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Objective: To describe the prevalence of tobacco use among a nationally representative sample of college students with disabilities. Participants: Analyses were conducted on a sample of 6189 college students. Methods: Data from the 2017 National Survey on Drug Use and Health were analyzed for ever use, past-month, past-year use of tobacco products, and nicotine dependence. Regression models were conducted to examine the association between tobacco use and disability. Results: Prevalence of tobacco use was higher for students with disabilities. Odds of current tobacco use were higher for students with disabilities (adjusted odds ratio = 1.77) compared to those without disabilities. Students with disabilities also had greater odds of nicotine dependence. Conclusions: The prevalence of tobacco use and nicotine dependence was higher among students with disabilities compared to nondisabled students. As more students with disabilities enroll in postsecondary institutions, services must be provided to these students who are at increased risk for tobacco use.

There is a dearth of medical literature that characterizes the experience of correctional health care workers (HCWs) during the COVID-19 pandemic. We performed a retrospective chart review of the results of an ongoing universal SARS-CoV-2 testing program for New Jersey correctional system HCWs and describe their presenting symptoms, perceived exposure, and demographic characteristics during the initial (March 15, 2020, to August 31, 2020) and Omicron (March 1, 2022, to August 31, 2022) COVID-19 surges. Analysis included 123 eligible records. In both surges, nurses had a high proportion of infections and cough was the most commonly reported symptom. Fever was more than twice as commonly reported in the initial surge. During the Omicron surge, nasal symptoms predominated (39.5% [95% CI: 28.4–51.4]) compared with the initial surge (8.5% [95% CI: 2.4–20.4]). Perceived exposure source was predominantly work related during the initial surge and multiple other sources of exposure were identified during the Omicron surge. Ninety-six percent of HCWs received a COVID-19 booster shot by February 2022. The reinfection rate was less than 10% for our initial cohort. Presenting symptoms correlated with the circulating variant. Mass vaccination of staff, the lower virulence of the Omicron variant, and possibly prior infection likely contributed to the milder illness experienced during the Omicron surge. [ABSTRACT FROM AUTHOR]

Background: Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two‐thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence‐based screening recommendations and evaluated factors influencing screening. Methods: We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines. Results: For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices. Conclusion: This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps. [ABSTRACT FROM AUTHOR]

Prostate cancer is the leading incident cancer among men in the United States. Firefighters are diagnosed with this disease at a rate 1.21 times higher than the average population. This increased risk may result from occupational exposures to many toxicants, including per‐ and polyfluoroalkyl substances (PFAS). This study assessed the association between firefighting as an occupation in general or PFAS serum levels, with DNA methylation. Only genomic regions previously linked to prostate cancer risk were selected for analysis: GSTP1, Alu repetitive elements, and the 8q24 chromosomal region. There were 444 male firefighters included in this study, with some analyses being conducted on fewer participants due to missingness. Statistical models were used to test associations between exposures and DNA methylation at CpG sites in the selected genomic regions. Exposure variables included proxies of cumulative firefighting exposures (incumbent versus academy status and years of firefighting experience) and biomarkers of PFAS exposures (serum concentrations of 9 PFAS). Proxies of cumulative exposures were associated with DNA methylation at 15 CpG sites and one region located within FAM83A (q‐value <0.1). SbPFOA was associated with 19 CpG sites (q < 0.1), but due to low detection rates, this PFAS was modeled as detected versus not detected in serum. Overall, there is evidence that firefighting experience is associated with differential DNA methylation in prostate cancer risk loci, but this study did not find evidence that these differences are due to PFAS exposures specifically. [ABSTRACT FROM AUTHOR]

Epigenetic changes may be biomarkers of health. Epigenetic age acceleration (EAA), the discrepancy between epigenetic age measured via epigenetic clocks and chronological age, is associated with morbidity and mortality. However, the intersection of epigenetic clocks with microRNAs (miRNAs) and corresponding miRNA-based health implications have not been evaluated. We analyzed DNA methylation and miRNA profiles from blood sampled among 332 individuals enrolled across 2 U.S.-based firefighter occupational studies (2015-2018 and 2018-2020). We considered 7 measures of EAA in leukocytes (PhenoAge, GrimAge, Horvath, skin-blood, and Hannum epigenetic clocks, and extrinsic and intrinsic epigenetic age acceleration). We identified miRNAs associated with EAA using individual linear regression models, adjusted for sex, race/ethnicity, chronological age, and cell type estimates, and investigated downstream effects of associated miRNAs with miRNA enrichment analyses and genomic annotations. On average, participants were 38 years old, 88% male, and 75% non-Hispanic white. We identified 183 of 798 miRNAs associated with EAA (FDR q < 0.05); 126 with PhenoAge, 59 with GrimAge, 1 with Horvath, and 1 with the skin-blood clock. Among miRNAs associated with Horvath and GrimAge, there were 61 significantly enriched disease annotations including age-related metabolic and cardiovascular conditions and several cancers. Enriched pathways included those related to proteins and protein modification. We identified miRNAs associated with EAA of multiple epigenetic clocks. PhenoAge had more associations with individual miRNAs, but GrimAge and Horvath had greater implications for miRNA-associated pathways. Understanding the relationship between these epigenetic markers could contribute to our understanding of the molecular underpinnings of aging and aging-related diseases. [ABSTRACT FROM AUTHOR]

Background: Firefighters have a higher risk of melanoma incidence and mortality compared to the general population. In the United States (US), the National Fire Protection Association recommends all firefighters receive annual skin cancer screening through visual skin examination by a clinician. However, there is limited information on skin cancer screening practices among volunteer firefighters who comprise two‐thirds of the US fire service. Methods: This cross‐sectional study of 552 US volunteer firefighters estimated the prevalence of skin cancer screening and evaluated associations with their fire service experience, demographics, sun protection practices, and cancer risk perception. Results: The prevalence of receiving skin cancer screening among volunteer firefighters was 26.1% (95% confidence interval [CI]: 22.4, 29.8). The odds of being screened for skin cancer, compared to not being screened, were twice as high for firefighters who used sunscreen (odds ratio [OR]: 2.35, 95% CI: 1.48, 3.73) and who perceived their skin likely to burn with prolonged sun exposure (OR: 1.81, 95% CI: 1.10, 3.00). Older age, some college education, and family history of skin cancer were also positively associated with skin cancer screening. A positive exposure‐response relationship was observed between more monthly firefighting calls and receiving screening. Cancer risk perception was not associated with screening. Conclusion: To our knowledge, this is the first large study to assess skin cancer screening among US volunteer firefighters. Our findings suggest gaps in skin cancer prevention efforts in the volunteer fire service. Additional assessment of skin cancer prevention practices within volunteer fire departments could help address these gaps. [ABSTRACT FROM AUTHOR]

Background: Firefighters have occupational and environmental exposures to per‐ and polyfluoroalkyl substances (PFAS). The goal of this study was to compare serum PFAS concentrations across multiple United States fire departments to National Health and Nutrition Examination Survey (NHANES) participants. Methods: Nine serum PFAS were compared in 290 firefighters from four municipal fire departments (coded A–D) and three NHANES participants matched to each firefighter on sex, ethnicity, age, and PFAS collection year. Only Departments A and C had sufficient women study participants (25 and six, respectively) to compare with NHANES. Results: In male firefighters compared with NHANES, geometric mean perfluorohexane sulfonate (PFHxS) was elevated in Departments A–C, sum of branched perfluoromethylheptane sulfonate isomers (Sm‐PFOS) was elevated in all four departments, linear perfluorooctane sulfonate (n‐PFOS) was elevated in Departments B and C, linear perfluorooctanoate (n‐PFOA) was elevated in Departments B–D, and perfluorononanoate (PFNA) was elevated in Departments B–D, but lower in A. In male firefighters compared with NHANES, perfluoroundecanoate (PFUnDA) was more frequently detected in Departments B and D, and 2‐(N‐methyl‐perfluorooctane sulfonamido) acetate (MeFOSAA) was less frequently detected in Departments B–D. In female firefighters compared with NHANES, PFHxS and Sm‐PFOS concentrations were elevated in Departments A and C. Other PFAS concentrations were elevated and/or reduced in only one department or not significantly different from NHANES in any department. Conclusions: Serum PFHxS, Sm‐PFOS, n‐PFOS, n‐PFOA, and PFNA concentrations were increased in at least two of four fire departments in comparison to NHANES. [ABSTRACT FROM AUTHOR]

We collaborated with Maine American Indian tribes to evaluate racial coding on death certificates and the effects of coding errors on estimation of cardiovascular disease (CVD) mortality. Lists of tribal decedents were matched to death certificates; 38.5% were misclassified (17.8% coding errors; 20.7% data entry errors). After errors were corrected, CVD mortality trends were similar between American Indians and all Maine residents. Racial misclassification occurred during a period when budget cuts had prompted procedural changes. doi:10.2105/AJPH.2004.053751)

The purpose of this qualitative study was twofold. First, we identified post-fire suppression contamination control procedures used in 10 New Jersey volunteer fire departments. These decontamination (decon) procedures remove hazardous contaminants from firefighters' gear and equipment (see Burgess et al., 2020; Fent et al., 2017; Fent et al., 2020), Second, we determined the challenges these 10 departments faced in implementing the decon best practices recommended by NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting and several academic studies. Data was gathered using semi-structured telephone interviews with a member of the leadership team in each of the 10 New Jersey volunteer departments. Thematic analysis of these interviews revealed significant variation in the post-fire suppression contamination control practices implemented by the 10 departments. Although the interview participants were highly aware of the health risks that firefighters face and the importance of decon control measures, many departments did not implement the recommended best practices. Financial and time constraints were identified as significant challenges to implementing comprehensive decontamination control procedures. [ABSTRACT FROM AUTHOR]

Objectives: Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case-control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC.Methods: We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression.Results: Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not.Conclusions: These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population. [ABSTRACT FROM AUTHOR]

The World Trade Center (WTC) attacks exposed rescue and recovery workers to a complex mix of toxicants, including carcinogens. our study compared site‐specific cancer incidence of head and neck cancers (HNC) from 2003 through 2012 among 33,809 consented WTC General Responder Cohort (GRC) members to the New Jersey State Cancer Registry, using standardized incidence ratios (SIRs). HNC grouped using SEER ICD‐O‐3 codes into HPV‐related (oropharyngeal) and non‐related (other oral‐nasal; laryngeal) tumors based on anatomical site. For the 73 GRC members identified with HNC, proportional hazard regression assessed the relationship between WTC exposure and other socio‐demographic characteristics. An overall excess of HNC was not observed (SIR = 1.00, 95% CI: 0.78, 1.25) but excess cancer was seen in the latest observation period (2009–2012: SIR = 1.4; 95% CI: 1.01, 1.89). A similar temporal pattern was seen for HPV‐related oropharyngeal cancer and laryngeal cancer, but not for non‐HPV‐related sites (oral‐nasal cancer). HNC was significantly associated with increasing age (8% per year, 95% CI: 5%, 12%), non‐Hispanic white ethnic group‐ethnicity (hazard ratio (HR) = 3.51, 95 CI: 1.49, 8.27); there was a borderline association with the 9/11 occupation of military/protective services vs. others (HR = 1.83 95% CI: 0.99, 3.38; p = 0.0504). Caution is needed in interpreting these results given the small number of cases, potential for surveillance bias, and long latency for most cancers. Our findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors, and the need for continued medical monitoring of WTC responders. What's new? Persons involved in rescue, recovery, and clean‐up efforts associated with the September 11, 2001, attacks on the World Trade Center (WTC) in New York City were exposed to numerous toxic chemicals. Within a decade of the attacks, excess cancer incidence was detected among individuals in the WTC Health Program General Responder Cohort (WTCHP GRC). The present report now describes a small but significant increase in head and neck cancer (HNC) in the WTCHP GRC, specifically in human papilloma virus (HPV)‐related oropharyngeal cancer and laryngeal cancer. Whether WTC exposures are associated with increased HPV‐related cancer in WTC responders, however, remains unclear. [ABSTRACT FROM AUTHOR]

The German cockroach, Blattella germanica (L.), is a common pest found in apartment buildings. Prevalence of cockroach infestations is affected by both environmental conditions and building occupant behavior, but their relationships are not well studied. The objective of this study was to analyze the presence of German cockroaches in relation to environmental conditions, resident demographics, and residents' tolerance of cockroaches. We conducted resident interviews, placed sticky traps to detect the presence of German cockroaches, and assessed apartment conditions. A total of 388 apartments from seven low-income apartment buildings, occupied by senior citizens in New Jersey, United States, were included. Among the 344 apartments where trap count data were obtained, 30% had German cockroaches. Among interviewed residents whose apartments had existing cockroach infestations, 36% were unaware of the presence of cockroaches. The odds of having cockroaches in apartments with a 'poor' sanitation rating in kitchens and bathrooms was 2.7 times greater than that in apartments with better sanitation conditions. Residents' tolerance to cockroaches is significantly associated with presence of cockroaches and cockroach population size. The median cockroach count when residents were bothered by cockroaches was ≥3, based on deployment of 4 sticky traps per apartment, over a 2-wk period. Assessing and reducing cockroach tolerance thresholds and improving housekeeping through resident education and assistance from community and housing management should be incorporated in future cockroach management programs in order to reduce high cockroach infestation rates found in similar communities. [ABSTRACT FROM AUTHOR]

Background: Published evidence indicates that individual use of metformin and statin is associated with reduced cancer mortality. However, their differential and joint effects on pancreatic cancer survival are inconclusive. Methods: We identified a large population-based cohort of 12,572 patients ages 65 years or older with primary pancreatic ductal adenocarcinoma (PDAC) diagnosed between 2008 and 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Exposure to metformin and statins was ascertained from Medicare Prescription Drug Event files. Cox proportional hazards models with time-varying covariates adjusted for propensity scores were used to assess the association while controlling for potential confounders. Results: Of 12,572 PDAC patients, 950 (7.56%) had used metformin alone, 4,506 (35.84%) had used statin alone, and 2,445 (19.45%) were dual users. Statin use was significantly associated with improved overall survival [HR, 0.94; 95% confidence interval (CI), 0.90-0.98], and survival was more pronounced in postdiagnosis statin users (HR, 0.69; 95% CI, 0.56-0.86). Metformin use was not significantly associated with overall survival (HR, 1.01; 95% CI, 0.94-1.09). No beneficial effect was observed for dual users (HR, 1.00; 95% CI, 0.95-1.05). Conclusions: Our findings suggest potential benefits of statins on improving survival among elderly PDAC patients; further prospective studies are warranted to corroborate the putative benefit of statin therapy in pancreatic cancer. Impact: Although more studies are needed to confirm our findings, our data add to the body of evidence on potential anticancer effects of statins. [ABSTRACT FROM AUTHOR]