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Nonparticipants in general population health surveys have been found to be less healthy than participants, but data on nonparticipants in work-site health surveys have been more scarce. We compared cause-specific mortality among 11 156 male employees of The Dow Chemical Company who participated in at least one work-site health examination between 1967 and 1978 with 6915 employees who did not participate. The nonparticipants experienced higher mortality rates for nearly every cause of death examined but particularly from smoking and alcohol-abuse related diseases. This was especially true during the first 5 years of follow-up, suggesting that some employees do not participate because they are already ill. These findings have important implications for the use of examination data for both primary and secondary disease prevention purposes, and these are discussed.

Recognizing the importance of early detection of breast cancer, the Dow Chemical Company initiated a breast cancer awareness program in 1988. Evaluation of operational aspects of mammography screening component revealed that about half (53) of 1186 eligible women in the evaluation cohort took part, although participation was three times higher for active than for retired employees. Eleven per cent of participants were considered to have “positive” screens, ie, had roentgenogram films with suspicious areas, and at least 82 of these women had follow-up medical services within 1 year of screening, as determined by a review of group insurance claims records. Two women with positive mammograms were subsequently diagnosed and treated for breast cancer within 2 months of screening. None of the women with negative mammograms developed breast cancer in the subsequent year. The suitability of group insurance data resources for responding to health care delivery questions is discussed.

This study provided 2 additional years of follow-up through 1984 for a previously studied cohort of 2192 employees potentially exposed to chlorinated dioxins. A separate analysis was done of the subgroup of 323 workers who had chloracne. No clear evidence was found for a causal association between any cause of death and potential occupational exposures to the higher chlorinated phenols, derivative products, or the chlorinated dioxins. Particular focus was directed at mortality from cancers of the stomach, liver, connective and other soft tissue, nasal and nasopharynx, and the lymphomas. Analyses by various indices of exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin and hexa- to octachlorinated dioxins did not show deaths from these cancers to have been disproportionately distributed among the workers considered to have had the highest exposures.