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Prevalence of Modifiable Cancer Risk Factors Among U.S. Adults Aged 18–44 Years

      Introduction

      Carcinogen exposure and unhealthy habits acquired in young adulthood can set the stage for the development of cancer at older ages. This study measured the current prevalence of several cancer risk factors among young adults to assess opportunities to intervene to change the prevalence of these risk factors and potentially reduce cancer incidence.

      Methods

      Using 2015 National Health Interview Survey data (analyzed in 2016), the prevalence of potential cancer risk factors was estimated among U.S. adults aged 18–44 years, based on responses to questions about diet, physical activity, tobacco product use, alcohol, indoor tanning, sleep, human papillomavirus vaccine receipt, and obesity, stratified by sex, age, and race/ethnicity.

      Results

      The prevalence of some risk factors varied by age and race/ethnicity. Obesity (one in four people) and insufficient sleep (one in three people) were common among men and women. Physical inactivity (one in five men, one in four women); binge drinking (one in four men, one in eight women); cigarette smoking (one in five men, one in seven women); and frequent consumption of red meat (one in four men, one in six women) also were common. More than half of the population of adults aged 18–44 years consumed sugar-sweetened beverages daily and processed meat at least once a week. Most young adults had never had the human papillomavirus vaccine.

      Conclusions

      Findings can be used to target evidence-based environmental and policy interventions to reduce the prevalence of cancer risk factors among young adults and prevent the development of future cancers.

      Introduction

      Most cancers are thought to be caused by a combination of factors operating over a person’s lifetime.
      • Hanahan D.
      • Weinberg R.A.
      Hallmarks of cancer: the next generation.
      • Hochberg M.E.
      • Noble R.J.
      A framework for how environment contributes to cancer risk.
      Approaches to cancer prevention need to address the changing exposome of non-genetic exposures over time.
      • Wild C.P.
      The exposome: from concept to utility.
      Actions to reduce the prevalence of harmful risk factors among young adults could prevent or delay the development of new cancer cases in the future,
      • White M.C.
      • Peipins L.A.
      • Watson M.
      • Trivers K.F.
      • Holman D.M.
      • Rodriguez J.L.
      Cancer prevention for the next generation.
      • Forman M.R.
      • Winn D.M.
      • Collman G.W.
      • Rizzo J.
      • Birnbaum L.S.
      Environmental exposures, breast development and cancer risk: through the looking glass of breast cancer prevention.
      • Spring B.
      • King A.C.
      • Pagoto S.L.
      • Van Horn L.
      • Fisher J.D.
      Fostering multiple healthy lifestyle behaviors for primary prevention of cancer.
      • Stewart B.W.
      • Bray F.
      • Forman D.
      • et al.
      Cancer prevention as part of precision medicine: ‘plenty to be done’.
      as well as prevent other chronic diseases.
      • Bauer U.E.
      • Briss P.A.
      • Goodman R.A.
      • Bowman B.A.
      Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA.
      The 2015 National Health Interview Survey included measures of several factors that could contribute to increased risk for one or more types of cancer. These include indoor tanning
      International Agency for Research on Cancer
      Exposure to artificial UV radiation and skin cancer.
      ; e-cigarette use
      • Grana R.
      • Benowitz N.
      • Glantz S.A.
      E-cigarettes: a scientific review.
      • Hecht S.S.
      • Carmella S.G.
      • Kotandeniya D.
      • et al.
      Evaluation of toxicant and carcinogen metabolites in the urine of e-cigarette users versus cigarette smokers.
      • U.S. DHHS
      E-cigarette use among youth and young adults: a report of the Surgeon General—executive summary.
      ; cigarette smoking
      • U.S. DHHS
      The health consequences of smoking—50 years of progress. A Report of the Surgeon General.
      ; binge drinking
      • Scoccianti C.
      • Straif K.
      • Romieu I.
      Recent evidence on alcohol and cancer epidemiology.
      ; frequent consumption of red and processed meats
      • Bouvard V.
      • Loomis D.
      • Guyton K.
      • et al.
      Carcinogenicity of consumption of red and processed meat.
      ; obesity
      • Vucenik I.
      • Stains J.P.
      Obesity and cancer risk: evidence, mechanisms, and recommendations.
      ; lack of human papillomavirus (HPV) vaccination
      • Petrosky E.
      • Bocchini JA Jr.,
      • Hariri S.
      • et al.
      Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices.
      ; insufficient sleep
      • Davis S.
      • Mirick D.K.
      Circadian disruption, shift work and the risk of cancer: a summary of the evidence and studies in Seattle.
      • Watson N.F.
      • Badr M.S.
      • Belenky G.
      • et al.
      Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.
      ; physical inactivity
      • Moore S.C.
      • Lee I.-M.
      • Weiderpass E.
      • et al.
      Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.
      Physical Activity Guidelines Advisory Committee
      Physical Activity Guidelines Advisory Committee report.
      ; and daily consumption of sugar-sweetened beverages (SSBs).
      • Kushi L.H.
      • Doyle C.
      • McCullough M.
      • et al.
      American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.
      • Mozaffarian D.
      • Ludwig D.S.
      The 2015 U.S. dietary guidelines: lifting the ban on total dietary fat.
      Current information on the prevalence of these potentially modifiable factors among young adults is essential for planning and targeting efforts to reduce long-term cancer incidence rates. This study estimated the current prevalence of common cancer risk factors among young adults, aged 18–44 years, stratified by sex, age, and race/ethnicity.

      Methods

      Data Sample

      Data came from the 2015 National Health Interview Survey, a cross-sectional household survey, conducted in person in English or Spanish and representative of the civilian, non-institutionalized U.S. population.
      National Center for Health Statistics
      Survey Description, National Health Interview Survey, 2015.
      Additional information was collected from a randomly selected adult (aged ≥18 years), and the final response rate for this section was 55.2%, taking household nonresponse into account.
      National Center for Health Statistics
      Survey Description, National Health Interview Survey, 2015.
      Respondents who reported a history of cancer other than non-melanoma skin cancer were excluded (n=240), leaving 6,384 men and 7,333 women aged 18–44 years for analysis. Analyses by race/ethnicity were limited to non-Hispanic white, non-Hispanic black, and Hispanic to yield adequate sample sizes for stable subgroup estimates. Prevalence estimates for the HPV vaccine were limited to adults aged 18–26 years.
      • Petrosky E.
      • Bocchini JA Jr.,
      • Hariri S.
      • et al.
      Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices.
      • Markowitz L.E.
      • Dunne E.F.
      • Saraiya M.
      • et al.
      Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).

      Measures

      Variables were treated as dichotomous and sample file recodes used for questionnaire items
      National Center for Health Statistics
      Survey Description, National Health Interview Survey, 2015.
      unless otherwise noted. Obesity was defined as BMI ≥30.
      Obesity Expert Panel
      Managing Overweight and Obesity in Adults: Systematic Evidence Review.

      Office of Disease Prevention and Health Promotion. Healthy People 2020. www.healthypeople.gov. Published 2017.

      Current cigarette smokers reported smoking ≥100 cigarettes during their lifetimes and smoking every day or some days; e-cigarette use included both every day and some day. Binge drinking was defined as four or more alcoholic drinks for women or five or more drinks for men on an occasion during the past 30 days.
      • Kushi L.H.
      • Doyle C.
      • McCullough M.
      • et al.
      American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.

      U.S. DHHS, U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans, 8th ed. 2015.

      World Cancer Research Fund/American Institute for Cancer Research
      Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
      Indoor tanning was defined as use of a tanning device during the past 12 months. Never receiving the HPV vaccine was defined as not receiving one or more shots. Insufficient sleep was defined as <7 hours of sleep/24-hour period on average.
      • Watson N.F.
      • Badr M.S.
      • Belenky G.
      • et al.
      Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.
      Physical inactivity was defined as not reporting any activity when queried about light- to moderate-intensity or vigorous-intensity leisure-time physical activity of ≥10 minutes at a time.
      • Carlson S.A.
      • Fulton J.E.
      • Schoenborn C.A.
      • Loustalot F.
      Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans.
      Consumption of specific foods with a frequency inconsistent with cancer prevention recommendations was defined as daily SSB consumption (one or more times/day), red meat five or more times/week, and processed meat one or more times/week.
      World Cancer Research Fund/American Institute for Cancer Research
      Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.

      Statistical Analysis

      Weighted proportions and 95% CIs were calculated for populations by sex, age, and race/ethnicity in 2015, using SAS, version 9.3, with SUDAAN, version 11, to adjust for the complex sampling design.
      National Center for Health Statistics
      Survey Description, National Health Interview Survey, 2015.

      Results

      Obesity (one in four people) and insufficient sleep (one in three people) were prevalent among men (Table 1) and women (Table 2). Other common risk factors included physical inactivity (i.e., no light- to moderate-intensity or vigorous-intensity leisure-time physical activity ≥10 minutes at a time; one in five men, one in four women); binge drinking (one in four men, one in eight women); cigarette smoking (one in five men, one in seven women); and frequent consumption of red meat (one in four men, one in six women). More than half consumed SSBs daily and processed meat at least once a week. The prevalence of some risk factors varied by age and race/ethnicity.
      Table 1.Prevalence of Cancer Risk Factors Among Young Adult Men in the U.S., 2015
      Risk factorAll men, % (95% CI) (n=6,384)By age group, % (95% CI)
      18–24 years (n=1,369)25–29 years (n=1,315)30–34 years (n=1,301)35–39 years (n=1,201)40–44 years (n=1,198)
      Obesity (BMI ≥30 kg/m2)
       Total (n=6,277)26.9 (25.4, 28.4)18.5 (15.8, 21.6)26.4 (23.3, 29.8)29.4 (26.4, 32.6)30.7 (27.2, 34.5)33.8 (30.1, 37.7)
       NH white (n=3,579)26.3 (24.5, 28.1)17.2 (13.8, 21.2)25.1 (21.2, 29.3)29.1 (25.1, 33.4)29.6 (25.0, 34.7)34.9 (30.2, 40.0)
       NH black (n=704)32.8 (28.8, 37.0)21.9 (15.3, 30.3)30.0 (20.8, 41.2)36.7 (27.8, 46.5)37.3 (27.8, 48.0)45.5 (34.7, 56.7)
       Hispanic (n=1,380)30.7 (27.4, 34.2)23.5 (17.8, 30.3)30.5 (23.9, 38.1)33.7 (26.5, 41.8)36.5 (29.7, 43.8)33.5 (26.2, 41.7)
      Current cigarette smoker
      Current cigarette smokers included respondents who reported smoking ≥100 cigarettes during their lifetimes and, at the time of interview, reported smoking every day or some days.
       Total (n=6,362)18.5 (17.2, 19.9)15.0 (12.7, 17.6)21.7 (18.6, 25.1)21.0 (18.6, 25.1)17.9 (15.4, 20.6)18.5 (15.7, 21.8)
       NH white (n=3,606)20.7 (18.9, 22.7)16.4 (13.1, 20.4)23.7 (19.8, 28.1)22.7 (19.1, 26.7)20.2 (16.6, 24.2)22.2 (18.1, 27.0)
       NH black (n=717)20.7 (17.1, 24.8)16.0 (10.2, 24.1)28.3 (19.9, 38.6)25.2 (16.7, 36.1)20.3 (13.4, 29.4)16.8
      n<30, interpret with caution.
      (10.5, 25.7)
       Hispanic (n=1,413)13.2 (11.1, 15.5)12.5 (8.9, 17.4)13.6 (9.6, 18.8)16.1 (11.4, 22.4)13.2 (9.2, 18.4)10.5 (6.6, 16.4)
      Current e-cigarette smoker
      Current e-cigarette smokers included respondents who reported using e-cigarettes every day or some days.
       Total (n=5,991)6.2 (5.4, 7.1)7.8 (6.1, 10.0)6.6 (4.9, 8.8)5.6 (4.0, 7.8)5.3 (3.9, 7.2)4.6 (3.1, 6.8)
       NH white (n=3,419)7.7 (6.5, 9.0)8.7 (6.4, 11.9)7.6 (5.4, 10.6)7.5 (5.0, 10.9)7.7 (5.4, 10.7)6.4 (4.1, 9.7)
       NH black (n=658)2.8
      n<30, interpret with caution.
      (1.6, 4.9)
      4.8
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (2.0, 11.1)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      2.5
      n<30, interpret with caution.
      ,?>
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.0, 5.9)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
       Hispanic (n=1,332)4.1 (2.8, 5.8)7.9
      n<30, interpret with caution.
      (4.9, 12.6)
      3.6
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.6, 7.8)
      3.3
      n<30, interpret with caution.
      ,?>
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.6, 6.8)
      1.6
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.6, 4.3)
      1.2
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.4, 3.4)
      Binge drank in last 30 days
      Binge drinking was defined as ≥4 alcoholic drinks for women and ≥5 drinks for men on an occasion during the past 30 days.
       Total (n=6,239)25.2 (23.9, 26.6)21.4 (18.5, 24.5)34.0 (30.4, 37.9)27.4 (24.3, 30.8)21.8 (19.1, 24.7)22.5 (19.5, 25.9)
       NH white (n=3,391)29.4 (27.4, 31.5)25.9 (21.3, 31.1)40.8 (35.9, 45.9)31.2 (26.9, 35.9)25.3 (21.5, 29.4)24.4 (20.3, 29.0)
       NH black (n=703)16.0 (12.8, 19.8)11.5
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (7.2, 17.6)
      26.1 (17.4, 37.3)13.1
      n<30, interpret with caution.
      (7.7, 21.4)
      10.9
      n<30, interpret with caution.
      (6.3, 18.2)
      20.7
      n<30, interpret with caution.
      (13.5, 30.2)
       Hispanic (n=1,372)22.1 (19.7, 24.7)16.9 (12.6, 22.4)23.3 (17.7, 30.1)28.8 (21.2, 37.8)21.4 (16.0, 28.0)23.3 (16.6, 31.8)
      Used indoor tanning device in last year
      Use of indoor tanning device included respondents who reported use of a sunlamp, sunbed, or tanning booth in the last year.
       Total (n=5,947)2.2 (1.7, 2.7)1.5 (0.9, 2.6)2.5 (1.6, 3.8)1.7 (1.0, 2.9)3.0 (1.9, 4.5)2.5 (1.6, 3.9)
       NH white (n=3,391)3.3 (2.6, 4.1)2.2
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.2, 3.9)
      3.9 (2.5, 6.2)2.6
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.4, 4.7)
      4.1
      n<30, interpret with caution.
      (2.7, 6.3)
      3.9
      n<30, interpret with caution.
      (2.4, 6.3)
       NH black (n=655)0.0
      n<30, interpret with caution.
      (0.0, 0.2)
      Quantity zero. NH, non-Hispanic.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Quantity zero. NH, non-Hispanic.
      Quantity zero. NH, non-Hispanic.
      Quantity zero. NH, non-Hispanic.
       Hispanic (n=1,323)0.9
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.5, 1.7)
      1.4
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.5, 3.8)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Insufficient sleep
      Insufficient sleep was defined as reporting <7 hours of sleep in a 24-hour period.
       Total (n=6,154)32.8 (31.2, 34.4)23.9 (21.0, 27.0)32.4 (28.7, 36.2)37.8 (34.4, 41.4)36.6 (32.9, 40.5)38.0 (34.3, 41.8)
       NH white (n=3,505)31.3 (29.2, 33.4)22.9 (18.9, 27.4)30.4 (25.7, 35.6)36.0 (31.6, 40.8)33.7 (29.1, 38.8)37.4 (32.5, 42.6)
       NH black (n=679)42.3 (37.4, 47.3)29.5 (22.7, 37.4)42.3 (31.9, 53.5)54.6 (43.6, 65.1)44.7 (33.6, 56.4)49.2 (39.3, 59.2)
       Hispanic (n=1,373)31.4 (28.2, 34.8)21.4 (15.9, 28.2)31.3 (24.4, 39.1)36.5 (29.2, 44.5)38.8 (31.6, 46.5)35.4 (28.6, 42.8)
      Physically inactive
      Physical inactivity was defined as not reporting any activity when queried about light- to moderate- or vigorous-intensity leisure-time physical activity of at least 10 minutes at a time.
       Total (n=6,288)22.6 (21.2, 24.1)21.4 (18.5, 24.7)21.1 (18.3, 24.2)23.9 (21.0, 27.1)21.2 (18.5, 24.3)26.1 (22.8, 29.7)
       NH white (n=3,562)18.7 (16.9, 20.7)18.8 (14.8, 23.6)15.0 (12.0, 18.6)21.5 (17.7, 25.8)16.3 (13.0, 20.4)22.4 (18.5, 26.9)
       NH black (n=708)23.6 (19.9, 27.8)18.5 (13.0, 25.5)26.0 (17.8, 36.4)30.1 (20.5, 41.8)18.7 (12.1, 27.7)28.2 (19.5, 38.8)
       Hispanic (n=1,398)33.9 (30.6, 37.4)28.4 (22.6, 35.0)37.9 (30.8, 45.5)30.0 (23.7, 37.2)36.9 (30.5, 43.7)39.5 (31.5, 48.2)
      Daily sugar-sweetened beverage consumption
      Daily sugar-sweetened beverage consumption included respondents who reported consuming sugar-sweetened drinks, such as regular soda, sweetened fruit drinks, sports and energy drinks, or sweetened coffee or tea, one or more times a day.
       Total (n=6,006)60.6 (58.9, 62.4)57.4 (53.4, 61.2)62.0 (58.4, 65.5)61.2 (57.8, 64.5)63.0 (59.5, 66.3)61.3 (57.4, 65.1)
       NH white (n=3,421)57.8 (55.4, 60.3)53.3 (47.6, 58.9)61.4 (56.4, 66.1)59.2 (54.6, 63.6)58.7 (53.7, 63.5)58.4 (53.1, 63.4)
       NH black (n=658)58.2 (53.1, 63.1)59.8 (49.9, 69.0)55.3 (44.2, 65.9)66.3 (54.8, 76.2)58.1 (47.8, 67.7)51.2 (41.3, 61.0)
       Hispanic (n=1,342)70.3 (67.5, 72.9)65.8 (59.2, 71.9)71.0 (64.6, 76.6)67.5 (60.2, 74.0)77.3 (71.2, 82.4)72.4 (63.2, 80.1)
      Red meat consumption
      Frequent red meat consumption was defined as eating red meat, such as beef, pork, ham, or sausage, five or more times a week.
       Total (n=5,997)24.8 (23.2, 26.5)27.3 (23.8, 31.0)26.6 (23.1, 30.3)24.3 (21.2, 27.6)22.0 (19.0, 25.3)22.3 (19.0, 26.0)
       NH white (n=3,415)25.8 (23.5, 28.2)26.4 (21.6, 31.8)26.9 (22.4, 31.9)27.5 (23.0, 32.5)22.8 (19.0, 27.2)24.9 (20.5, 29.8)
       NH black (n=658)24.5 (20.7, 28.8)24.8 (17.0, 34.6)33.3 (23.6, 44.7)23.5 (15.6, 33.9)21.5 (14.0, 31.5)19.2 (12.3, 28.6)
       Hispanic (n=1,342)22.6 (19.7, 25.9)27.9 (22.0, 34.7)25.7 (19.2, 33.3)16.1 (11.4, 22.2)19.8 (14.2, 26.8)19.7 (13.2, 28.3)
      Processed meat consumption
      Frequent processed meat consumption was defined as eating processed meat, such as bacon, lunch meats, or hot dogs, one or more times a week.
       Total (n=5,996)66.2 (64.5, 67.8)68.2 (64.6, 71.6)68.4 (64.7, 71.8)64.0 (60.3, 67.5)66.3 (62.5, 69.9)62.7 (58.9, 66.3)
       NH white (n=3,416)71.9 (69.8, 73.9)71.6 (66.2, 76.4)72.0 (66.7, 76.7)70.8 (66.3, 75.0)73.1 (67.9, 77.8)72.1 (67.3, 76.4)
       NH black (n=657)64.9 (60.5, 69.0)68.1 (59.1, 76.0)71.7 (60.2, 80.9)58.3 (47.8, 68.1)60.5 (49.9, 70.3)62.9 (53.2, 71.7)
       Hispanic (n=1,342)58.6 (54.8, 62.3)63.4 (56.0, 70.2)63.1 (55.2, 70.3)54.7 (46.4, 62.7)58.8 (51.3, 66.0)47.9 (39.6, 56.4)
      Source: National Health Interview Survey, 2015.
      Note: Estimates are weighted to the population.
      a Current cigarette smokers included respondents who reported smoking ≥100 cigarettes during their lifetimes and, at the time of interview, reported smoking every day or some days.
      b Current e-cigarette smokers included respondents who reported using e-cigarettes every day or some days.
      c Binge drinking was defined as ≥4 alcoholic drinks for women and ≥5 drinks for men on an occasion during the past 30 days.
      d Use of indoor tanning device included respondents who reported use of a sunlamp, sunbed, or tanning booth in the last year.
      e Insufficient sleep was defined as reporting <7 hours of sleep in a 24-hour period.
      f Physical inactivity was defined as not reporting any activity when queried about light- to moderate- or vigorous-intensity leisure-time physical activity of at least 10 minutes at a time.
      g Daily sugar-sweetened beverage consumption included respondents who reported consuming sugar-sweetened drinks, such as regular soda, sweetened fruit drinks, sports and energy drinks, or sweetened coffee or tea, one or more times a day.
      h Frequent red meat consumption was defined as eating red meat, such as beef, pork, ham, or sausage, five or more times a week.
      i Frequent processed meat consumption was defined as eating processed meat, such as bacon, lunch meats, or hot dogs, one or more times a week.
      j n<30, interpret with caution.
      k Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      l Quantity zero.NH, non-Hispanic.
      Table 2.Prevalence of Cancer Risk Factors Among Young Adult Women in the U.S., 2015
      Risk factorAll women, % (95% CI) (n=7,333)By age group, % (95% CI)
      18–24 years (n=1,508)25–29 years (n=1,457)30–34 years (n=1,623)35–39 years (n=1,407)40–44 years (n=1,338)
      Obesity (BMI ≥30)
       Total (n=6,277)26.4 (25.0, 27.8)19.4 (16.8, 22.3)28.8 (25.8, 31.9)28.3 (25.5, 31.3)28.0 (25.3, 31.0)30.6 (27.6, 33.9)
       NH white (n=3,651)24.3 (22.5, 26.2)17.5 (14.0, 21.5)27.4 (23.5, 31.7)26.1 (22.3, 30.3)26.5 (22.7, 30.8)27.0 (23.2, 31.3)
       NH black (n=1,166)39.1 (35.4, 43.0)27.3 (20.4, 35.6)44.9 (36.7, 53.3)37.9 (31.4, 44.9)40.2 (32.9, 47.9)55.5 (46.8, 63.9)
       Hispanic (n=1,773)28.4 (25.7, 31.3)21.1 (16.3, 27.0)29.4 (23.5, 36.2)31.8 (25.5, 38.8)31.8 (26.3, 37.9)32.3 (25.1, 40.5)
      Current cigarette smoker
      Current cigarette smokers included respondents who reported smoking ≥100 cigarettes during their lifetimes and, at the time of interview, reported smoking every day or some days.
       Total (n=7,312)14.1 (13.1, 15.2)10.9 (8.9, 13.3)14.0 (11.8, 16.5)15.0 (12.7, 17.7)15.5 (13.1, 18.1)16.6 (13.9, 19.7)
       NH white (n=3,773)18.2 (16.5, 20.0)13.5 (10.4, 17.2)17.5 (14.2, 21.5)19.9 (16.2, 24.2)20.5 (16.7, 24.9)21.6 (17.6, 26.3)
       NH black (n=1,150)13.5 (11.0, 16.3)8.9
      n<30, interpret with caution.
      (5.3, 14.5)
      16.2 (10.8, 23.6)15.3 (10.6, 21.4)16.8 (10.9, 24.8)13.0
      n<30, interpret with caution.
      (8.0, 20.4)
       Hispanic (n=1,744)6.0 (5.0, 7.3)4.6
      n<30, interpret with caution.
      (2.9, 7.3)
      4.8
      n<30, interpret with caution.
      (3.0, 7.5)
      5.7
      n<30, interpret with caution.
      (3.6, 8.8)
      8.5 (5.8, 12.2)7.5
      n<30, interpret with caution.
      (4.9, 11.5)
      Current e-cigarette smoker
      Current e-cigarette smokers included respondents who reported using e-cigarettes every day or some days.
       Total (n=6,892)3.0 (2.5, 3.5)2.5 (1.8, 3.5)2.0
      n<30, interpret with caution.
      (1.2, 3.3)
      3.1 (2.1, 4.5)3.4 (2.3, 5.1)4.1 (2.9, 6.0)
       NH white (n=3,584)3.7 (3.1, 4.5)3.5 (2.4, 5.0)2.5
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.3, 4.9)
      3.3
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (2.0, 5.4)
      4.6
      n<30, interpret with caution.
      (2.8, 7.7)
      5.1 (3.2, 7.8)
       NH black (n=1,062)2.7 (1.6, 4.3)1.0
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.5, 2.2)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      5.7
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (2.8, 11.3)
      2.5
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (1.0, 6.3)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
       Hispanic (n=1,642)1.5
      n<30, interpret with caution.
      (0.9, 2.4)
      1.7
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.7, 4.2)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      2.3
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.8, 5.9)
      2.3
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.9, 5.5)
      Binge drank in last 30 days
      Binge drinking was defined as ≥4 alcoholic drinks for women and ≥5 drinks for men on an occasion during the past 30 days.
       Total (n=7,252)13.6 (12.5, 14.8)15.6 (12.8, 18.7)14.8 (12.6, 17.3)13.1 (11.2, 15.3)11.1 (9.2, 13.2)12.6 (10.3, 15.4)
       NH white (n=3,734)17.2 (15.6, 19.0)20.3 (16.3, 25.1)18.1 (14.9, 21.9)16.2 (13.3, 19.614.7 (11.8, 18.2)15.1 (11.8, 19.1)
       NH black (n=1,142)9.4 (7.4, 11.9)10.9
      n<30, interpret with caution.
      (6.6, 17.5)
      9.3
      n<30, interpret with caution.
      (5.5, 15.4)
      8.6
      n<30, interpret with caution.
      (5.6, 13.0)
      5.5
      n<30, interpret with caution.
      (3.1, 9.6)
      11.9
      n<30, interpret with caution.
      (6.8, 20.1)
       Hispanic (n=1,732)8.5 (7.0, 10.1)7.3 (5.0, 10.6)11.1 (8.1, 15.1)8.3 (5.4, 12.5)8.3 (5.7, 11.8)8.0
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (4.3, 14.5)
      Used indoor tanning device in last year
      Use of indoor tanning device included respondents who reported use of a sunlamp, sunbed, or tanning booth in the last year.
       Total (n=6,837)7.9 (7.0, 8.8)10.9 (8.9, 13.2)8.7 (6.7, 11.3)6.2 (5.0, 7.7)6.6 (5.0, 8.6)5.6 (3.9, 7.8)
       NH white (n=3,561)12.6 (11.2, 14.2)17.2 (14.0, 21.0)13.3 (10.2, 17.2)10.1 (8.1, 12.5)11.2 (8.5, 14.7)9.0 (6.3, 12.7)
       NH black (n=1,049)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Quantity zero. NH, non-Hispanic.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Quantity zero. NH, non-Hispanic.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
       Hispanic (n=1,628)2.6 (1.7, 3.9)4.1
      n<30, interpret with caution.
      (2.4, 7.1)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      1.8
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.7, 4.6)
      1.7
      n<30, interpret with caution.
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      (0.7, 4.2)
      Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      Insufficient sleep
      Insufficient sleep was defined as reporting <7 hours of sleep in a 24-hour period.
       Total (n=7,092)32.2 (30.6, 33.8)23.4 (20.5, 26.6)30.9 (27.5, 34.4)37.0 (33.9, 40.1)38.4 (35.1, 41.8)35.0 (31.5, 38.7)
       NH white (n=3,678)30.8 (28.7, 32.9)20.5 (16.8, 24.9)28.7 (24.6, 33.2)37.9 (33.5, 42.5)38.5 (34.1, 43.1)33.1 (28.5, 37.9)
       NH black (n=1,102)40.9 (36.8, 45.1)32.4 (23.9, 42.3)48.6 (39.3, 58.0)40.7 (34.0, 47.8)44.6 (36.3, 53.2)45.0 (36.5, 53.7)
       Hispanic (n=1,688)29.8 (27.1, 32.6)23.9 (19.0, 29.6)28.5 (22.4, 35.6)32.8 (26.9, 39.2)34.1 (28.1, 40.6)32.9 (27.2, 39.2)
      Physically inactive
      Physical inactivity was defined as not reporting any activity when queried about light- to moderate- or vigorous-intensity leisure-time physical activity of at least 10 minutes at a time.
       Total (n=7,225)26.8 (25.4, 28.3)28.5 (25.5, 31.8)24.8 (22.0, 27.7)27.7 (24.8, 30.7)26.8 (23.8, 30.0)25.6 (22.7, 28.7)
       NH white (n=3,738)21.6 (19.6, 23.6)23.8 (19.7, 28.5)21.7 (18.0, 26.020.8 (17.0, 25.1)19.7 (16.1, 23.9)20.7 (17.0, 25.0)
       NH black (n=1,136)38.4 (34.6, 42.5)43.2 (35.2, 51.7)39.0 (31.3, 47.4)36.5 (29.0, 44.7)40.0 (32.1, 48.4)30.0 (22.4, 38.9)
       Hispanic (n=1,713)34.7 (32.1, 37.4)32.2 (27.0, 37.9)29.2 (23.5, 35.6)39.1 (33.6, 44.9)35.1 (29.4, 41.2)39.2 (32.0, 46.9)
      Daily sugar-sweetened beverage consumption
      Daily sugar-sweetened beverage consumption included respondents who reported consuming sugar-sweetened drinks, such as regular soda, sweetened fruit drinks, sports and energy drinks, or sweetened coffee or tea, one or more times a day.
       Total (n=6,918)55.7 (54.0, 57.4)52.9 (49.4, 56.4)53.5 (50.2, 56.7)56.7 (53.4, 59.8)59.1 (55.5, 62.6)57.7 (53.9, 61.3)
       NH white (n=3,596)55.3 (52.8, 57.7)53.7 (48.9, 58.5)55.4 (50.8, 59.8)55.1 (50.4, 59.8)58.5 (53.2, 63.6)54.7 (49.5, 59.9)
       NH black (n=1,070)57.0 (53.2, 60.8)56.8 (46.9, 66.1)52.6 (44.3, 60.8)61.4 (54.0, 68.3)60.3 (51.9, 68.2)52.6 (44.0, 61.1)
       Hispanic (n=1,644)58.1 (54.9, 61.3)51.6 (44.7, 58.3)51.7 (44.6, 58.8)58.3 (52.3, 64.1)60.3 (53.9, 66.5)73.6 (66.6, 79.7)
      Red meat consumption
      Frequent red meat consumption was defined as eating red meat, such as beef, pork, ham, or sausage, five or more times a week.
       Total (n=6,899)16.4 (15.2, 17.6)18.0 (15.5, 20.8)16.0 (13.6, 18.7)15.7 (13.6, 18.1)17.3 (14.8, 20.1)14.2 (11.9, 16.7)
       NH white (n=3,589)15.7 (14.2, 17.4)16.7 (13.3, 20.8)15.5 (12.3, 19.3)15.4 (12.5, 18.8)17.0 (13.5, 21.3)13.7 (10.6, 17.4)
       NH black (n=1,066)18.0 (15.0, 21.4)18.5 (12.8, 25.9)21.7 (15.9, 29.0)18.1 (13.0, 24.5)17.8 (11.7, 26.3)13.7
      n<30, interpret with caution.
      (8.9, 20.4)
       Hispanic (n=1,639)16.1 (14.1, 18.4)19.1 (14.8, 24.3)15.4 (11.2, 20.8)14.0 (10.5, 18.3)15.9 (11.8, 21.1)14.4 (9.9, 20.3)
      Processed meat consumption
      Frequent processed meat consumption was defined as eating processed meat, such as bacon, lunch meats, or hot dogs, one or more times a week.
       Total (n=6,898)52.2 (50.5, 53.9)53.0 (49.1, 56.9)48.8 (45.2, 52.4)53.6 (50.3, 56.9)52.6 (49.2, 56.0)52.5 (48.5, 56.4)
       NH white (n=3,589)54.6 (52.2, 56.9)52.2 (46.5, 57.8)50.7 (45.8, 55.6)58.0 (53.0, 62.8)55.0 (49.9, 59.9)58.4 (53.2, 63.5)
       NH black (n=1,067)58.9 (54.5, 63.1)64.1 (54.8, 72.4)53.5 (44.9, 61.9)60.6 (52.9, 67.8)58.5 (49.8, 66.8)52.4 (42.5, 62.0)
       Hispanic (n=1,639)45.0 (41.8, 48.2)47.6 (40.9, 54.3)44.3 (37.3, 51.6)44.1 (37.4, 51.0)45.5 (39.2, 51.9)41.9 (35.0, 49.0)
      Source: National Health Interview Survey, 2015.
      Note: Estimates are weighted to the population.
      a Current cigarette smokers included respondents who reported smoking ≥100 cigarettes during their lifetimes and, at the time of interview, reported smoking every day or some days.
      b Current e-cigarette smokers included respondents who reported using e-cigarettes every day or some days.
      c Binge drinking was defined as ≥4 alcoholic drinks for women and ≥5 drinks for men on an occasion during the past 30 days.
      d Use of indoor tanning device included respondents who reported use of a sunlamp, sunbed, or tanning booth in the last year.
      e Insufficient sleep was defined as reporting <7 hours of sleep in a 24-hour period.
      f Physical inactivity was defined as not reporting any activity when queried about light- to moderate- or vigorous-intensity leisure-time physical activity of at least 10 minutes at a time.
      g Daily sugar-sweetened beverage consumption included respondents who reported consuming sugar-sweetened drinks, such as regular soda, sweetened fruit drinks, sports and energy drinks, or sweetened coffee or tea, one or more times a day.
      h Frequent red meat consumption was defined as eating red meat, such as beef, pork, ham, or sausage, five or more times a week.
      i Frequent processed meat consumption was defined as eating processed meat, such as bacon, lunch meats, or hot dogs, one or more times a week.
      j n<30, interpret with caution.
      k Estimates considered unreliable. Data presented have a relative SE (RSE) >30%–≤50% and should be used with caution. Data not shown have an RSE >50%.
      l Quantity zero.NH, non-Hispanic.
      Among adults aged ≤26 years, the proportion who never had the HPV vaccine was 57.9% (95% CI=54.6%, 61.2%) for women aged 18–26 years, 79.0% (95% CI=73.7%, 83.5%) for men aged 18–21 years, and 86.4% (95% CI= 69.7%, 94.7%) for gay or bisexual men aged 22–26 years.

      Discussion

      Young adulthood is recognized as a period of pivotal life transitions and health vulnerability.
      • Park M.J.
      • Scott J.T.
      • Adams S.H.
      • Brindis C.D.
      • Irwin C.E.
      Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents.
      • Stroud C.
      • Walker L.R.
      • Davis M.
      • Irwin CE Jr,
      Investing in the health and well-being of young adults.
      These data from 2015 on the prevalence of common cancer risk factors can inform and support efforts by healthcare providers and public health professionals to prevent cancer and other chronic diseases in this generation of young adults. Successful prevention strategies include community-wide approaches to reduce risk.

      Community Preventive Services Task Force. The Guide to Community Preventive Services. Atlanta, GA. www.thecommunityguide.org/.

      Overall, about one in four young adult men and women are obese; this proportion varied by age and race/ethnicity. Increased cancer risk also has been reported at excess weight levels below this definition of obesity.
      • Renehan A.G.
      • Tyson M.
      • Egger M.
      • Heller R.F.
      • Zwahlen M.
      Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.
      Recommended strategies to prevent excess weight gain focus on policy and environmental changes such as increasing access to affordable healthy food options and safe opportunities for physical activity.
      • Khan L.K.
      • Sobush K.
      • Keener D.
      • et al.
      Recommended community strategies and measurements to prevent obesity in the United States.
      The prevalence of cigarette smoking and e-cigarette use was higher for men than women. Cigarette smoking has declined by 46.6% over the past decade among young adults aged 18–24 years and by 26.2% among adults aged 25–44 years.
      • Jamal A.
      • King B.A.
      • Neff L.J.
      • Whitmill J.
      • Babb S.D.
      • Graffunder C.M.
      Current cigarette smoking among adults—United States, 2005–2015.
      Behavioral change is possible with the implementation of approaches that operate at multiple levels and include context-changing interventions, such as tobacco tax increases and indoor air policies.
      • Frieden T.R.
      A framework for public health action: the health impact pyramid.
      Binge drinking was reported by one in four men and one in eight women, and was highest among white men aged 25–29 years. Although the risk of cancer tends to be higher among excessive drinkers, cancer risk increases with any alcohol consumption.
      • Scoccianti C.
      • Straif K.
      • Romieu I.
      Recent evidence on alcohol and cancer epidemiology.
      Adherence to the Dietary Guidelines on alcohol

      U.S. DHHS, U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans, 8th ed. 2015.

      can be improved by implementing evidence-based strategies to prevent excessive alcohol consumption, such as those in the Community Guide.
      • Henley S.J.
      • Kanny D.
      • Roland K.B.
      • et al.
      Alcohol control efforts in comprehensive cancer control plans and alcohol use among adults in the USA.

      The Community Preventive Services Task Force. Excessive alcohol consumption. The Guide to Community Preventive Services (The Community Guide). www.thecommunityguide.org/topic/excessive-alcohol-consumption. Accessed November 15, 2016.

      Cancer prevention guidelines recommend limiting SSB consumption to prevent weight gain without specifying a limit.
      • Kushi L.H.
      • Doyle C.
      • McCullough M.
      • et al.
      American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.
      World Cancer Research Fund/American Institute for Cancer Research
      Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
      These data demonstrate that daily SSB consumption was the norm across all sex, age, and race/ethnicity groups, and was highest among Hispanic men. High intake of added sugars has been associated with obesity and an increased risk for some types of cancer.
      • Larsson S.C.
      • Giovannucci E.L.
      • Wolk A.
      Sweetened beverage consumption and risk of biliary tract and gallbladder cancer in a prospective study.
      • Makarem N.
      • Lin Y.
      • Bandera E.V.
      • Jacques P.
      • Parekh N.
      Consumption of total and individual sugars, sugary foods and sugary beverages in relation to adiposity-related cancer risk in the Framingham Offspring cohort (1991–2013).
      • Stepien M.
      • Duarte-Salles T.
      • Fedirko V.
      • et al.
      Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort.
      Indoor tanning was highest among white women. Indoor tanning has been declining among adults, possibly because of increased awareness about the danger posed by ultraviolet radiation.
      • Guy G.P.
      • Berkowitz Z.
      • Holman D.M.
      • Hartman A.M.
      Recent changes in the prevalence of and factors associated with frequency of indoor tanning among U.S. adults.
      The recent Surgeon General’s Call to Action to Prevent Skin Cancer outlines several strategies to reduce harms from indoor tanning, including organizational policies to discourage indoor tanning by students on college campuses.
      U.S. DHHS
      The Surgeon General׳s Call to Action to Prevent Skin Cancer.
      Many young men and women reported being physically inactive, a risk factor for some forms of cancer, particularly colon and breast cancers.
      Physical Activity Guidelines Advisory Committee
      Physical Activity Guidelines Advisory Committee report.
      Adults who are physically inactive and those who are insufficiently active (some activity but not meeting the guideline) can increase health benefits by working toward meeting the aerobic physical activity guideline.
      Physical Activity Guidelines Advisory Committee
      Physical Activity Guidelines Advisory Committee report.
      Step it Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities outlines several community-based strategies to better support walking and walkability for all people.

      U.S. DHHS. Step It Up! The Surgeon General׳s call to action to promote walking and walkable communities. U.S. DHHS, Office of the Surgeon General. www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/index.html. Published 2015.

      Within the recommended age ranges for the HPV vaccine, men were more likely never to have received the HPV vaccine than women. Routine HPV vaccination is recommended at age 11 or 12 years.
      • Petrosky E.
      • Bocchini JA Jr.,
      • Hariri S.
      • et al.
      Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices.
      HPV vaccination is also recommended for women up to age 26 years, men up to age 21 years, and men who have sex with men up to age 26 years who were not previously vaccinated.
      • Markowitz L.E.
      • Dunne E.F.
      • Saraiya M.
      • et al.
      Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).
      Even though the HPV vaccine is most effective when administered to young adolescents, many young adults have never received the HPV vaccine and could potentially benefit from catch-up vaccination.

      Limitations

      Findings are subject to several limitations. All measures are subject to potential reporting bias. The strength of evidence is not equal across risk factors and may vary by cancer type. Many cancer risk factors were not measured. Cut points do not reflect thresholds for cancer risk. Small sample sizes for many strata yielded unstable estimates.

      Conclusions

      Many modifiable cancer risk factors are common among young adults in the U.S. The implementation of policy and environmental strategies for these risk factors could prevent future cancers.

      Acknowledgments

      Publication of this article was supported by the U.S. Centers for Disease Control and Prevention (CDC), an Agency of the U.S. Department of Health and Human Services, under contract number: 200-2017-M-94637. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of CDC.
      The authors thank Trevor Thompson for his valuable statistical advice and consultation.
      This research was supported in part by an appointment (ML Shoemaker) to the Research Participation Program at CDC administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC. All other authors are federal employees and their work on this paper was performed as part of their official duties.
      MC White conceptualized the study and led the drafting of the article. ML Shoemaker performed data analysis. All authors contributed to the selection of specific cancer risk measures, interpreted findings, reviewed and edited drafts of the article, and approved the final version.
      No financial disclosures were reported by the authors of this paper.

      References

        • Hanahan D.
        • Weinberg R.A.
        Hallmarks of cancer: the next generation.
        Cell. 2011; 144: 646-674https://doi.org/10.1016/j.cell.2011.02.013
        • Hochberg M.E.
        • Noble R.J.
        A framework for how environment contributes to cancer risk.
        Ecol Lett. 2017; 20: 117-134https://doi.org/10.1111/ele.12726
        • Wild C.P.
        The exposome: from concept to utility.
        Int J Epidemiol. 2012; 41: 24-32https://doi.org/10.1093/ije/dyr236
        • White M.C.
        • Peipins L.A.
        • Watson M.
        • Trivers K.F.
        • Holman D.M.
        • Rodriguez J.L.
        Cancer prevention for the next generation.
        J Adolesc Health. 2013; 52: S1-S7https://doi.org/10.1016/j.jadohealth.2013.02.016
        • Forman M.R.
        • Winn D.M.
        • Collman G.W.
        • Rizzo J.
        • Birnbaum L.S.
        Environmental exposures, breast development and cancer risk: through the looking glass of breast cancer prevention.
        Reprod Toxicol. 2015; 54: 6-10https://doi.org/10.1016/j.reprotox.2014.10.019
        • Spring B.
        • King A.C.
        • Pagoto S.L.
        • Van Horn L.
        • Fisher J.D.
        Fostering multiple healthy lifestyle behaviors for primary prevention of cancer.
        Am Psychol. 2015; 70: 75-90https://doi.org/10.1037/a0038806
        • Stewart B.W.
        • Bray F.
        • Forman D.
        • et al.
        Cancer prevention as part of precision medicine: ‘plenty to be done’.
        Carcinogenesis. 2016; 37: 2-9https://doi.org/10.1093/carcin/bgv166
        • Bauer U.E.
        • Briss P.A.
        • Goodman R.A.
        • Bowman B.A.
        Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA.
        Lancet. 2014; 384: 45-52https://doi.org/10.1016/S0140-6736(14)60648-6
        • International Agency for Research on Cancer
        Exposure to artificial UV radiation and skin cancer.
        WHO, Geneva2006
        • Grana R.
        • Benowitz N.
        • Glantz S.A.
        E-cigarettes: a scientific review.
        Circulation. 2014; 129: 1972-1986https://doi.org/10.1161/CIRCULATIONAHA.114.007667
        • Hecht S.S.
        • Carmella S.G.
        • Kotandeniya D.
        • et al.
        Evaluation of toxicant and carcinogen metabolites in the urine of e-cigarette users versus cigarette smokers.
        Nicotine Tob Res. 2015; 17: 704-709https://doi.org/10.1093/ntr/ntu218
        • U.S. DHHS
        E-cigarette use among youth and young adults: a report of the Surgeon General—executive summary.
        U.S. DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2016
        • U.S. DHHS
        The health consequences of smoking—50 years of progress. A Report of the Surgeon General.
        U.S. DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
        • Scoccianti C.
        • Straif K.
        • Romieu I.
        Recent evidence on alcohol and cancer epidemiology.
        Future Oncol. 2013; 9: 1315-1322https://doi.org/10.2217/fon.13.94
        • Bouvard V.
        • Loomis D.
        • Guyton K.
        • et al.
        Carcinogenicity of consumption of red and processed meat.
        Lancet Oncol. 2015; 16: 1599https://doi.org/10.1016/S1470-2045(15)00444-1
        • Vucenik I.
        • Stains J.P.
        Obesity and cancer risk: evidence, mechanisms, and recommendations.
        Ann N Y Acad Sci. 2012; 1271: 37-43https://doi.org/10.1111/j.1749-6632.2012.06750.x
        • Petrosky E.
        • Bocchini JA Jr.,
        • Hariri S.
        • et al.
        Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 300-304
        • Davis S.
        • Mirick D.K.
        Circadian disruption, shift work and the risk of cancer: a summary of the evidence and studies in Seattle.
        Cancer Causes Control. 2006; 17: 539-545https://doi.org/10.1007/s10552-005-9010-9
        • Watson N.F.
        • Badr M.S.
        • Belenky G.
        • et al.
        Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.
        Sleep. 2015; 38: 843-844https://doi.org/10.5665/sleep.4716
        • Moore S.C.
        • Lee I.-M.
        • Weiderpass E.
        • et al.
        Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.
        JAMA Intern Med. 2016; 176: 816-825https://doi.org/10.1001/jamainternmed.2016.1548
        • Physical Activity Guidelines Advisory Committee
        Physical Activity Guidelines Advisory Committee report.
        U.S. DHHS, Washington DC2008
        • Kushi L.H.
        • Doyle C.
        • McCullough M.
        • et al.
        American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity.
        Cancer J Clin. 2012; 62: 30-67https://doi.org/10.3322/caac.20140
        • Mozaffarian D.
        • Ludwig D.S.
        The 2015 U.S. dietary guidelines: lifting the ban on total dietary fat.
        JAMA. 2015; 313: 2421-2422https://doi.org/10.1001/jama.2015.5941
        • National Center for Health Statistics
        Survey Description, National Health Interview Survey, 2015.
        U.S. DHHS, CDC, National Center for Health Statistics, Atlanta, GA2016
        • Markowitz L.E.
        • Dunne E.F.
        • Saraiya M.
        • et al.
        Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2014; 63: 1-30
        • Obesity Expert Panel
        Managing Overweight and Obesity in Adults: Systematic Evidence Review.
        National Heart, Lung and Blood Institute, NIH, U.S. DHHS, Bethesda, MD2013
      1. Office of Disease Prevention and Health Promotion. Healthy People 2020. www.healthypeople.gov. Published 2017.

      2. U.S. DHHS, U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans, 8th ed. 2015.

        • World Cancer Research Fund/American Institute for Cancer Research
        Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
        World Cancer Research Fund International, Washington, DC2007
        • Carlson S.A.
        • Fulton J.E.
        • Schoenborn C.A.
        • Loustalot F.
        Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans.
        Am J Prev Med. 2010; 39: 305-313https://doi.org/10.1016/j.amepre.2010.06.006
        • Park M.J.
        • Scott J.T.
        • Adams S.H.
        • Brindis C.D.
        • Irwin C.E.
        Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents.
        J Adolesc Health. 2014; 55: 3-16https://doi.org/10.1016/j.jadohealth.2014.04.003
        • Stroud C.
        • Walker L.R.
        • Davis M.
        • Irwin CE Jr,
        Investing in the health and well-being of young adults.
        J Adolesc Health. 2015; 56: 127-129https://doi.org/10.1016/j.jadohealth.2014.11.012
      3. Community Preventive Services Task Force. The Guide to Community Preventive Services. Atlanta, GA. www.thecommunityguide.org/.

        • Renehan A.G.
        • Tyson M.
        • Egger M.
        • Heller R.F.
        • Zwahlen M.
        Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.
        Lancet. 2008; 371: 569-578https://doi.org/10.1016/S0140-6736(08)60269-X
        • Khan L.K.
        • Sobush K.
        • Keener D.
        • et al.
        Recommended community strategies and measurements to prevent obesity in the United States.
        MMWR Recomm Rep. 2009; 58: 1-26
        • Jamal A.
        • King B.A.
        • Neff L.J.
        • Whitmill J.
        • Babb S.D.
        • Graffunder C.M.
        Current cigarette smoking among adults—United States, 2005–2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1205-1211https://doi.org/10.15585/mmwr.mm6544a2
        • Frieden T.R.
        A framework for public health action: the health impact pyramid.
        Am J Public Health. 2010; 100: 590-595https://doi.org/10.2105/AJPH.2009.185652
        • Henley S.J.
        • Kanny D.
        • Roland K.B.
        • et al.
        Alcohol control efforts in comprehensive cancer control plans and alcohol use among adults in the USA.
        Alcohol Alcohol. 2014; 49: 661-667https://doi.org/10.1093/alcalc/agu064
      4. The Community Preventive Services Task Force. Excessive alcohol consumption. The Guide to Community Preventive Services (The Community Guide). www.thecommunityguide.org/topic/excessive-alcohol-consumption. Accessed November 15, 2016.

        • Larsson S.C.
        • Giovannucci E.L.
        • Wolk A.
        Sweetened beverage consumption and risk of biliary tract and gallbladder cancer in a prospective study.
        J Natl Cancer Inst. 2016; 108: djw125https://doi.org/10.1093/jnci/djw125
        • Makarem N.
        • Lin Y.
        • Bandera E.V.
        • Jacques P.
        • Parekh N.
        Consumption of total and individual sugars, sugary foods and sugary beverages in relation to adiposity-related cancer risk in the Framingham Offspring cohort (1991–2013).
        FASEB J. 2016; 30 (42.1)
        • Stepien M.
        • Duarte-Salles T.
        • Fedirko V.
        • et al.
        Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort.
        Eur J Nutr. 2016; 55: 7-20https://doi.org/10.1007/s00394-014-0818-5
        • Guy G.P.
        • Berkowitz Z.
        • Holman D.M.
        • Hartman A.M.
        Recent changes in the prevalence of and factors associated with frequency of indoor tanning among U.S. adults.
        JAMA Dermatol. 2015; 151: 1256-1259https://doi.org/10.1001/jamadermatol.2015.1568
        • U.S. DHHS
        The Surgeon General׳s Call to Action to Prevent Skin Cancer.
        U.S. DHHS, Office of the Surgeon General, Washington, DC2014
      5. U.S. DHHS. Step It Up! The Surgeon General׳s call to action to promote walking and walkable communities. U.S. DHHS, Office of the Surgeon General. www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/index.html. Published 2015.