Infants and children are particularly vulnerable to in utero and early-life exposures. Thus, a mother’s exposures before and during pregnancy could have important consequences for her child’s health, including cancer development. We examined whether birth certificate–derived maternal anthropometric characteristics were associated with increased risk of subsequent childhood cancer development, accounting for established maternal and infant risk factors. Pennsylvania birth and cancer registry files were linked by the state Department of Health, yielding a virtual cohort of births and childhood cancers from 2003 through 2016. The analysis included 1,827,875 infants (13,785,309 person-years at risk), with 2,352 children diagnosed with any cancer and 747 with leukemia before age 14 years. Children born to mothers with a body mass index (weight (kg)/height (m)2) of ≥40 had a 57% (95% confidence interval: 12, 120) higher leukemia risk. Newborn size of ≥30% higher than expected was associated with 2.2-fold and 1.8-fold hazard ratios for total childhood cancer and leukemia, respectively, relative to those with expected size. Being <30% below expected size also increased the overall cancer risk (P for curvilinearity < 0.0001). Newborn size did not mediate the association between maternal obesity and childhood cancer. The results suggest a significant role of early-life exposure to maternal obesity- and fetal growth–related factors in childhood cancer development.

IntroductionScientific evidence shows that cigarette price increases can significantly reduce smoking prevalence and smoking initiation among adolescents and young adults. However, data are lacking regarding the effectiveness of increasing Pennsylvania’s cigarette tax to reduce smoking and/or adverse health effects of smoking. The objective of our study was to assess the impact of cigarette tax increases and resulting price increases on smoking prevalence, acute myocardial infarction (AMI) and asthma hospitalization rates, and sudden cardiac death (SCD) rates in Pennsylvania.MethodsWe used segmented regression analyses of interrupted time series to evaluate the level and trend changes in Pennsylvania adults’ current smoking prevalence, age-adjusted AMI and asthma hospitalization rates, age-specific asthma hospitalization rates, and age-adjusted SCD rates following 2 cigarette excise tax increases.ResultsAfter the first excise tax increase, no beneficial effects were noted on the outcomes of interest. The second tax increase was associated with significant declines in smoking prevalence for people aged 18 to 39, age-adjusted AMI hospitalization rates for men, age-adjusted asthma hospitalizations rates, and SCD rates among men. Overall smoking prevalence declined by 5.2% (P = .01), with a quarterly decrease of 1.4% (P = .01) for people aged 18 to 39 years. The age-adjusted AMI hospitalization rate for men showed a decline of 3.87/100,000 population (P = .04). The rate of age-adjusted asthma hospitalizations decreased by 10.05/100,000 population (P < .001), and the quarterly trend decreased by 3.21/100,000 population (P < .001). Quarterly SCD rates for men decreased by 1.34/100,000 population (P < .001).ConclusionAn increase in the price of cigarettes to more than $4 per 20-cigarette pack was associated with a significant decrease in smoking among younger people (aged 18–39). Decreases were also seen in asthma hospitalizations and men’s age-adjusted AMI hospitalization and SCD rates. Further research and policy development regarding the effect of cigarette taxes on tobacco consumption should be cognizant of the psychological tipping points at which overall price affects smoking patterns.

Although studies indicate school-based HIV/ AIDS education programs effectively reduce risky behaviors, only 33 states and the District

The estimated national expenditure for cancer care in the US rose from $190.2 billion in 2015 to $208.9 billion in 2020, a 10% increase mainly due to the aging and growth of the US population (3,4). Costs will likely increase in future years as the population grows and ages and new and often more expensive treatments are adopted as standards of care.Approximately 30% to 50% of cancers diagnosed today could be prevented by reducing exposure to tobacco smoke and other environmental carcinogens, maintaining healthy body weight, and receiving recommended cancer screenings and vaccinations (5,6). Cancer screening, which is different from diagnostic testing, can detect cancer at early stages before symptoms occur, when it can be more successfully treated. In addition to early detection, screening can prevent colorectal and cervical cancers by identifying precancerous lesions that can be removed before they become cancer (7-9). Thus, understanding screening patterns and factors associated with screening will help public health policy makers and practitioners improve cancer prevention programs further by implementing evidence-based policies and practices (10,11). This special collection of articles from Preventing Chronic Disease presents research on determinants of cancer screening, public health practices that increase cancer screening uptake in specific populations, and cancer screening trends.

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