between 2001 and 2030, corresponding to 12·6 million YPLL and Int$22·6 billion in productivity losses. From 2001–2005 (observed) to 2026–2030 (estimated), CRC deaths are expected to increase by 181% and 165% among males and females, respectively. The largest relative increases among males will be observed in the North region, with productivity losses increasing 9·7-fold. Among females, North and Northeast regions will experience the highest increases in productivity lost, 8·7 and 10·3-fold respectively.
Interpretation
CRC productivity loss will increase substantially by 2030, primarily due to increasing incidence and mortality, as a consequence of the epidemiological transition and health services access, especially in the North and Northeast regions. Implementing primary prevention, screening, early diagnosis and ensuring timely access to treatment is essential to reduce the economic impact of CRC overall and reduce regional inequities.
Funding
This study was funded by the MSD Independent Oncology Policy Grant Program.
{"title":"Regional inequalities in mortality from colorectal cancer and its indirect economic impact in Brazil from 2001 to 2030: a human capital approach study","authors":"Jonas Eduardo Monteiro dos Santos , Alison Pearce , Arn Migowski , Dyego Leandro Bezerra de Souza , Isabelle Soerjomataram , Leonardo Borges Lopes de Souza , Linda Sharp , Luís Felipe Leite Martins , Paul Hanly , Marianna De Camargo Cancela","doi":"10.1016/j.lana.2026.101383","DOIUrl":"10.1016/j.lana.2026.101383","url":null,"abstract":"<div><h3>Background</h3><div>Brazil contributes to 41% of colorectal cancer (CRC) deaths in Latin America. CRC is the second most incident cancer among males and females in Brazil, with wide regional variation. We aimed to estimate the years of potential life lost (YPLL) and the productivity lost due to mortality from CRC by region, between 2001 and 2030.</div></div><div><h3>Methods</h3><div>We estimated the indirect costs of mortality from CRC using the Human Capital Approach. Mortality data (2001–2016) were obtained from the national Mortality Information System. Economic data were obtained from the Continuous National Household Sample Survey. Productivity lost was calculated for those aged over 15. Results for 2016–2030 were estimated based on the observed data (2001–2015).</div></div><div><h3>Findings</h3><div>We estimated 635,253 deaths from CRC between 2001 and 2030, corresponding to 12·6 million YPLL and Int$22·6 billion in productivity losses. From 2001–2005 (observed) to 2026–2030 (estimated), CRC deaths are expected to increase by 181% and 165% among males and females, respectively. The largest relative increases among males will be observed in the North region, with productivity losses increasing 9·7-fold. Among females, North and Northeast regions will experience the highest increases in productivity lost, 8·7 and 10·3-fold respectively.</div></div><div><h3>Interpretation</h3><div>CRC productivity loss will increase substantially by 2030, primarily due to increasing incidence and mortality, as a consequence of the epidemiological transition and health services access, especially in the North and Northeast regions. Implementing primary prevention, screening, early diagnosis and ensuring timely access to treatment is essential to reduce the economic impact of CRC overall and reduce regional inequities.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>MSD Independent Oncology Policy Grant Program</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101383"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-28DOI: 10.1016/j.lana.2025.101371
Lucas Almeida Andrade , Maria Amélia dos Santos Lemos Gurgel , Wandklebson Silva da Paz , Glauber Rocha Monteiro , Karina Conceição Gomes de Araújo , Allan Dantas dos Santos , Carlos Dornels Freire de Souza , Álvaro Francisco Lopes de Sousa , Lariane Angel Cepas , Ana Paula Morais Fernandes , Débora dos Santos Tavares , Tatiana Rodrigues de Moura , Márcio Bezerra-Santos
Background
The COVID-19 pandemic has disrupted healthcare services and intensified socio-economic vulnerabilities, potentially escalating harmful substance use. In Brazil, pre-pandemic mortality from alcohol and drug use was stable. However, the pandemic introduced new risks that may have triggered a significant increase in related deaths. This study, therefore, aims to assess the impact of the COVID-19 pandemic on alcohol- and drug-related deaths in Brazil from 2020 to 2022.
Methods
This population-based ecological study analyzed alcohol- and drug-related mortality across Brazil from 2015 to 2022 using data from the Brazilian Mortality Information System (SIM). Temporal trends were examined using Joinpoint regression, while interrupted time-series analyses assessed deviations post-pandemic onset. Spatial variations were visualized using choropleth maps.
Findings
Alcohol- and drug-related mortality increased by 18.3% in 2020, 22.4% in 2021, and 26.0% in 2022. The Northeast (2020 = 24.9%; 2021 = 24.0%; 2022 = 31.8%), Southeast (2020 = 18.2%; 2021 = 24.3%; 2022 = 21.0%), and South (2020 = 13.1%; 2021 = 23.6%; 2022 = 35.2%) regions recorded the highest increases, with most states showing significant growth in deaths. We also observed an increase in mortality associated with the use of Psychoactive substances (PAS) in both sexes (male: average annual percentage changes (AAPCs) = 3.6%; female: AAPC = 4.6%), individuals aged 20 to 39 (AAPC = 2.0%), and those aged 60 and above (AAPC = 1.8%). Interrupted time-series analyses confirmed a marked and statistically significant increase in mortality post-March 2020.
Interpretation
The findings suggest a collateral epidemic of substance-related deaths fueled by the COVID-19 pandemic's disruptions to harm reduction services, treatment access, and socio-economic stability. These results underscore the urgent need to enhance healthcare systems, reinforce harm reduction services, and develop intersectoral policies targeting social inequalities to mitigate future crises.
Funding
This research is part of the PEGA@ACAO study and was funded by the São Paulo Research Foundation (FAPESP, grant #2024/15320-5 and #2025/04763-6); the National Council for Scientific and Technological Development (CNPq, grant #405741/2024-3); and the Coordination for the Improvement of Higher Education Personnel (CAPES, finance code #001).
{"title":"Alcohol- and drug-related mortality in Brazil: an ecological and population-based study on changes observed during the COVID-19 pandemic","authors":"Lucas Almeida Andrade , Maria Amélia dos Santos Lemos Gurgel , Wandklebson Silva da Paz , Glauber Rocha Monteiro , Karina Conceição Gomes de Araújo , Allan Dantas dos Santos , Carlos Dornels Freire de Souza , Álvaro Francisco Lopes de Sousa , Lariane Angel Cepas , Ana Paula Morais Fernandes , Débora dos Santos Tavares , Tatiana Rodrigues de Moura , Márcio Bezerra-Santos","doi":"10.1016/j.lana.2025.101371","DOIUrl":"10.1016/j.lana.2025.101371","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has disrupted healthcare services and intensified socio-economic vulnerabilities, potentially escalating harmful substance use. In Brazil, pre-pandemic mortality from alcohol and drug use was stable. However, the pandemic introduced new risks that may have triggered a significant increase in related deaths. This study, therefore, aims to assess the impact of the COVID-19 pandemic on alcohol- and drug-related deaths in Brazil from 2020 to 2022.</div></div><div><h3>Methods</h3><div>This population-based ecological study analyzed alcohol- and drug-related mortality across Brazil from 2015 to 2022 using data from the Brazilian Mortality Information System (SIM). Temporal trends were examined using Joinpoint regression, while interrupted time-series analyses assessed deviations post-pandemic onset. Spatial variations were visualized using choropleth maps.</div></div><div><h3>Findings</h3><div>Alcohol- and drug-related mortality increased by 18.3% in 2020, 22.4% in 2021, and 26.0% in 2022. The Northeast (2020 = 24.9%; 2021 = 24.0%; 2022 = 31.8%), Southeast (2020 = 18.2%; 2021 = 24.3%; 2022 = 21.0%), and South (2020 = 13.1%; 2021 = 23.6%; 2022 = 35.2%) regions recorded the highest increases, with most states showing significant growth in deaths. We also observed an increase in mortality associated with the use of Psychoactive substances (PAS) in both sexes (male: average annual percentage changes (AAPCs) = 3.6%; female: AAPC = 4.6%), individuals aged 20 to 39 (AAPC = 2.0%), and those aged 60 and above (AAPC = 1.8%). Interrupted time-series analyses confirmed a marked and statistically significant increase in mortality post-March 2020.</div></div><div><h3>Interpretation</h3><div>The findings suggest a collateral epidemic of substance-related deaths fueled by the COVID-19 pandemic's disruptions to harm reduction services, treatment access, and socio-economic stability. These results underscore the urgent need to enhance healthcare systems, reinforce harm reduction services, and develop intersectoral policies targeting social inequalities to mitigate future crises.</div></div><div><h3>Funding</h3><div>This research is part of the PEGA@ACAO study and was funded by the São Paulo Research Foundation (FAPESP, grant #2024/15320-5 and #2025/04763-6); the National Council for Scientific and Technological Development (CNPq, grant #405741/2024-3); and the Coordination for the Improvement of Higher Education Personnel (CAPES, finance code #001).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101371"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.lana.2026.101375
Tara O. Henderson , Brian Egleston , Sarah Howe , Mary Ashley Allen , Rajia Mim , Linda G. Fleisher , Elena B. Elkin , Kevin C. Oeffinger , Kevin R. Krull , Demetrios Ofidis , Briana McLeod , Hannah Griffin , Elisabeth M. Wood , Cara N. Cacioppo , Sarah Brown , Melody Perpich , Gregory T. Armstrong , Angela R. Bradbury
Background
Identifying childhood cancer survivors who are already at high risk of subsequent neoplasms and may also have an inherited genetic susceptibility is essential for effective surveillance and prevention. This trial evaluated the effectiveness of remote, centralized telehealth genetic services in increasing service uptake.
Methods
Childhood Cancer Survivor Study (CCSS) participants at the St. Jude Research Hospital, who were ≥18 years old and survivors of a CNS tumor, sarcoma, or more than one primary cancer, were recruited for the study. After completing a baseline survey, participants were randomly assigned to one of the two arms: remote telehealth genetic services (via phone or videoconference) or usual care. Uptake of genetic services was obtained through study records and the six-month Status Survey. This trial was registered with ClinicalTrials.gov (NCT04455698), and accrual has closed.
Findings
Of the 391 participants recruited, 262 were assigned to remote telehealth services (via phone or videoconference) and 129 to usual care. At six months, 43% (113/262) of participants in remote telehealth services received genetic services compared to 15% (19/129) in the usual care group (OR = 4.4, 95% CI: 2.5–8.0, p < 0.0001). Uptake of genetic counseling (42% vs. 15%, p < 0.0001) and genetic testing (19% vs. 9%, p = 0.020) were higher in remote telehealth services. Factors associated with higher uptake included not having high-deductible health insurance (OR = 1.67, 95% CI: 1.00–2.91, p = 0.049) and lower perceived cost of testing (OR = 1.51, 95% CI: 1.17–1.96, p = 0.0014). Top barriers included experiencing higher levels of depression (OR = 0.91, 95% CI: 0.85–0.98, p = 0.0067) and anxiety (OR = 0.93, 95% CI: 0.87–1.00, p = 0.036).
Interpretation
Remote telehealth genetic services improve genetic counseling and testing uptake in childhood cancer. Addressing remaining barriers could maximize their impact and ensure equitable access for childhood cancer survivors and their families.
Funding
National Cancer Institute (R01-CA237369, U24-CA55727).
背景：鉴别儿童癌症幸存者是否已经处于后续肿瘤的高风险中，并且可能具有遗传易感性，对于有效的监测和预防至关重要。本试验评估了远程集中远程医疗遗传服务在提高服务接受度方面的有效性。方法招募St. Jude研究医院的儿童癌症幸存者研究（CCSS）参与者，年龄≥18岁，患有中枢神经系统肿瘤、肉瘤或一种以上原发癌症的幸存者。在完成基线调查后，参与者被随机分配到两组中的一组：远程远程医疗遗传服务（通过电话或视频会议）或常规护理。通过研究记录和为期六个月的状况调查获得了遗传服务的吸收情况。该试验已在ClinicalTrials.gov注册（NCT04455698），项目已结束。在被招募的391名参与者中，262人被分配到远程医疗服务（通过电话或视频会议），129人被分配到常规护理。六个月时，43%（113/262）的远程医疗服务参与者接受了遗传服务，而常规护理组的这一比例为15% (19/129)（OR = 4.4, 95% CI: 2.5-8.0, p < 0.0001）。在远程医疗服务中，遗传咨询（42%对15%，p < 0.0001）和基因检测（19%对9%，p = 0.020）的使用率更高。与较高的吸收率相关的因素包括没有高免赔额医疗保险（OR = 1.67, 95% CI: 1.00-2.91, p = 0.049）和较低的感知检测成本（OR = 1.51, 95% CI: 1.17-1.96, p = 0.0014）。主要障碍包括经历较高程度的抑郁（OR = 0.91, 95% CI: 0.85-0.98, p = 0.0067）和焦虑（OR = 0.93, 95% CI: 0.87-1.00, p = 0.036）。远程远程医疗遗传服务改善了儿童癌症遗传咨询和检测的吸收。解决剩下的障碍可以最大限度地发挥其影响，并确保儿童癌症幸存者及其家人公平获得机会。国家癌症研究所（R01-CA237369, U24-CA55727）。
{"title":"The ENGAGE study: a randomized trial optimizing uptake of germline cancer genetic services in childhood cancer survivors","authors":"Tara O. Henderson , Brian Egleston , Sarah Howe , Mary Ashley Allen , Rajia Mim , Linda G. Fleisher , Elena B. Elkin , Kevin C. Oeffinger , Kevin R. Krull , Demetrios Ofidis , Briana McLeod , Hannah Griffin , Elisabeth M. Wood , Cara N. Cacioppo , Sarah Brown , Melody Perpich , Gregory T. Armstrong , Angela R. Bradbury","doi":"10.1016/j.lana.2026.101375","DOIUrl":"10.1016/j.lana.2026.101375","url":null,"abstract":"<div><h3>Background</h3><div>Identifying childhood cancer survivors who are already at high risk of subsequent neoplasms and may also have an inherited genetic susceptibility is essential for effective surveillance and prevention. This trial evaluated the effectiveness of remote, centralized telehealth genetic services in increasing service uptake.</div></div><div><h3>Methods</h3><div>Childhood Cancer Survivor Study (CCSS) participants at the St. Jude Research Hospital, who were ≥18 years old and survivors of a CNS tumor, sarcoma, or more than one primary cancer, were recruited for the study. After completing a baseline survey, participants were randomly assigned to one of the two arms: remote telehealth genetic services (via phone or videoconference) or usual care. Uptake of genetic services was obtained through study records and the six-month Status Survey. This trial was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT04455698</span><svg><path></path></svg></span>), and accrual has closed.</div></div><div><h3>Findings</h3><div>Of the 391 participants recruited, 262 were assigned to remote telehealth services (via phone or videoconference) and 129 to usual care. At six months, 43% (113/262) of participants in remote telehealth services received genetic services compared to 15% (19/129) in the usual care group (OR = 4.4, 95% CI: 2.5–8.0, p < 0.0001). Uptake of genetic counseling (42% vs. 15%, p < 0.0001) and genetic testing (19% vs. 9%, p = 0.020) were higher in remote telehealth services. Factors associated with higher uptake included not having high-deductible health insurance (OR = 1.67, 95% CI: 1.00–2.91, p = 0.049) and lower perceived cost of testing (OR = 1.51, 95% CI: 1.17–1.96, p = 0.0014). Top barriers included experiencing higher levels of depression (OR = 0.91, 95% CI: 0.85–0.98, p = 0.0067) and anxiety (OR = 0.93, 95% CI: 0.87–1.00, p = 0.036).</div></div><div><h3>Interpretation</h3><div>Remote telehealth genetic services improve genetic counseling and testing uptake in childhood cancer. Addressing remaining barriers could maximize their impact and ensure equitable access for childhood cancer survivors and their families.</div></div><div><h3>Funding</h3><div><span>National Cancer Institute</span> (R01-CA237369, U24-CA55727).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101375"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-04DOI: 10.1016/j.lana.2026.101398
Sara Benitez Majano , Nathalia Katz , Soledad Urrutia , Roberta Caixeta , Carlos Torres , Carolina Chavez Cortes , Maribel Almonte , Melissa Lopez Varon , Reina Guerrero , Kathleen Schmeler , Erin Kobetz , Corinne Ferrari , Carlos Espinal , Francisco Becerra-Posada , Karla Alfaro , Daniel Salas , Anselm Hennis , Silvana Luciani , Mauricio Maza
Background
Cervical cancer is a public health problem in Latin America and the Caribbean (LAC). The Cervical Cancer Elimination strategy sets three targets (90% HPV vaccination, 70% screening, 90% treatment) for countries to be in the path towards elimination. This study provides an overview of the current status of cervical cancer control in LAC, highlighting opportunities and challenges for cervical cancer elimination.
Methods
We conducted a descriptive analysis of the cervical cancer control status in LAC, using an online questionnaire completed by delegates from health authorities of 35 countries/territories.
Findings
We found marked advances in the development of national plans and cervical cancer elimination strategies, particularly in Latin America. Caribbean countries and territories face barriers in program organization and human resource provision. While HPV vaccination is systematically monitored, surveillance systems for screening and treatment are limited, reducing the ability to track program performance and progress. Transition to HPV testing is ongoing, but ensuring adequate funding and management of screen-positive females remain challenging. Gaps in histopathology and treatment —especially radiotherapy— are most pronounced in the Caribbean.
Interpretation
Regional collaboration, resource mobilization, and investment in information systems and workforce capacity are essential to achieve equitable access to cervical cancer prevention and care. This analysis provides a baseline to guide future studies to support LAC countries in achieving the 90-70-90 targets.
Funding
Work funded by the Spanish Agency for International Development Cooperation (AECID) and Gavi, the Vaccine Alliance.
{"title":"Accelerating the elimination of cervical cancer: cross-sectional examination of cancer prevention and control in Latin America and the Caribbean","authors":"Sara Benitez Majano , Nathalia Katz , Soledad Urrutia , Roberta Caixeta , Carlos Torres , Carolina Chavez Cortes , Maribel Almonte , Melissa Lopez Varon , Reina Guerrero , Kathleen Schmeler , Erin Kobetz , Corinne Ferrari , Carlos Espinal , Francisco Becerra-Posada , Karla Alfaro , Daniel Salas , Anselm Hennis , Silvana Luciani , Mauricio Maza","doi":"10.1016/j.lana.2026.101398","DOIUrl":"10.1016/j.lana.2026.101398","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer is a public health problem in Latin America and the Caribbean (LAC). The Cervical Cancer Elimination strategy sets three targets (90% HPV vaccination, 70% screening, 90% treatment) for countries to be in the path towards elimination. This study provides an overview of the current status of cervical cancer control in LAC, highlighting opportunities and challenges for cervical cancer elimination.</div></div><div><h3>Methods</h3><div>We conducted a descriptive analysis of the cervical cancer control status in LAC, using an online questionnaire completed by delegates from health authorities of 35 countries/territories.</div></div><div><h3>Findings</h3><div>We found marked advances in the development of national plans and cervical cancer elimination strategies, particularly in Latin America. Caribbean countries and territories face barriers in program organization and human resource provision. While HPV vaccination is systematically monitored, surveillance systems for screening and treatment are limited, reducing the ability to track program performance and progress. Transition to HPV testing is ongoing, but ensuring adequate funding and management of screen-positive females remain challenging. Gaps in histopathology and treatment —especially radiotherapy— are most pronounced in the Caribbean.</div></div><div><h3>Interpretation</h3><div>Regional collaboration, resource mobilization, and investment in information systems and workforce capacity are essential to achieve equitable access to cervical cancer prevention and care. This analysis provides a baseline to guide future studies to support LAC countries in achieving the 90-70-90 targets.</div></div><div><h3>Funding</h3><div>Work funded by the <span>Spanish Agency for International Development Cooperation</span> (AECID) and <span>Gavi</span>, the Vaccine Alliance.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101398"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-16DOI: 10.1016/j.lana.2026.101385
Nandini Raghuraman , Roni Shafir , GianCarlo Colloca , Craig Kier , Barbara Brawn , Amitabh Varshney , Sarah Murthi , Yang Wang , Luana Colloca
Background
The dual challenges of the opioid crisis and the global burden of chronic pain underscore the need for safe, non-pharmacological alternatives. Virtual reality (VR) is a promising digital therapeutic for pain, yet its mechanisms remain unclear. This study aimed to disentangle the roles of immersion and emotional engagement in VR-induced analgesia in individuals with temporomandibular disorders (TMD).
Methods
In a counterbalanced within-subject design, 62 adults with TMD (21 males, 41 females; mean age 34.7 years [19–55]; 57 (91.9%) non-Hispanic or Latino, 30 (48.4%) White) were exposed to seven conditions: three immersive VR environments (ocean, opera, pink noise), matched non-immersive (2D) versions, and a 2-back working memory task. Heat pain tolerance was assessed using thermal stimulation. Participants rated pain intensity, pain unpleasantness, mood, anxiety, and enjoyment. Skin conductance response (SCR) indexed autonomic arousal. Multilevel mediation models tested the underlying psychological mechanisms.
Findings
VR Ocean significantly increased heat pain tolerance (Cohen's d = 1.60), reduced pain intensity and unpleasantness, improved mood, and reduced situational anxiety relative to all other conditions (all p < 0.05). It was also rated as the most enjoyable experience (p < 0.01). Mediation analyses indicated mood (ab = −5.15) and enjoyment (ab = −6.12) significantly mediated VR Ocean's effect on pain intensity, whereas anxiety did not. No mediators explained changes in pain tolerance. SCR did not differ between VR and 2D conditions.
Interpretation
VR-based analgesia relies not only on immersion but also on affectively rewarding contents. Digital therapeutics that enhance positive mood and enjoyment may be especially effective for chronic pain management.
Funding
This study was supported by the National Institutes of Health and the University of Maryland.
{"title":"A critical role of affective content in the analgesic effect of virtual reality: a cross-sectional within-subject study","authors":"Nandini Raghuraman , Roni Shafir , GianCarlo Colloca , Craig Kier , Barbara Brawn , Amitabh Varshney , Sarah Murthi , Yang Wang , Luana Colloca","doi":"10.1016/j.lana.2026.101385","DOIUrl":"10.1016/j.lana.2026.101385","url":null,"abstract":"<div><h3>Background</h3><div>The dual challenges of the opioid crisis and the global burden of chronic pain underscore the need for safe, non-pharmacological alternatives. Virtual reality (VR) is a promising digital therapeutic for pain, yet its mechanisms remain unclear. This study aimed to disentangle the roles of immersion and emotional engagement in VR-induced analgesia in individuals with temporomandibular disorders (TMD).</div></div><div><h3>Methods</h3><div>In a counterbalanced within-subject design, 62 adults with TMD (21 males, 41 females; mean age 34.7 years [19–55]; 57 (91.9%) non-Hispanic or Latino, 30 (48.4%) White) were exposed to seven conditions: three immersive VR environments (ocean, opera, pink noise), matched non-immersive (2D) versions, and a 2-back working memory task. Heat pain tolerance was assessed using thermal stimulation. Participants rated pain intensity, pain unpleasantness, mood, anxiety, and enjoyment. Skin conductance response (SCR) indexed autonomic arousal. Multilevel mediation models tested the underlying psychological mechanisms.</div></div><div><h3>Findings</h3><div>VR Ocean significantly increased heat pain tolerance (Cohen's d = 1.60), reduced pain intensity and unpleasantness, improved mood, and reduced situational anxiety relative to all other conditions (all p < 0.05). It was also rated as the most enjoyable experience (p < 0.01). Mediation analyses indicated mood (ab = −5.15) and enjoyment (ab = −6.12) significantly mediated VR Ocean's effect on pain intensity, whereas anxiety did not. No mediators explained changes in pain tolerance. SCR did not differ between VR and 2D conditions.</div></div><div><h3>Interpretation</h3><div>VR-based analgesia relies not only on immersion but also on affectively rewarding contents. Digital therapeutics that enhance positive mood and enjoyment may be especially effective for chronic pain management.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Institutes of Health</span> and the University of Maryland.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101385"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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