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Disinfection by-products (DBP) are a side effect of water chlorination. Some toxicological studies suggest an association between DBP exposure and adverse reproductive and developmental effects. This investigation considered all toxicological and epidemiological evidence for the various effects, outcome by outcome. The weight of evidence demonstrated that no association with DBP exposure exists for over a dozen outcomes including low and very low birth weight, preterm delivery, some specific congenital anomalies, and neonatal death. The analysis found inconsistent or very weak results for all congenital anomalies/birth defects, all central nervous system anomalies, neural tube defects, spontaneous abortion, and stillbirth. The weight of evidence suggested a positive association with DBP exposure for some measure of growth retardation (such as intrauterine growth retardation or small for gestational age) and for urinary tract anomalies. Having catalogued these effects, it should be noted that exposure assessment in the epidemiological studies published to date has been inadequate to definitively demonstrate an association of small magnitude. Exposure to DBP primarily has been based on routine (i.e., quarterly) monitoring of public water supplies for trihalomethanes (THM) matched to maternal residence. In order to determine whether an association exists between adverse reproductive and developmental effects and exposure to DBP, studies must consider the THM concentration and the quantity of the water actually consumed by pregnant women., (Copyright 2001 Academic Press.)

The long-term health consequences of exposure to phenoxyherbicides used in Vietnam has been a great concern to the veterans. In addition to the Air Force Ranch Hand personnel, Army Chemical Corps personnel who served in Vietnam are thought to have had some of the highest herbicide exposures. The Department of Veterans Affairs commenced a study of veterans who served in Vietnam as members of the Army Chemical Corps and a comparison cohort of Army Chemical Corps personnel who served elsewhere. A total of 2872 Vietnam veterans and 2737 non-Vietnam veterans who served in the Army Chemical Corps were identified for inclusion in a telephone health interview survey with a random 20% sample of veterans receiving serum dioxin and other congeners assessments. In a feasibility study which included 284 Vietnam veterans and 281 non-Vietnam veterans, 100 serum assessments were conducted of which 95 were included in the analysis. Vietnam veterans with a history of spraying herbicides were found to have a statistically significant elevation in their current serum 2,3,7,8-TCDD concentrations compared to non-Vietnam veterans without a spray history (P = 0.05). Other 2,3,7,8-substituted dioxins levels were comparable to the levels found in the non-Vietnam veterans. This feasibility study demonstrated that serum dioxin concentrations from a sample of the study participants can be used to identify exposure variables in the health survey that can serve as a surrogate measure of phenoxyherbicide exposure.

A population from a hearing clinic in Washington County, Maryland, in 1943-1960 was followed to assess the risk of developing neoplasms from radium treatment of the nasopharynx for adenoid hypertrophy. Of the 2,925 subjects who attended the clinic, 904 received radium treatment. A nonconcurrent prospective study compared the cancer incidence among the irradiated persons with that among persons with other treatments. Seven brain tumor cases (three malignant and four benign) were identified in the irradiated group versus none in the nonirradiated group (relative risk = 14.8, 95% confidence interval: 0.76, 286.3). A nonsignificant excess risk of thyroid cancer was detected in the irradiated group based on two cases in the exposed group and one case in the nonexposed group (relative risk = 4.2, 95% confidence interval: 0.38, 46.6). Decreased risks of breast cancer, female genital cancers, and prostate cancer were observed among the irradiated individuals, although these deficits were not statistically significant individually. The decreased risk of sex hormone-related cancers in the irradiated group suggests possible radiation damage to the pituitary, with consequent reduction in pituitary hormone output and alterations in sexual and other hormonal development in early life. This hypothesis needs further evaluation.

Carbonless copy paper (CCP), introduced in 1954, is ubiquitous in the U.S. marketplace, and because of this, many workers come into contact with it. Its safety to workers who handle large amounts of CCP has been addressed in numerous studies and reports; and the National Institute for Occupational Safety and Health (NIOSH) on two occasions has sought to determine what, if any, hazards to health CCP might pose. This review encompasses the world's literature on CCP and provides a weight-of-evidence analysis of the safety of CCP to workers in the United States. CCP is systematically studied on large groups of humans using repeat insult patch tests. Consistently, CCP in U.S. commerce since 1987 (the focus of this review) has produced neither primary skin irritation nor skin sensitization under exaggerated test conditions, demonstrating that no irritation or sensitization is expected on contact with CCP under normal conditions of manufacture and use. Years after the introduction of CCP, the first case reports appeared in 1974 suggesting an association between CCP use and various generic symptoms. Most of the earliest reports occurred in Sweden in response to negative publicity concerning the product, and to date approximately half of all published articles originate in Scandinavia. Many early reports were questionnaire/interview studies which suffered from suggestive questions, biases, and lack of control for confounding factors. Few studies included a comparison group (i.e., people not exposed to CCP) making it impossible to estimate risk values. Later, sick building syndrome studies, accounting for many relevant factors in the office environment, found no association between CCP exposure and symptoms unexplained by other factors. Animal studies showed that compounds used to manufacture CCP do not have acute toxic potential and are not genotoxic. Finally, very few published complaints have come from the manufacturing sector where the closest and most voluminous contact occurs. A few reports of symptoms have emanated from printing facilities (with a multiplicity of other chemical exposures), but generally most symptoms are reported in the office setting where the exposure is lower than in the manufacturing or printing settings. Based on the weight of the evidence, CCP currently in commerce in the United States is shown not to be the causative agent for the reported general symptoms sometimes associated with it over the years. Recently NIOSH evaluated the literature as to possible hazards to health posed by CCP, and NIOSH is anticipated to conclude that CCP is not a hazard to workers and has only a small possibility of producing mild and transient skin irritation., (Copyright 2000 Academic Press.)

Drinking mutagenic downstream water from the Huangpu River was hypothesized to have increased the risk for male esophageal cancer in Shanghai, China. The authors conducted a population-based case-control study of a total of 71 esophageal cancer deaths and 1,122 controls collected during a 5-year follow-up period, 1984-1988, from four male cohorts born before January 1, 1944, living in four communities consuming water with different mutagenicities in the Shanghai area. The controls represented a 1% random sample of the defined living cohorts selected at the end of each of the 5 years of follow-up. Logistic regression showed an odds ratio of 2.77 (95% confidence interval: 1.52, 5.03) for drinking mutagenic downstream water from the river versus drinking nonmutagenic upstream water after controlling for possible confounders including age, disease history (hepatitis, cirrhosis, schistosomiasis, digestive tract ulcer), hazardous occupational history, pesticide exposure, lifestyle factors (cigarette smoking, tea intake, and alcohol intake), dietary habits (intake of pickled vegetables, maize, peanuts, and cured meat), education, poverty, urban environment, and water chlorination.

A study of pulp and paper mill workers indicated low risks of death from all causes (standardized mortality ratio (SMR) = 0.74) and all cancers (SMR = 0.81) compared with U.S. rates. The leukemia death rate in workers was not higher than the U.S. rate but was higher than the rate in county populations surrounding mills. Workers whose last jobs were in the finishing areas of the mills had an elevated SMR for liver cancer. An internal comparison of occupational characteristics indicated that workers employed in mills using other chemical pulping operations had significantly elevated mortality from all causes, all cancers, heart disease, lymphomas, and brain cancers. Lung cancer mortality was elevated in mills using kraft pulping. The internal comparisons confirmed the association between work in finishing and the risk of liver cancer. This study was designed to investigate whether pulp and paper mill workers have any risks that would indicate the need for studies detailing exposures.

In 1978 an epidemiologic study exploring the health consequences of nasopharyngeal radium irradiation among individuals treated for adenoid enlargement in Washington County, Maryland, found an excess risk of brain tumors and a deficit of female breast cancers. The study population included all persons first seen at the Washington County Clinic for the Prevention of Deafness in Children from 1940 to January 1, 1960. We will continue the follow-up of irradiated and nonirradiated patients to (1) assess the risk of brain tumors and other neoplasms of the head and neck developing during a 40-year period, (2) assess hormone-related disorders resulting from irradiation of the pituitary gland, and (3) compare cancer incidence and mortality rates among exposed and nonexposed groups. Of the 2135 persons eligible for this study, 93.5% have been traced, and 90% have replied to a mailed questionnaire that elicits information on demographic characteristics, reproductive and medical history, infertility, and other sources of radiation exposure. Information on cancer incidence and mortality is being obtained from the Washington County Cancer Registry and death certificate files from Washington County and the Social Security Administration. Statistical methods to be used in the data analysis include standardized mortality ratios, standardized cancer incidence ratios, and Kaplan-Meier survival analysis.

Sunlight exposure and certain host factors such as red hair and fair skin are established risk factors for non-melanoma skin cancers. Because deficient DNA repair capacity has contributed to the development of skin cancers in a rare genetic disease, xeroderma pigmentosum, we explored this deficiency as an etiologic factor in a recent population study. We used a new DNA repair assay, the host-cell reactivation, in a clinic-based case-control study to test the hypothesis that reduced DNA repair is the underlying molecular mechanism for the development of sunlight-induced basal cell carcinoma. The peripheral lymphocytes from 88 patients with primary BCC and 135 cancer-free controls were tested for their capacity to repair ultraviolet light-induced DNA damage in a reporter gene, chloramphenicol acetyl transferase. All subjects were between the ages of 20 and 60 years and were frequency matched by age (+/- 5) and sex. Among those who reported frequent sunbathing, poor tanning ability, a history of multiple sunburns, exposure to chemicals, or multiple medical irradiations, the BCC patients had significantly lower DNA repair capacity than controls (p < 0.05). DNA repair capacity was also found substantially lower in the basal cell carcinoma patients who had red hair and light skin (type I). Compared to controls, basal cell carcinoma cases with selected risk factors had a relative decrease in DNA repair capacity of 10-28%. These findings provided evidence that reduced DNA repair capacity is one of the underlying molecular mechanisms for sunlight-induced skin carcinogenesis in the general population.

Workers in abattoirs and meatpacking plants have potential for exposure to bovine leukemia virus (BLV) and bovine papilloma viruses (BPV), which are oncogenic in cattle. These workers also have increased exposure to human papilloma viruses (HPV) and certain chemical carcinogens. We investigated whether such a group showed increased risk of cancers. We report mortality results after an additional 9-year follow-up of a previously studied group of 5,522 workers in abattoirs and 4,589 workers in meatpacking plants. Excess risk of all cancers combined, cancers of the lung, buccal cavity and pharynx, esophagus, colon, bladder, kidney, and bone was observed. Since factors such as tobacco smoking, alcohol, and diet, which have known associations with some of these cancers, were not taken into account, the significance of these findings is not known, except for lung cancer, for which occupational factors are probably involved. Because some of these findings have been consistently reported before, studies that will control for confounding factors as well are now urgently needed.

The purpose of this paper is to present the assessment of magnetic field exposure conducted as a part of a nested case-control investigation of leukemia mortality in telephone lineworkers. For the purposes of exposure classification, telephone company jobs were initially divided into two classes: those with potential for working in an electric environment, referred to as linework jobs, and those not working in an electric environment, referred to as nonlinework jobs. Linework jobs were further divided into the following four categories: outside plant technicians (OPT), installation/maintenance/repair (IMR) technicians, central office technicians (COT), and cable splicing technicians (CST). These job groupings were based on similarity of work tasks and exposure environments. Emdex data-logging dosimeters were used to measure personal exposures to ELF magnetic fields for 204 telephone company workers. Three general classes of exposure indices were calculated for each exposure record: measures of central tendency, measures of peak or maximum exposure, and measures of exposure variability. CSTs had the highest full-shift mean and median exposure, 4.3 and 3.2 mG, respectively. CSTs also ranked the highest, with average peak, average 95th percentile, and average time above background equal to 99.2 mG, 11.1 mG, and 156 min, respectively. In addition, the results suggest the OPT and IMR technicians have exposures similar to nonlineworkers. Exposure classifications, therefore, which misclassify all lineworkers into one "telephone lineworker" job grouping are not appropriate and future studies should concentrate on cable splicing technicians.

This study investigated the role of DNA repair in susceptibility to sunlight-induced basal cell carcinoma using a host cell reactivation assay in peripheral lymphocytes. The study included Maryland basal cell carcinoma patients and cancer-free dermatologic controls who had had noncancerous skin disorders diagnosed between 1987 and 1990. Logistic regression models were used to assess the independent effect of the selected variables stratified by DNA repair level, with adjustment for age and family history. Skin type, lifetime number of severe sunburns, and actinic elastosis were also selected as risk factors for basal cell carcinoma. Cryopreserved lymphocytes from 88 cases and 135 controls were used for the DNA repair assay. When data were stratified by DNA repair level and adjusted for age and family history of skin cancer, significantly increased odds ratios associated with lighter skin (odds ratio (OR) = 3.2, 95% confidence interval (CI) 1.5-7.3), six or more severe sunburns in a lifetime (OR = 4.2, 95% CI 1.6-10.7), and moderate or severe actinic elastosis (OR = 4.4, 95% CI 1.5-12.8) were observed in persons with low DNA repair but not in those with high DNA repair. These findings suggest that impaired DNA repair may be a susceptibility factor for sunlight-induced skin cancer in the general public, as it is in patients with xeroderma pigmentosum.

A clinic-based case-control study was conducted to determine the association between vitamin supplement use and risk of basal cell carcinoma (BCC) of the skin. The subjects were 131 patients with histopathologically confirmed primary BCC and 200 cancer-free controls with non-premalignant skin disorders. Use of any vitamins (mainly multivitamins and vitamins A, C, and E) was associated with reduced risk of BCC. After controlling for age, sex, cigarette smoking, number of lifetime severe sunburns, and skin actinic elastosis, regular vitamin supplementation was associated with a significantly reduced risk of BCC (odds ratio (OR) = 0.3; 95% confidence interval (CI) = 0.2-0.06). The ORs decreased as the regularity (p < 0.001) and daily doses of supplement used increased, especially for vitamins A (p < 0.005) and E (p < 0.005). Vitamin supplementation was not associated with alterations in cellular DNA repair. These results, however, cannot be considered conclusive because of the relatively low participation rates (131/830 for cases and 200/1406 for controls) due to the requirement of blood donation and more rigorous studies are needed to clarify the effect of supplemental vitamins, particularly of vitamins A and E, on the risk of BCC of the skin.

Defective repair of sunlight-induced DNA photodamage, coupled with an unusually high occurrence of multiple primary basal cell carcinomas (BCCs), is the major characteristic of xeroderma pigmentosum. Our recent work has indicated that this etiological paradigm may apply to skin cancer patients without an apparent hereditary disease. The present study reports on an investigation of whether medications such as photosensitizing drugs (antibiotics, corticosteroids, and aspirin) modulate skin cancer risk through alterations in DNA repair capacity (DRC). Using a new DNA repair (host cell reactivation) assay with peripheral T-lymphocytes, we tested DRCs of 88 Caucasian BCC patients and 135 cancer-free controls. Subjects were between 20 and 60 years of age and free of known hereditary skin diseases. The age-adjusted means of DRC were calculated to compare repair levels associated with the use of specific drugs and hormones. Multiple linear regression models were used to correlate DRC with the number of skin cancers. The estimated odds ratio was used to describe the risk of BCCs. The distribution of DRCs of subjects was approximately normal, with a 5-fold variation between individuals. DRCs below the upper 30th percentile of controls were associated with an estimated 2.3-fold (95% confidence interval, 1.17-4.54-fold) increased risk for the occurrence of BCCs. The lower the DRC was, the greater the number of skin tumors in individuals (P < 0.05), after adjustment for age. Although supplemental vitamin use was associated with reduced risk of skin cancer, it was not associated with differences in subjects' DRCs. However, individuals who reported taking either tetracycline or estrogen, two photosensitizing drugs, had higher DRCs, compared with those who had not used these drugs. Low DRC or a family history of skin cancer increased the probability that patients who were overexposed to sunlight would have multiple BCCs. DNA repair levels may be influenced by the use of selected photosensitizing drugs and estrogen.

This case-control study examines potential associations between telephone linework and the occurrence of leukemia except chronic lymphocytic leukemia in a primarily retired population of American Telephone and Telegraph Company (AT&T) workers. Cases died between 1975 and 1980. Exposure is defined both by job title and, for workers with complete job histories, by a lifetime exposure score based on industrial hygiene personal monitoring measurements of line and nonline jobs. When the time-weighted average mean for each job is accumulated into a lifetime exposure score, workers with scores above the median for the population show an excess of leukemia 2.5 times higher than workers below the median (95% confidence interval (CI) 0.7-8.6). Those individuals with long duration of employment in jobs with intermittent peak exposures may be at higher risk of leukemia than those with a constant exposure level. Analyses that allow for a latent period suggest the risk is associated with exposures that occurred 10 or more years before death. Workers with peak exposure scores above the median have odds ratios of 2.4 (95% CI 0.7-9.0) and 6.6 (95% CI 0.7-58) for latent periods of 10 and 15 years, respectively. The data suggest an increasing risk with increasing exposure (p for trend = 0.05) when cumulated scores are based on peak exposure scores. Peak exposures tended to occur in cable splicing work and in old telephone switching offices. The numbers in this study are small and observed differences may be due to chance.

This molecular epidemiology study examines the DNA-repair capacities (DRCs) of basal cell carcinoma (BCC) skin cancer patients (88) and their controls (135) by using a plasmid/host-cell reactivation assay. In this assay UV-damaged expression vector plasmid is transfected into peripheral blood T lymphocytes from the subjects. The host-cellular repair enzymes repair the photochemical damage in the plasmid, and 40 hr later the plasmid-encoded reporter chloramphenicol acetyltransferase is measured. An age-related decline in this DRC, amounting to approximately 0.61% per yr occurred in the controls from 20 to 60 yr of age. Reduced DRC was a particularly important risk factor for young individuals with BCC and for those individuals with a family history of skin cancer. Young individuals with BCC repaired DNA damage poorly when compared with controls. As the BCC patients aged, however, differences between cases and controls gradually disappeared. The normal decline in DNA repair with increased age may account for the increased risk of skin cancer that begins in middle age, suggesting that the occurrence of skin cancer in the young may represent precocious aging. Patients with reduced DRCs and overexposure to sunlight had an estimated risk of BCC > 5-fold greater than the control group. Such a risk was even greater (10-fold) in female subjects.

1,3-Butadiene and styrene are suspected carcinogens and common chemicals used in the synthesis of rubber. To investigate any potential human hazards from exposure to these chemicals, a case-control study of 59 lymphohematopoietic cancers was conducted within a cohort of male workers employed between 1943 and 1982 in eight North American styrene-butadiene rubber polymer-producing plants. A total of 193 controls were matched to the cases by plant, age, year of hire, duration worked, and survival to time of death of the case. Each job was assigned an estimated exposure rank, and each worker's cumulated rank score was calculated on the basis of the time spent in each job throughout his employment. "Exposure" as a dichotomous variable was defined as a log rank score above the mean of the log scores for the total population of cases and controls within a subtype of cancer. Matched-pair analysis identified a strong association between leukemia and butadiene, with an odds ratio of 9.36 (95% confidence interval 2.05-22.9) and an association between styrene and leukemia (odds ratio = 3.13, 95% confidence interval 0.84-11.2) that did not achieve statistical significance. When exposure to both styrene and butadiene was included in a conditional logistic regression model, the odds ratio for butadiene remained high (odds ratio = 7.39), but the estimated association of leukemia with styrene was small. The results of this study support the hypothesis that exposure to butadiene is associated with the risk of leukemia. There also appears to be an additional risk from work in specific subdivisions of the industry.

A method for measuring nucleotide excision repair in response to UV irradiation and chemical-induced DNA damage has been developed, validated, and field tested in cultured human lymphocytes. The methodology is amenable to population-based screening and should facilitate future epidemiological studies seeking to investigate associations between DNA repair proficiency and cancer susceptibility. The impetus for such endeavors derives from the suggestion that the high incidence of skin cancer in the genetic disorder xeroderma pigmentosum is manifested as a result of the reduced capacity of patients' cells to repair DNA damaged by UV-mimetic agents. For the assay, damaged, nonreplicating, recombinant plasmid DNA harboring a chloramphenicol acetyltransferase (cat) reporter gene is introduced into lymphocytes by using a DEAE-dextran/DNA complex short-term transfection conditions. Excision repair of the damaged bacterial cat gene is monitored proportionately as a function of reactivated CAT enzyme activity following a 40-h repair/expression incubation period. The validity of the approach was indicated by the ability of the assay to discriminate xeroderma pigmentosum virus-transformed lymphocyte cell lines of both severe (complementation groups A and D) and moderate (complementation group C) excision repair deficiencies from repair-proficient cell lines. Similar results were observed when a mitogen-stimulated peripheral blood lymphocyte culture from an xeroderma pigmentosum A patient was assayed concurrently with mitogen-stimulated peripheral blood lymphocytes obtained from healthy individuals. Adaptation of this DNA repair assay as a field test in a pilot-tested select group of basal cell carcinoma patients and cancer-free controls led to the preliminary identification of a specific subset at risk for this disease as a consequence of significant reduction to the repair of photochemically (UV)-damaged plasmid DNA.

This study evaluated risk factors for injurious and noninjurious slips, trips, and falls among painters and investigated the hypothesis that exposure to solvents influenced the risk of such accidents. The data were collected longitudinally over an 11 month period. Weekly self-administered questionnaires detailed paint solvent exposure; work-related slips, trips, and falls (STFs); and potentially hazardous job tasks and environmental conditions. An initial questionnaire ascertained personal data, such as age, solvent exposure history, and alcohol consumption. During the study, 2,088 person-weeks of data were collected. Some participants provided many weeks of data, while others responded sporadically. Exposure to potentially hazardous environmental conditions was significantly related to the occurrence of STFs during a week. Several measures of solvent exposure were evaluated for their effect on STFs. Low solvent exposure during a week significantly increased the occurrence of slips, trips, and falls compared to no exposure. Moderate and high weekly exposure were not associated with increased risk, however. Week-to-week variability in the amount of solvent exposure was a strong positive predictor of STFs. Further analysis showed that both increases and decreases in solvent exposure between the preceding 2 weeks and the week of the STF were positively related to the risk of such events. The strongest effect was observed for exposure increases over the preceding 2 weeks. Overall, the results suggest that solvent exposure variability may increase accident risk, and possible explanations are explored.

Community interventions are increasingly recognized as an effective method for reaching individuals in need of health behavior change. We present our experience in developing and implementing an intervention to increase Pap test screening in an inner-city community with a high rate of cervical cancer mortality. Results of a baseline needs assessment survey showed that: almost one-half of the population was inadequately screened; 66 percent of inadequately screened women reported belonging to a church; and, a significant proportion of those who tended to rely on the physician for screening did not receive adequate testing. These results formed the basis of our community intervention strategy: lay peer educators, recruited predominantly from churches, were trained to motivate inadequately screened women to actively seek testing. The implementation of the intervention was flexible and responsive to insights gained in the field and process evaluation data. Recommendations for future community-based interventions are offered.

The association between weight, physical activity, and stress and variation in the length of the menstrual cycle was prospectively examined in 166 college women, aged 17-19 years, who kept menstrual diaries during their freshman year. The unadjusted probability of a menstrual cycle being longer than 43 days was 5%. Women with a history of long cycles were more likely to have a long cycle during the study (odds ratio (OR) = 4.3). Stressors, characterized by situations which create a demand for performance or require adjustments to new demands, also increased the risk of a long cycle. Odds ratios for gain events and for coping with multiple performance demands (2 vs. 0) were 1.9. Starting college increased the risk of long cycles (OR = 2.3) regardless of whether a woman had left home. Moderate exercise minimally increased the probability of a long cycle (OR = 1.1, 75th vs. 50th percentiles). Change in weight (OR = 1.9) and being overweight (OR = 1.2, 15% above standard weight for height) were independently associated with the probability of long cycles. When 17- to 43-day cycles were evaluated, a history of long cycles lengthened expected cycle length by 1.42 days, while dieting, living on campus, and starting college tended to shorten expected length by 1.38, 0.90, and 0.64 days, respectively. Further investigation of the biologic mechanisms that mediate the stress effect is warranted.

It has long been known that the risks of some cancers, including endometrial, are associated with obesity. Recent evidence suggests that body fat distribution patterns also affect the risk of developing some diseases. A question that remains is whether cancers are associated with specific distributions of body fat. In this study, women with endometrial cancer were compared to community controls of similar age and race. Participants were interviewed and then measured to determine fat distribution patterns defined by the waist-to-hip circumference ratio. Women with upper body fat distribution had a 3.2-fold (95% confidence limits 1.2, 8.9) higher risk of endometrial cancer than women with lower body fat distribution even with correction for age, parity, and smoking. Obese women with an upper body fat pattern had a 5.8-fold (confidence limits 1.7, 19.9) higher risk of endometrial cancer than nonobese/lower body fat patterned women. Obese women who never smoked had a 3.3-fold statistically significant higher risk of endometrial cancer than nonobese women who never smoked. Current smokers had lower risks than their nonsmoking counterparts. The 3-fold increased risk of endometrial cancer associated with upper body fat did not disappear with adjustment for obesity and smoking.

This study investigated the relationships between health care utilization, knowledge, attitudes, sociodemographic characteristics, and adequacy of cervical cancer screening among a random sample of women from inner-city neighborhoods with high rates of cervical cancer mortality. Of 416 women interviewed, 30.3% reported hysterectomies; women with intact uteri (N = 290) are the subjects of this analysis. Over two-fifths (44.1%) reported not receiving adequate Pap testing during the previous 4 years. Compared with adequately screened women, they were more likely to be 45 years or older, have no medical insurance, report never having been to an obstetrician-gynecologist, recall never having been told by a medical provider how often to get a Pap test, rely on providers for adequate screening, report not seeking care as often as they think they should, have less knowledge of risk factors for cervical cancer, and believe that women should get Pap tests less than yearly. Separate models for younger and older women showed that these factors vary by age, demonstrating the need for interventions to be sensitive to age subgroups. These findings suggest that cancer control activities should place more emphasis on motivating women as well as influencing the health care delivery system to maximize reductions in cervical cancer.

A cohort of 12,110 male workers employed 1 or more years in eight styrene-butadiene polymer (SBR) manufacturing plants in the United States and Canada has been followed for mortality over a 40-year period, 1943 to 1982. The all-cause mortality of these workers was low [standardized mortality ratio (SMR) = 0.81] compared to that of the general population. However, some specific sites of cancers had SMRs that exceeded 1.00. These sites were then examined by major work divisions. The sites of interest included leukemia and non-Hodgkin's lymphoma in whites. The SMRs for cancers of the digestive tract were higher than expected, especially esophageal cancer in whites and stomach cancer in blacks. The SMR for arteriosclerotic heart disease in black workers was significantly higher than would be expected based on general population rates. Employees were assigned to a work area based on job longest held. The SMRs for specific diseases differed by work area. Production workers showed increased SMRs for hematologic neoplasms and maintenance workers, for digestive cancers. A significant excess SMR for arteriosclerotic heart disease occurred only in black maintenance workers, although excess mortality from this disease occurred in blacks regardless of where they worked the longest. A significant excess SMR for rheumatic heart disease was associated with work in the combined, all-other work areas. For many causes of death, there were significant deficits in the SMRs.

The cohort mortality experience of radiologists and other specialists over a 50-year period was examined on the assumption that these groups would differ relative to a presumed decrease in radiation exposure. Radiologists had an excess in all-cause mortality rates compared to the other specialists for all cohorts who entered the Radiological Society of North America before 1940; the excess remained even when the cancer deaths were removed from the rates. These data are consistent with the concept of accelerated aging due to radiation. The cancer mortality rates for radiologists were higher than those of other specialists for an additional decade through 1949. The 1950-1959 cohort had not aged sufficiently to demonstrate the expected peak cancer mortality in the 60-64 year age group. Several hypotheses are presented to suggest reasons for differences in the trends of age-specific cancer mortality by cohorts of entry.

A total of 13,920 males who had worked in eight styrene-butadiene rubber polymer manufacturing plants in the US and Canada for at least 1 year were followed for deaths from 1943 when the industry began to 1979. Mortality ratios standardized for age, race, and calendar time using US male rates as a comparison revealed no excess mortality in this population for any cause of death. The overall standardized mortality ratio (SMR) for all causes was 0.81. Only the SMR for arteriosclerotic heart disease among black males showed a significant excess (SMR = 1.28). Examination of risks by major work areas such as production, utilities, maintenance, and other jobs, as well as by salaried and hourly pay grade, revealed no significant differences in cancer mortality by specific sites. Because the ratios for selected digestive cancers were above the all-cause SMR, this group of neoplasms is under further investigation as is the exposure profile of specific jobs within the industry.

An evaluation of the effectiveness of a screening program using the Phono Cardio Scan to detect heart disease in 18,872 Baltimore (Meryland) elementary school children indicated that few cases were discovered and only one child medical treatment instituted as a result of the program. Most of the children referred to a cardiologist had known disease. There was considerable variability in performance both of the machine and of the three center which were involved in the program. The sensitivity of the machine may have been low as reported in some other studies.

The ability of subjects to recall their year of hire, year of termination, and job title was studied by comparing reported information to that recorded in personnel records. Former shipyard workers were interviewed in 1982. A majority was first employed in one of two shipyards during the early 1940s and 1950s. kappa statistics and crude and adjusted measures of percent agreement were derived to determine whether reported work history agreed with what was recorded in the subjects' personnel record and to determine whether recall was associated with race, age of the respondent at the time of interview, years since leaving the yard, length of employment, and year of hire. After adjusting for other covariates, only the number of years since leaving the yard was associated with recall of year of hire and termination, but not job title. In addition, however, there were several other noteworthy findings. Individuals who were 65-69 years of age at the time of interview had the poorest recall. Recall of both the year of hire and the job title appears to improve with increasing length of employment.

Patients with acute viral hepatitis were identified at five hospitals in Baltimore, Maryland between February 1979-August 1980. Of the 295 patients with serologically diagnosed hepatitis, 42% had non-A, non-B hepatitis; 48% had hepatitis B; and 10% had hepatitis A. Compared with matched control patients with no liver disease, patients with non-A, non-B hepatitis more often had received a blood transfusion (11% vs. O, P less than 0.001), used parenteral drugs (42% vs. 4%, P less than 0.001), were employed as health workers in direct patient care or hospital laboratory work (6% vs. 3%, P less than 0.05), had personal contact with others who had hepatitis (16% vs. 1%, P less than 0.001), or had ingested raw shellfish (34% vs. 20%, P less than 0.01). A history of previous clinical hepatitis and serologic markers indicating previous hepatitis B infection were found in patients with non-A, non-B hepatitis more often than in the control patients. Chronic non-A, non-B hepatitis was found in 34 (42.5%) of 80 patients with non-A, non-B hepatitis.

Eighteen to 35 years after admission to a clinic for the prevention of deafness, no increased overall cancer risk could be detected among 904 persons who had been treated with nasopharyngeal radium irradiation when compared with the risk among 2,021 persons who were either treated surgically or not treated at all, although there were differences at specific sites. An increased risk of developing both benign and malignant head and neck tumors was found among irradiated persons. Whereas no one head and neck site showed a statistically significant excess, a slight excess of brain cancer occurred 15-20 years after radium treatment. No increase in thyroid cancer risk was observed, a result possibly attributable to the low radiation doses to this organ, and the relatively small population irradiated.

Exogenous female sex hormone exposure was studied in the mothers of 110 infants with conotruncal malformations of the heart, born in the years 1972-75. Cases were ascertained throughout the referral area of the Maryland State Intensive Care Neonatal Program. For each case, three normal controls were chosen from the birth population: Two matched on eight characteristics related to the likelihood of hormone-taking (race, maternal age, parity, fetal losses, gestational age, delivery mode, time of prenatal registration, private/service), and one also on the infant's sex and birthweight; the third control was chosen at random. In personal interviews, information was obtained on the mother's general health, family history, reproductive characteristics, pregnancy health, and environmental exposures. Identification of hormonal products was aided by a display of pills and packages. Maternal recall was examined in comparison to the responses of a group of mothers of infants with hypoplastic left heart ("disease controls"). Regression analysis on time elapsed since the infant's birth revealed no difference in recall between the mothers of cases and of controls. Multilogistic regression analysis, controlling for confounding variables and for scores constructed for reproductive, malformation, and exposure risks, showed no increase in relative risk for cases when compared with matched controls. When compared to random controls, the analysis suggested a possible increase in relative risk with increased environmental exposure scores; components of the risk score were excess smoking and alcohol intake, exposure to X-ray, drugs, paints, insecticides, and chemicals. The possible significance of this finding needs to be further investigated.

We investigated the use of analgesics containing phenacetin or acetaminophen in 173 young women with urinary bladder cancer and 173 matched controls. The cases, who were 20 to 49 years old at the time of diagnosis of cancer, were 6.5 times more likely to report regular use of analgesics containing phenacetin at least one year before diagnosis than were their matched controls (odds ratio, 6.5; 95 per cent confidence interval, 1.5 to 59.2). Among the 15 women (13 cases and 2 controls) reporting regular use of phenacetin-containing drugs, 8 of the cases and 1 of the controls reported daily use for over one year (P = 0.04). Excessive use of analgesics containing acetaminophen was not reported. The increased risk of bladder cancer in young women who regularly used phenacetin-containing products remained present after adjustments for all other identified risk factors.

A study was conducted among 13,844 members of a meat-cutter's union, from July 1949 to December 1980, to examine cancer occurrence in the meat industry. Separate analyses were carried out for the whole group, and for subgroups defined by job-categories characteristic of the industry, including a control group. Mortality was compared with that of the United States through the estimation of standardized mortality ratios (SMR) and proportional mortality ratios. A statistically significant proportional mortality ratio of 2.9 was obtained for Hodgkin's disease among abattoir workers; the SMR of 2.2 was not significant. Among meat-packing plant workers, highly statistically significant SMRs were recorded for bone cancer, SMR = 9.6; cancer of the buccal cavity and pharynx, SMR = 3.4; and lung cancer, SMR = 1.9. The role of oncogenic viruses and other carcinogenic exposures was investigated.

A follow up study of 7261 white women from a meatcutters' union was conducted between July 1949 and December 1980. Proportional mortality ratio (PMR) and standardised mortality ratio (SMR) analyses, using the United States general population mortality rates, were conducted for the group as a whole and for subgroups defined according to the four main job categories in the meat industry, and a fifth category of workers from outside the industry but belonging to the same union (control group). At least a threefold risk of death was observed both for myeloid leukaemia and non-Hodgkin's lymphomas among workers in the meat department of retail food stores. No excess risk from these diseases was observed in the control group. SMRs of 4.56, 4.02, and 1.95, which were statistically significant, were observed for lung cancer among workers in chicken slaughtering plants, meatpacking plants, and retail food stores respectively. The lung cancer SMR for abattoir workers was 1.41 (not significant) and 1.11 for workers in non-meat companies. The role of potentially harmful exposures within the industry in the occurrence of these excesses is discussed.

A method for estimating year of birth using only Social Security number is described. The method relies on estimating the year of issue of the Social Security number, using either precise information from a Social Security Administration table (for numbers issued since 1950) or extrapolation (for numbers issued before 1951). Age at issue was estimated using data from individuals in an occupationally defined population for whom both birth date and Social Security number were known. Year of birth is then year of issue minus age at issue. A highly statistically significant correlation of 0.91 for known vs. estimated year of birth was observed. Predictions correct within +/- 5 years were achieved for 78 per cent of the entire study population. For individuals born after approximately 1934, predictions within +/- 5 years of the correct year were achieved 95 per cent of the time, and within +/- 2 years 77 per cent of the time. The method may be useful in epidemiologic research in situations in which date of birth is missing. Some applications are discussed.

The exact risk of multiple primary neoplasms in patients with salivary gland or thyroid gland malignancies is difficult to ascertain from the data available in the literature. This study examines, retrospectively, 198 patients with a first malignancy of the salivary gland and 186 patients with a first malignancy of the thyroid gland, treated over a 10-year period. Fourteen cases of second tumors were found in the first group and 29 cases in the latter. Patients whose second neoplasm was a skin cancer or who had a previous neoplasm at a site other than those selected for study were excluded. The risk of a second tumor compared to the expected number of second cancers from the Combined National Cancer Institute Registry Data, and the results indicated an increased risk in males with a first malignancy of the salivary gland and in both men and women with a first thyroid malignancy. The salivary glands, larynx, and colon were the most common sites of second tumors after a first salivary cancer. The adrenals, brain, lymphatic system, and breast were the most common site after a first thyroid cancer. The previously reported association of cancers of the thyroid and the breast in females is confirmed here in men and women. The excess of brain tumors and lymphomas has not been reported previously.

The cohort mortality experience of radiologists over a 50-year period has been compared to that of other specialists with low levels of radiation exposure. The 1920-1929 cohort of radiologists who joined the Radiological Society of North America had the highest mortality for several chronic diseases. After this early period, radiologists ranked highest only for cancer mortality. The excess risk of leukemia which was observed in the 1920-1929 and 1930-1939 cohorts has subsequently decreased. During the same period, lymphoma mortality, especially multiple myeloma, has been increasing with a significant excess of deaths appearing in radiologists who entered the specialty society between 1930-1939 and 1940-1949. A posible relationship between this finding and immunologic changes induced by radiation has been proposed.