OBJECTIVES:Human papillomavirus (HPV) is a common sexually transmitted infection linked to several cancers, including cervical cancer, which ranks fourth in cancer incidence and mortality among women globally. Despite its significance, awareness of HPV and the HPV vaccine remains limited across many populations. This project assessed HPV and HPV vaccine awareness among Indigenous adults in Northwest Territories communities in Canada and explored factors influencing HPV vaccine utilization; such data have never been available or explored. METHODS:Using a community-based participatory research approach, quantitative and qualitative data were collected in 11 Indigenous communities in Northwest Territories. Indigenous adults aged 18 years and older were invited to complete a semi-structured questionnaire administered by trained local research assistants. Multiple logistic regression was used to examine potential associations among age, gender, education, and awareness of HPV and the HPV vaccine. A thematic analysis of qualitative data explored reasons for non-vaccination. RESULTS:Among the 221 participants (66.5% women; mean age 43.6 years (±13.9)), approximately half had heard of HPV, and fewer than one-third had heard of the HPV vaccine. Education emerged as a key factor, with individuals with lower educational attainment being significantly less aware of HPV (p < .000). Age (p < .033), gender (p < .019), and education (p < .004) predicted vaccine awareness, with women, individuals with higher education, and younger adults being more likely to have heard about the vaccine. Only 26.3% of participants aged up to 26 years had received the HPV vaccine. Qualitative data revealed that limited awareness and insufficient information about HPV and the vaccine are the main barriers to vaccination. Participants recommended enhancing vaccine promotion by raising awareness about the connection between HPV and cancer, as well as increasing educational efforts in schools and communities. CONCLUSIONS:Limited awareness of the HPV vaccine may contribute to low vaccination rates. Tailored and targeted interventions are crucial to increasing HPV vaccine utilization in Indigenous communities in Northwest Territories.

Background: The development and distribution of COVID-19 vaccines were crucial during the pandemic; however, adverse events can affect public perception and vaccine utilization. This project explored COVID-19 vaccine adverse events among Indigenous communities in Northwest Territories, Canada, where overcrowding, limited healthcare access, and historical disparities increase disease risk. Methods: This cross-sectional study surveyed Indigenous adults (18+) in Northwest Territories using intervieweradministered questionnaires. Phase one (Apr-Nov 2021) in ten communities examined adverse events after the first COVID-19 vaccine dose. Phase two (Aug 2022-Jan 2023) in eleven communities assessed adverse events after doses two to five. Results: In phase one (n = 93) and phase two (n = 190), most participants were women (62.4% and 67.9%), with mean ages of 41.6 years (+/- 12.1) and 43.7 years (+/- 14.2), respectively. Adverse events were most frequent after the first dose (97.9%) and declined with subsequent doses (p < .001). Injection site pain/swelling was most common. Severe symptoms after dose one included chills (64.3%), muscle pain (56.9%), and fatigue (51.3%). Fatigue was more frequent in women than men (50.9% vs. 23.5%, p = .04). Younger adults reported higher rates of pain (p = .003), chills (p = .01), headache (p = .02), and fever (p = .003) than adults over 50. Conclusions: Adverse events decreased with each additional dose and were generally mild to moderate after the first dose. Communicating the mild nature of side effects and the protection vaccines offer against severe illness may help increase uptake. Higher rates among younger individuals and women highlight the need for targeted public health messaging and supportive strategies.

Vaccine hesitancy is a persistent global health challenge. This project explored attitudes towards and utilization of COVID-19 vaccination, as well as suggestions to improve utilization within Indigenous communities in Northwest Territories, Canada. Utilizing a cross-sectional design, this project spanned two phases: 10 communities in Phase 1 (April to November 2021), and 11 in Phase 2 (August 2022-January 2023). Self-identifying Indigenous adults (≥18 years) were invited. Quantitative and qualitative data were collected via a semi-structured interviewer-administered questionnaire. In Phase 1 (n = 124; mean age = 41.6 years; 63.7% women) and Phase 2 (n = 221; mean age = 43.6 years; 66.21% women), 78.2% and 87.2% of participants had received at least one dose, respectively. In Phase 1, 67.2% reported not being concerned about the vaccine, and 61.2% believed the benefits outweighed the risks. In Phase 2, 56.2% of participants agreed all eligible individuals should be vaccinated, and 59.2% agreed the vaccine prevented serious outcomes. Bivariate analyses revealed that negative attitudes towards COVID-19 severity, vaccine safety, and effectiveness were significantly associated with lower intention to receive a COVID-19 vaccine in the future. Qualitative insights revealed factors of vaccination hesitancy, including: concerns about safety, efficacy, and necessity; a need for information; and distrust in government. Reasons for utilization included: trust in vaccine safety; perceived necessity; and employment and travel requirements. COVID-19 vaccine utilization in Indigenous communities is high, yet hesitancy persists due to safety and efficacy concerns, and distrust in government. Culturally safe strategies, improved communication, and equitable access are essential to sustaining confidence and future pandemic preparedness.

Background Indigenous communities in Canada have high age-standardized rates of cancer mortality. Remote communities in Canada’s northern territories have a high proportion of Indigenous residents and disproportionately low utilization rates of screening services for breast, cervical, and colorectal cancers, which could contribute to delayed cancer diagnosis and less favourable clinical outcomes. Knowledge is limited regarding the under-utilization of cancer screening services. Objective This study identified factors contributing to the underutilization of breast, cervical, and colorectal cancer screening services and documented suggestions to promote utilization in remote Indigenous communities in Northwest Territories, Canada. Methods This qualitative study consisted of four sessions of sharing circles and two one-on-one interviews with nine healthcare professionals, eight community members including Elders, and five community leadership from two Northwest Territories communities. Data were transcribed verbatim and coded and analyzed using NVivo-10. The constant comparative method determined emergent themes. Results Data identified four themes of factors influencing the utilization of cancer screening services (socio-environmental, socio-cultural, socio-political, and personal themes), covering limited resources, limited cultural considerations, the legacy of colonial practices, and fear. Five themes regarding suggested approaches to encourage utilization were community outreach, collaboration, sustainability, cultural safety, and support for healthcare professionals. Conclusions Factors identified to affect cancer screening service utilization and suggested approaches to improve the utilization are supported by other studies and initiatives in the region highlighting the relevance and feasibility of the findings. The findings could further inform community-based interventions for improving the utilization of cancer screening and support services in remote Indigenous communities.

The health systems' response to the COVID-19 pandemic controlled the virus's spread but exposed fragmented systems and operational challenges globally. Understanding these issues is essential for enhancing health system capabilities and improving future pandemic responses. This study explored the perspectives of health policymakers in Northwest Territories (NWT), Canada, on the challenges to responding to COVID-19 and implementing the necessary public health measures in the jurisdiction. This study utilized a qualitative descriptive design and a community-based participatory research approach. Framework analysis, guided by the World Health Organization's Health Emergency and Disaster Risk Management framework, was used for data analysis. The Consolidated Criteria for Reporting Qualitative Research were followed. Convenience sampling was used to recruit policymakers working in NWT. Data were collected between June and August 2021 from 65 policymakers using semi-structured interviews. Participants worked in territorial (71.7%), regional (14.3%), and community (14.3%) organizations. Four themes were identified: governance (e.g. unclear roles and responsibilities, policy lag, and limited community consultation), public risk communication (e.g. complexity of information and language barriers), community-level (e.g. community's distrust of the health system and geographic barriers), and health system challenges (e.g. limited human resource capacity and material resources, absence of robust information systems). To build a resilient health system in NWT for future pandemics, it is essential to define roles and responsibilities, collaborate with healthcare providers and community leaders, develop efficient data infrastructure, and enhance system capacity. Effective communication and fostering trust between the government and communities are important.

Background: Adjuvant endocrine therapy (AET) is prescribed for 5–10 years to women with hormone-sensitive breast cancer to prevent recurrence. However, a significant proportion of women do not adhere to AET. We developed SOIE, a one-year program designed to enhance the AET experience and adherence. SOIE was pilot-tested in a mixed-methods randomized controlled trial. This report presents the experience of women and healthcare providers (HCPs) with SOIE. Methods: A descriptive qualitative study using semi-structured interviews and thematic analysis was conducted with 20 women and 7 HCPs who participated in the program. Results: Most women and HCPs reported high satisfaction with the program. Women felt it addressed their need for information and strategies to manage side effects. They felt supported and developed a more positive attitude toward AET, which contributed to their intention to pursue AET. They perceived that the program helped them navigate the AET experience and reduced their stress or fear regarding AET. HCPs corroborated these benefits. Conclusions: Findings suggest that SOIE can enhance the experience and motivation to pursue the AET treatment by meeting important needs for information, side-effects management, and psycho-emotional support. Programs like SOIE can have benefits beyond adherence by improving patients’ well-being during this crucial long-term treatment.

The aim of this project is to explore perceptions towards and adherence to COVID-19 public health preventive measures in Indigenous communities within Northwest Territories, Canada. Utilizing a cross-sectional study design the project took place within ten Northwest Territories communities between 1st April and 30th November 2021. Convenience sampling methods were utilized and adhered to public health restrictions. Self-identifying Indigenous adults (≥ 18 years old) were invited to complete a semi-structured interviewer-administered questionnaire. Participants (n = 287; 33.1

Adjuvant endocrine therapy (AET) reduces recurrence risk after hormone receptor-positive breast cancer, but non-adherence is common. We pilot-tested SOIE, a program to enhance AET experience and adherence, to assess its acceptability, feasibility, and effects on psychosocial precursors of AET adherence. We conducted a 12-month pilot randomized controlled trial among women who had a first AET prescription. Intervention group received SOIE while control group received usual care. Psychosocial factors from the Theory of Planned Behavior (TPB) (intention – primary outcome -, attitude, subjective norm, behavioral control), additional constructs (AET knowledge, social support, coping planning), impact of AET services received, and adherence were measured by questionnaires at baseline, 3-month, and 12-month endpoints. Group patterns were compared using repeated measures analyses with generalized estimating equations. A total of 106 women were randomized (participation = 54.9

Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide and are the major focus of the World Health Organization’s joint prevention programs. While, diverse diseases, CVD and cancer, have many similarities. These include common lifestyle-related risk factors and shared environmental, metabolic, cellular, inflammatory, and genetic pathways. In this review, we will discuss the shared lifestyle-related and environmental risk factors central to both diseases and how the strategies commonly used to prevent atherosclerotic vascular disease can be applied to cancer prevention.

PURPOSE Women have more adverse events (AEs) from chemotherapy than men, but few studies have investigated sex differences in immune or targeted therapies. We examined AEs by sex across different treatment domains. METHODS We analyzed treatment-related AEs by sex in SWOG phase II and III clinical trials conducted between 1980 and 2019, excluding sex-specific cancers. AE codes and grade were categorized using the Common Terminology Criteria for Adverse Events. Symptomatic AEs were defined as those aligned with the National Cancer Institute's Patient-Reported Outcome–Common Terminology Criteria for Adverse Events; laboratory-based or observable/measurable AEs were designated as objective (hematologic v nonhematologic). Multivariable logistic regression was used, adjusting for age, race, and disease prognosis. Thirteen symptomatic and 14 objective AE categories were examined. RESULTS In total, N = 23,296 patients (women, 8,838 [37.9%]; men, 14,458 [62.1%]) from 202 trials experiencing 274,688 AEs were analyzed; 17,417 received chemotherapy, 2,319 received immunotherapy, and 3,560 received targeted therapy. Overall, 64.6% (n = 15,051) experienced one or more severe (grade ≥ 3) AEs. Women had a 34% increased risk of severe AEs compared with men (odds ratio [OR] = 1.34; 95% CI, 1.27 to 1.42; P < .001), including a 49% increased risk among those receiving immunotherapy (OR = 1.49; 95% CI, 1.24 to 1.78; P < .001). Women experienced an increased risk of severe symptomatic AEs among all treatments, especially immunotherapy (OR = 1.66; 95% CI, 1.37 to 2.01; P < .001). Women receiving chemotherapy or immunotherapy experienced increased severe hematologic AE. No statistically significant sex differences in risk of nonhematologic AEs were found. CONCLUSION The greater severity of both symptomatic AEs and hematologic AEs in women across multiple treatment modalities indicates that broad-based sex differences exist. This could be due to differences in AE reported, pharmacogenomics of drug metabolism/disposition, total dose received, and/or adherence to therapy. Particularly large sex differences were observed for patients receiving immunotherapy, suggesting that studying AEs from these agents is a priority.

Objective: To describe the burden of osteoarthritis (OA) in India from 1990 to 2019. Design: Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA -knee OA, hip OA, hand OA, and other OA- was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, years lived with disability (YLD), and disability-adjusted life years (DALY) using methods reported in GBD 2019 study. Result: Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI):4,420-5,447) in 1990-5313 (95%UI:4,799-5,898) in 2019, per 100,000 persons. Similarly, DALYs due to OA increased from 0.79 million (95%UI:0.40-1.55) to 2.12 million (95%UI:1.07-4.23); while age-standardised DALYs increased from 164 (95%UI:83-325) to 180 (95%UI:91-361) per 100,000 persons from 1990 to 2019. OA was the 20th most common cause of YLDs in India in 2019, accounting for 1.48% (95%UI:0.88-2.78) of all YLDs; increasing from 23rd most common cause in 1990 (1.25%(95%UI:0.74-2.34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and DALYs for OA and knee OA were consistently higher in females than males. Conclusion: The burden and impact of OA in India are substantial and is increasing. Adopting suitable control and preventive community measures to reduce modifiable risk factors (obesity, injuries, occupational stress) are needed to reduce the current and future burden of OA in India. (c) 2022 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

IntroductionAdherence to cancer prevention recommendations can greatly reduce colorectal cancer risk. This study explored patterns and determinants of adherence to these recommendations by participants (n = 26 074) at baseline in a cohort study in British Columbia, Canada. MethodsAdherence to five colorectal cancer primary prevention behaviours derived from Canadian Cancer Society/World Cancer Research Fund recommendations (nonsmoking, body mass index (BMI), physical activity, alcohol consumption and fruit and vegetable consumption) was measured, and a composite score constructed based on their sum. The definition of secondary prevention adherence was based on the Canadian Task Force on Preventive Health Care recommendations for colorectal cancer screening. ResultsAdherence to primary prevention guidelines ranged from 94.8% (nonsmoking) to 44.2% (healthy BMI). Median composite score was 4. Higher composite scores were associated with being female, being married and with a higher educational attainment. Colorectal cancer screening adherence was 62.4%. Older age, chronic conditions, a recent medical examination and higher income were associated with greater odds of adherence to screening. ConclusionAdherence to some colorectal cancer prevention behaviours was high, consistent with findings that British Columbia has low rates of many risky health behaviours. However, there was a clustering of poorer adherence to prevention behaviours with each other and with other risk factors. Screening adherence was high but varied with some sociodemographic and health factors. Future work should evaluate targeted interventions to improve adherence among those in the lowest socioeconomic status and health groups. A better understanding is also needed of the barriers to access and engagement with colorectal cancer screening that persist even in the Canadian public health care system.

L’adhésion aux recommandations en matière de prévention du cancer peut grandement réduire le risque de cancer colorectal. Cette étude porte sur les tendances et les déterminants de l’adhésion à ces recommandations par les participants (n = 26 074) au début d’une étude de cohorte en Colombie‑Britannique (Canada). Nous avons mesuré l’adhésion à cinq comportements de prévention primaire du cancer colorectal tirés des recommandations émises par la Société canadienne du cancer et le Fonds mondial de recherche contre le cancer (absence de tabagisme, indice de masse corporelle (IMC), activité physique, consommation d’alcool et consommation de fruits et légumes) et nous avons établi un score composite reposant sur la somme des mesures. La définition de l’adhésion aux comportements de prévention secondaire est fondée sur les recommandations du Groupe d’étude canadien sur les soins de santé préventifs pour le dépistage du cancer colorectal. L’adhésion aux lignes directrices en matière de prévention primaire variait entre 94,8 % (absence de tabagisme) à 44,2 % (IMC santé). Le score composite médian était de 4. Les scores composites supérieurs ont été associés au fait d’être une femme, d’être marié(e) et d’avoir un niveau de scolarité plus élevé. Le taux d’adhésion au dépistage du cancer colorectal était de 62,4 %. Un âge avancé, la présence de maladies chroniques, le fait d’avoir subi un examen médical récemment et le fait de faire partie d’un ménage à revenu élevé étaient associés à une probabilité accrue d’adhésion au dépistage. L’adhésion à certains comportements de prévention du cancer colorectal s’est révélée élevée, ce qui concorde avec les constatations selon lesquelles la Colombie-Britannique affiche des taux faibles pour de nombreux comportements risqués pour la santé. Cependant, on a constaté une agglomération de plus faible adhésion aux comportements de prévention les uns avec les autres et en présence d’autres facteurs de risque. L’adhésion au dépistage s’est révélée élevée, mais varie en fonction de certains facteurs sociodémographiques et sanitaires. Les travaux futurs devraient porter sur des interventions ciblées visant à améliorer l’adhésion des individus faisant partie des groupes dont le statut socioéconomique et l’état de santé sont les plus précaires. Il faut également mieux comprendre les obstacles à l’accès et à la participation au dépistage du cancer colorectal, qui persistent même au sein du système de santé public canadien.

Background: Sleep is a modifiable risk factor increasingly linked with cancer incidence. Disrupted sleep patterns and circadian rhythms may increase the risk of developing breast cancer in female night shift workers. This pilot study examined the impact of a sleep hygiene intervention on the sleep quality (SQ) and quality of life (QOL) in women who work night shifts. Methods: A single arm, sleep hygiene intervention was delivered by telephone to a convenience sample of 47 female shift workers (mean age=47yrs) on rotating or permanent night shifts at least 3 times per month for at least 2 years. The program was adapted from a hospital sleep clinic protocol based on cognitive behaviour therapy (CBT) principles. Women received 10 sessions and 2 booster sessions over a 40-week period. SQ was assessed at baseline, 6and 12-months using the Pittsburgh Sleep Quality Index, a Sleep Diary, and Actigraph readings. QOL was measured by the Quality of Life Enjoyment and Satisfaction Questionnaire. Changes in SQ were examined according to chronotype (morning-type, evening-type, neither-type). Results: SQ improved significantly over the period of the study, with good sleep reported by 21%, 46% and 51% of participants at baseline, 6 months and 12 months, respectively. Consistency was seen across the different SQ measures. The intervention had significant positive effects for all chronotypes, but was more effective for both morning-types and neither-types than for evening-types. Women’s sense of well-being improved after 6 months (p=.01) and was maintained at one year. Conclusion: The CBT-based sleep hygiene intervention led to improvements in sleep quality at 6 months that were maintained at one year. Interventions to improve sleep quality for women shift workers offer a novel approach with the potential to reduce breast cancer risk.