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Public health policymakers must make crucial decisions rapidly during a pandemic. In such situations, accurate measurements from health surveys are essential. As a consequence of limited time and resource constraints, it may be infeasible to implement a probability-based sample that yields high response rates. An alternative approach is to select a quota sample from a large pool of volunteers, with the quota sample selection based on the census distributions of available—often demographic—variables, also known as quota variables. In practice, however, census data may only contain a subset of the required predictor variables. Thus, the realized quota sample can be adjusted by propensity score pseudoweighting using a “reference” probability-based survey that contains more predictor variables. Motivated by the SARS-CoV-2 serosurvey (a quota sample conducted in 2020 by the National Institutes of Health), we identify the condition under which the quota variables can be ignored in constructing the propensity model but still produce nearly unbiased estimation of population means. We conduct limited simulations to evaluate the bias and variance reduction properties of alternative weighting strategies for quota sample estimates under three propensity models that account for varying sets of predictors and degrees of correlation among the predictor sets and then apply our findings to the empirical data.

Joinpoint regression can model trends in time-specific estimates from aggregated data. These methods have been developed mainly for nonsurvey data such as cancer registry data assuming that the time-specific estimates are uncorrelated from time point to time point. This independence assumption can be violated for trends in time-specific estimates from complex survey samples due to using the same primary sampling units across time and, therefore, the full variance–covariance matrix of the time-specific estimates should be incorporated into the regression model fitting. This article extends these joinpoint methods for analyzing complex survey data within the National Cancer Institute’s Joinpoint software and empirically compares the extended method to existing methods for analyses of time trends in three surveys.

Background: Little is known about the association of contributors of total water intake with dietary characteristics in US children. Objective: We examined intakes of total water and its contributors and their associations with diet and meal reporting in children and adolescents. Design: Dietary data for children 2-19 y of age (n = 3978) from the National Health and Nutrition Examination Survey 2005-2006 were used to compute usual intake of total water. The association of total water and its contributors with sociodemographic characteristics and dietary and meal attributes was examined by using multiple regression analysis. Results: The adjusted mean intakes of total water in Americans aged 2-5, 6-1l, and 12-19 y were 1.4, 1.6, and 2.4 L, respectively. The mean usual intake of total water was generally less than the Adequate Intake; overall, more boys reported intakes of at least the Adequate Intake. The percentage of total water intake from plain water increased with age. Plain water intake was inversely associated with the intake of beverage moisture and the energy density of foods; conversely, beverage moisture was positively associated with dietary energy, fat, and the energy density of foods. Associations of water contributors with meal patterns (number of eating occasions, reporting of breakfast or snack) were inconsistent across age groups. Nearly 80% of food moisture, >66% of beverage moisture, and [approximately equal to]30% of plain water were reported with main meals. Conclusions: Intake of total water over 24 h from different contributors varied by age. Qualitative differences in dietary intake in association with the amount of plain water and beverage moisture in the recalls were observed. American children and adolescents consumed more than two-thirds of their daily beverages with main meals. Am J Clin Nutr 2010;92:887-96. doi: 10.3945/ajcn.2010.29708.

Background: Body mass index (BMI)--for-age has been recommended as a screening test for excess adiposity in children and adolescents. Objective: We quantified the performance of standard categories of BMI-for-age relative to the population prevalence of high adiposity in children and adolescents overall and by race-ethnic group in a nationally representative US population sample by using definitions of high adiposity that are consistent with expert committee recommendations. Design: Percentage body fat in 8821 children and adolescents aged 8-19 y was measured by using dual-energy X-ray absorptiometry in 1999-2004 as part of a health examination survey. Results: With the use of several different cutoffs for percentage fat to define high adiposity, most children with high BMI-for-age ([greater than or equal to]95th percentile of the growth charts) had high adiposity, and few children with normal BMI-for-age ( Conclusions: Current BMI cutoffs can identify a high prevalence of high adiposity in children with high BMI-for-age and a low prevalence of high adiposity in children with normal BMI-for-age. By these adiposity measures, less than one-half of children with intermediate BMIs-for-age (85th to doi: 10.3945/ajcn.2009.28589.

Background: Estimates of obesity-associated deaths in the United States for 1991 were published by Allison et al (JAMA 1999;282: 1530-8) and subsequently for 2000 by Mokdad et al (JAMA 2004; 291:1238-45). Flegal et al (JAMA 2005;293:1861-7) then published lower estimates of obesity-associated deaths for 2000. All 3 studies incorporated data from the first National Health and Nutrition Examination Survey (NHANES I). Objective: The objective was to clarify the effects of methodologic differences between the 3 studies in estimates of obesity-associated deaths in the US population by using NHANES I hazard ratios. Design: The earlier reports used imputed smoking data for much of the NHANES I sample rather than the available reported data and applied a method of calculating attributable fractions that did not adjust for the effects of age, sex, and smoking on mortality in the target US population and did not account for effect modification by age. The effects of these and other methodologic factors were examined. Results: The NHANES I hazard ratios in the earlier reports were too low, probably because of the imputed smoking data. The low hazard ratios obscured the magnitude and direction of the bias arising from the incompletely adjusted attributable fraction method. When corrected hazard ratios were used, the incompletely adjusted attributable fraction method overestimated obesity-associated mortality in the target population by > 100,000 deaths. Conclusion: Methodologic sources of bias in the reports by Allison et al and Mokdad et al include the assessment of smoking status in NHANES I and the method of calculating attributable fractions. Am J Clin Nutr 2010;91:519-27. doi: 10.3945/ajcn.2009.28222.

Background: There is a surprising paucity of studies that have systematically examined the correlates of water intake in the US population. Objective: The objective was to examine the association of contributors of water intake with dietary characteristics, meal consumption, and body weight in the US population. Design: We used 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 (n = 12,283) and the NHANES 2005-2006 (n = 4112) to examine the independent association of intakes of plain water, beverage moisture, food moisture, and total water with sociodemographic factors, dietary characteristics (energy, nutrients, diet quality, and energy density), and meal patterns (number of eating episodes, mention of breakfast or snack) by using multiple regression methods. Results: In 2005-2006, American adults reported consuming 3.18 L of total water within the previous 24 h (in 1999-2004, estimated total water intake was 3.35 L), with plain water and beverages contributing 33% and 48% of the total, respectively. Plain water intake was unrelated to the intake of energy and body mass index but was positively related to dietary fiber and inversely related to beverages, sugars, and the energy density of foods; these associations were in the opposite direction for beverage moisture intake. Total water intake was inversely related to energy from fat and energy density but positively related to dietary fiber, caffeine, alcohol, and diet quality. The number of eating episodes predicted higher beverage and food moisture and total water intakes. A higher body mass index predicted higher intakes of beverage moisture and total water. Conclusion: Various contributors of total water intake differed in their association with dietary characteristics and body weight in the adult US population.

Background: Estimates of excess mortality associated with body mass index (BMI; in kg/[m.sup.2]) have been calculated for the US population. Objective: The objective of this article is to compare the excess mortality associated with BMI levels to the excess mortality associated with other anthropometric variables. Design: For the 1988-1994 Third National Health and Nutrition Examination Survey, estimates of excess deaths were calculated for standard BMI levels and for comparable levels of percentage body fat, waist circumference, hip and arm circumferences, waist-hip ratio, the sum of 4 skinfold thicknesses, and waist-stature ratio. The outcome measure is the percentage of deaths in the full sample in excess of those predicted for the reference category. Results: For the level equivalent to BMI < 18.5, estimates of excess deaths ranged from 0.3% for waist-hip ratio to 2.4% for percentage body fat. All except waist circumference, waist-hip ratio, and waist-stature ratio were significantly greater than zero (P < 0.05). For the level equivalent to BMI 25 to Conclusion: In this population-based study, attributable fractions of deaths were similar across measures.

Background: Body mass index (BMI), waist circumference (WC), and the waist-stature ratio (WSR) are considered to be possible proxies for adiposity. Objective: The objective was to investigate the relations between BMI, WC, WSR, and percentage body fat (measured by dual-energy X-ray absorptiometry) in adults in a large nationally representative US population sample from the National Health and Nutrition Examination Survey (NHANES). Design: BMI, WC, and WSR were compared with percentage body fat in a sample of 12,901 adults. Results: WC, WSR, and BMI were significantly more correlated with each other than with percentage body fat (P < 0.0001 for all sex-age groups). Percentage body fat tended to be significantly more correlated with WC than with BMI in men but significantly more correlated with BMI than with WC in women (P < 0.0001 except in the oldest age group). WSR tended to be slightly more correlated with percentage body fat than was WC. Percentile values of BMI, WC, and WSR are shown that correspond to percentiles of percentage body fat increments of 5 percentage points. More than 90% of the sample could be categorized to within one category of percentage body fat by each measure. Conclusions: BMI, WC, and WSR perform similarly as indicators of body fatness and are more closely related to each other than with percentage body fat. These variables may be an inaccurate measure of percentage body fat for an individual, but they correspond fairly well overall with percentage body fat within sex-age groups and distinguish categories of percentage body fat.

Background Exposure to endocrine-disrupting chemicals, such as persistent organochlorine pesticides, has been suggested to increase the risk of testicular germ cell tumors (TGCTs). Methods To study the relationship of POP exposure to TGCT risk, prediagnostic serum samples from 754 case subjects and 928 control subjects enrolled in the Servicemen's Testicular Tumor Environmental and Endocrine Determinants Study were analyzed for cis-nonachlor, trans-nonachlor, oxychlordane, total chlordanes, [beta]-hexachlorocyclohexane, mirex, p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), and p,p'-dichlorodiphenyltrichloroethane. Adjusted odds ratios (ORs) and their associated 95% confidence intervals (Cls) for the risk of TGCT overall and for the histological subgroups, seminoma and nonseminoma, were estimated using multivariable logistic regression. All statistical tests were two-sided. Results TGCT risk was statistically significantly associated with higher plasma levels of p,p'-DDE (for highest quartile [Q4] vs lowest quartile [Q1], OR = 1.71, 95% CI = 1.23 to 2.38, [P.sub. trend] = .0002) and of twO chlordane components, cis-nonachlor (Q4 vs Q1, OR = 1.56, 95% CI = 1.11 to 2.18, [P.trend = .009) and trans-nonachlor (Q4 vs Q1, OR = 1.46, 95% CI = 1.07 to 2.00, [P.sub.trend] = .026). Seminoma risk was statistically significantly associated with p,p'-DDE (Q4 vs Q1, OR = 1.91, 95% CI = 1.22 to 2.99, [P.sub. trend] = .0008), cis-nonachlor (Q4 vs Q1, OR = 1.93, 95% CI = 1.27 to 2.93, [P.sub. trend] = .0045), trans-nonachlor (Q4 vs Q1, OR = 1.72, 95% CI = 1.11 to 2.67, [P.sub. trend] = .033), and a chlordane metabolite, oxychlordane (Q4 vs Q1, OR = 1.64, 95% CI = 1.04 to 2.60, Ptrend = .048), whereas nonseminoma risk showed a statistically significant association with p,p'-DDE only (Q4 vs Q1, OR = 1.63, 95% CI = 1.10 to 2.42, [P.sub. trend] = .0044). Conclusions Increased exposure to p,p'-DDE may be associated with the risk of both seminomatous and nonseminomatous TGCTs, whereas exposure to chlordane compounds and metabolites may be associated with the risk of seminoma. Because evidence suggests that TGCT is initiated in very early life, it is possible that exposure to these persistent organic pesticides during fetal life or via breast feeding may increase the risk of TGCT in young men.

Background: Several studies have reported ethnic, education, and income differentials in concentrations of selected nutritional biomarkers in the US population. Although biomarker measurements are not subject to biased self-reports, biologic variability due to individual characteristics and behaviors related to dietary exposures contributes to within-subject variability and measurement error. Objective: We aimed to establish whether the magnitude of components of variance for nutritional biomarkers also differs in these high-risk groups. Design: We used data from 2 replicate measurements of serum concentrations of vitamins A, C, D, and E; folate; carotenoids; ferritin; and selenium in the third National Health and Nutrition Examination Survey second examination subsample (n = 948) to examine the within-subject and between-subject components of variance. We used multivariate regression methods with log-transformed analyte concentrations as outcomes to estimate the ratios of the within-subject to between-subject components of variance by categories of ethnicity, income, and education. Results: In non-Hispanic blacks, the within-subject to between-subject variance ratio for [beta]-cryptoxanthin concentration was higher (0.23; 95% CI: 0.17, 0.29) relative to non-Hispanic whites (0.13; 0.11, 0.16) and Mexican Americans (0.11; 0.07, 0.14), and the lutein + zeaxanthin ratio was higher (0.29; 0.21, 0.38) relative to Mexican Americans (0.15; 0.10, 0.19). Higher income was associated with larger within-subject to between-subject variance ratios for serum vitamin C and red blood cell folate concentrations but smaller ratios for serum vitamin A. Overall, there were few consistent up- or down-trends in the direction of covariate-adjusted variability by ethnicity, income, or education. Conclusion: Population groups at high risk of adverse nutritional profiles did not have larger variance ratios for most of the examined biomarkers.

Background: Research on the association between fruit and vegetable intake and risk of colorectal adenoma is inconclusive. Objective: We studied whether intake of fruit, vegetables, or their subgroups is associated with a lower risk of prevalent colorectal adenoma. Design: In men and women (aged 55-74 y) who were screened for colorectal cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (1993-2001), we compared 3057 cases with at least one prevalent histologically verified adenoma of the distal large bowel with 29 413 control subjects. Using a food-frequency questionnaire, we quantified intake of fruit and vegetables in the 12 mo before screening as energy-adjusted pyramid servings/d (ps/d). Adjusted odds ratios (ORs) and 95% CIs were estimated by logistic regression. Results: Risk of distal adenoma was significantly lower among subjects in high ([approximately equal to] 5.7 ps/d) versus low ([approximately equal to] 1.2 ps/d) quintiles of total fruit intake (OR: 0.75; 95% CI: 0.66, 0.86, P for trend Conclusion: Diets rich in fruit and deep-yellow vegetables, dark-green vegetables, and onions and garlic are modestly associated with reduced risk of colorectal adenoma, a precursor of colorectal cancer. KEY WORDS Fruit, vegetables, epidemiology, colorectal neoplasms, adenoma, diet

Background Vitamin D has been hypothesized to reduce cancer mortality through its effects on incidence and/or survival. Epidemiologic studies of the association of 25-hydroxyvitamin D [25(OH)D] and the risk of cancer, however, have been largely limited to incident cancers at a few sites. Methods A total of 16818 participants in the Third National Health and Nutrition Examination Survey who were 17 years or older at enrollment were followed from 1988-1994 through 2000. Levels of serum 25(OH)D were measured at baseline by radioimmunoassay. Cox proportional hazards regression models were used to examine the relationship between serum 25(OH)D levels and total cancer mortality (in the entire population or according to race/ethnicity, sex, age, and retinol status) and mortality from specific cancers. Because serum was collected in the south in cooler months and the north in warmer months, we examined associations by collection season. All statistical tests were two-sided. Results We identified 536 cancer deaths in 146578 person-years. Total cancer mortality was unrelated to baseline vitamin D status in the entire population, men, women, non-Hispanic whites, non-Hispanic blacks, Mexican Americans, and in persons younger than 70 or 70 years or older. We found no interaction between vitamin D and season or vitamin D and serum retinol. Colorectal cancer mortality was inversely related to serum 25(OH)D level, with levels 80 nmol/L or higher associated with a 72% risk reduction (95% confidence interval = 32% to 89%) compared with lower than 50 nmol/L, [P.sub.trend] = .02. Conclusions Our results do not support an association between 25(OH)D and total cancer mortality, although there was an inverse relationship between 25(OH)D levels and colorectal cancer mortality. J Natl Cancer Inst 2007;99:1594-602

Background: The contributors to trends in increasing prevalence of obesity in the US population are poorly understood. Objective: We examined secular trends in food consumption behaviors to understand their possible contribution to increasing energy intakes and adiposity in the American population. Design: We used dietary data from 4 consecutive National Health and Nutrition Examination Surveys (NHANES) to examine trends (1971-2002) in frequency of eating episodes, meal and snack consumption, quantity of food consumed, and the energy density of foods reported by adult Americans (n = 39 094). Logistic and linear regression methods were used to adjust for multiple covariates and survey design. Results: The reported number of all eating episodes increased slightly in women from 4.90 in 1971-1975 to 5.04 in 1999-2002 (P for trend = 0.002). The amount (in g) of foods and beverages consumed, the energy density of foods, and energy intake per eating episode increased, but the mention of breakfast declined in both sexes (P for trend < 0.0001). The observed trends in mention of a snack (in men) and percentage of energy from evening food intake (in women) were downward. The amount (in g) of foods and their energy density were independent positive correlates of obesity in combined data from all surveys (P for trend < 0.0001). Conclusions: Our results do not support large increases in eating frequency, snacking, or evening eating by the American population from 1971 to 2002. The quantity of foods and their energy density increased beginning in NHANES III (1988-1994) with trajectories roughly parallel to the rates of prevalence of obesity in the US population. However, we urge cautious interpretation of these results because of concurrent changes in dietary methods during this period. KEY WORDS Secular trends, National Health and Nutrition Examination Surveys, NHANES, eating frequency, snack intake, breakfast intake, energy density, evening eating, portion size, energy intake, obesity, body mass index

Background: Dairy intake may increase prostate cancer risk, but whether this is due to calcium's suppression of circulating vitamin D remains unclear. Findings on calcium and vitamin D intake and prostate cancer are inconsistent. Objective: We examined the association of dairy, calcium, and vitamin D intake with prostate cancer. Design: In a prospective study of 3612 men followed from 1982-1984 to 1992 for the first National Health and Nutrition Examination Epidemiologic Follow-up Study, 131 prostate cancer cases were identified. Dietary intake was estimated from questionnaires completed in 1982-1984. Relative risk (RR) and 95% CIs were estimated by using Cox proportional hazards models adjusted for age, race, and other covariates. Results: Compared with men in the lowest tertile for dairy food intake, men in the highest tertile had a relative risk (RR) of 2.2 (95% CI: 1.2, 3.9; trend P = 0.05). Low-fat milk was associated with increased risk (RR = 1.5; 95% CI: 1.1,2.2; third compared with first tertile; trend P = 0.02), but whole milk was not (RR = 0.8; 95% CI: 0.5, 1.3; third compared with first tertile; trend P = 0.35). Dietary calcium was also strongly associated with increased risk (RR = 2.2; 95% CI: 1.4, 3.5; third compared with first tertile; trend P = 0.001). After adjustment for calcium intake, neither vitamin D nor phosphorus was clearly associated with risk. Conclusions: Dairy consumption may increase prostate cancer risk through a calcium-related pathway. Calcium and low-fat milk have been promoted to reduce risk of osteoporosis and colon cancer. Therefore, the mechanisms by which dairy and calcium might increase prostate cancer risk should be clarified and confirmed. KEY WORDS Dairy, diet, calcium, vitamin D, prostatic neoplasms

Background: The National Cancer Institute funded an 8-year, nonrandomized demonstration project for tobacco prevention and control, the American Stop Smoking Intervention Study (ASSIST). To evaluate ASSIST, we compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia. Methods: The strength of tobacco control index was used to measure state-level program elements directed at tobacco control, and the initial outcomes index (IOI) was used to measure states' tobacco control policy outcomes. Prevalence data were obtained from the Tobacco Use Supplement to the Current Population Survey, and consumption data were obtained from the Tobacco Institute's bimonthly sales figures for cigarette packs moved from wholesale warehouses. Two-stage regression and mixed-effects linear modeling were used to analyze the various outcomes. Statistical analyses for testing individual regression coefficients were one-sided. Results: ASSIST states had a greater decrease in adult smoking prevalence than non-ASSIST states, with an adjusted difference of -0.63% (P = .049). Per capita cigarette consumption was not statistically significantly different between ASSIST and non-ASSIST states. However, an increase in the IOI of a state from the 25th to the 75th percentile was associated with a reduction in per capita cigarette consumption by 0.57 packs per person per month. State IOI was also inversely, albeit not statistically significantly, associated with smoking prevalence (regression coefficient = -0.11; P = .06). Conclusions: The reduction in adult smoking prevalence associated with ASSIST could have translated into approximately 278 700 fewer smokers nationwide if all states had implemented ASSIST. Investment in building state-level tobacco control capacity and promoting changes in tobacco control policies are effective strategies for reducing tobacco use.

Background: The Breast Cancer Prevention Trial demonstrated that tamoxifen treatment produced a 49% reduction in the risk of invasive breast cancer among women at elevated risk for the disease. The U.S. Food and Drug Administration (FDA) subsequently approved tamoxifen for women aged 35 years or older with a 5-year breast cancer risk of 1.67% or higher for breast cancer chemoprevention. However, tamoxifen use has been associated with adverse outcomes, and not all eligible women have a positive benefit/risk ratio. Methods: We used weighted data from the year 2000 National Health Interview Survey Cancer Control Module to estimate the total number of U.S. women, aged 35-79 years, who were eligible for tamoxifen chemoprevention based on the FDA eligibility criteria. We also estimated the numbers of white and black women who would benefit from tamoxifen chemoprevention on the basis of a positive benefit/risk index developed by Gail et al. Results: Of the 65 826 074 women aged 35-79 years without reported breast cancer in the United States in 2000, 10 232 816 women (15.5%, 95% confidence interval [CI] = 14.7% to 16.3%) would be eligible for tamoxifen chemoprevention. The percentage of U.S. women who would be eligible varied dramatically by race, with 18.7% (95% CI = 17.8% to 19.7%) of white women, 5.7% (95% CI = 4.3% to 7.5%) of black women, and 2.9% (95% CI = 2.1% to 3.9%) of Hispanic women being eligible. Of the 50 104 829 white U.S. women aged 35-79 years, 2431911 (4.9%, 95% CI = 4.3% to 5.4%) would have a positive benefit/risk index for tamoxifen chemoprevention. Of the 7 481 779 black U.S. women aged 35-79 years, only 42 768 (0.6%, 95% CI = 0.2% to 1.3%) would have a positive benefit/risk index. Among white women, 28492 (95% CI = 24 693 to 32 292) breast cancers would be prevented or deferred if those women who have a positive net benefit index took tamoxifen over the next 5 years. Conclusion: A substantial percentage of U.S. women would be eligible for tamoxifen chemoprevention according to FDA criteria, but a much smaller percentage would have an estimated net benefit. Nevertheless, this latter percentage corresponds to more than two million women.

Background: Dietary pattern analysis is a unique approach to studying relations between diet and disease. Objective: Our objective was to describe the dietary patterns of an eastern Nebraska population and investigate the associations between those dietary patterns and risks of adenocarcinoma of the esophagus and distal stomach. Design: We recruited 124 subjects with esophageal adenocarcinoma, 124 subjects with distal stomach adenocarcinoma, and 449 control subjects in a population-based, case-control study. Results: Six dietary patterns were identified with the use of cluster analysis. The first dietary pattern represented healthy food choices and had higher energy contributions from fruit and vegetables and grain products and lower energy contributions from red meats, processed meats, and gravy than did the other dietary patterns. In contrast, a second dietary pattern was high in meats and low in fruit and cereals. The other 4 dietary patterns were each characterized by a concentrated energy source: salty snacks, desserts, milk, and white bread, respectively. The test of overall difference in cancer risk across dietary patterns was significant for distal stomach adenocarcinoma (P = 0.04) but not for esophageal adenocarcinoma. Risk of esophageal adenocarcinoma was inversely associated with intakes of dairy products, fish, all vegetables, citrus fruit and juices, and dark bread and was positively associated with gravy intake. Risk of distal stomach adenocarcinoma was positively associated with red meat intake. Conclusions: Our study suggests that a diet high in fruit and vegetables may decrease the risk of esophageal adenocarcinoma and that a diet high in meats may increase the risk of distal stomach adenocarcinoma. Am J Clin Nutr 2002;75:137-44. KEY WORDS Esophagus, stomach, neoplasm, dietary pattern, cluster analysis, cancer

Misclassified frame records (also called stratum jumpers) and low response rates are characteristic for business surveys. In the context of estimation of the domain parameters, jumpers may contribute to extreme variation in sample weights and skewed sampling distributions of the estimators, especially for domains with a small number of observations. There is limited literature about the extent to which these problems may affect the performance of the ratio estimators with nonresponse-adjusted weights. To address this gap, we designed a simulation study to explore the properties of the Horvitz-Thompson type ratio estimators, with and without smoothing of the weights, under different scenarios. The ratio estimator with propensity-adjusted weights showed satisfactory performance in all scenarios with a high response rate. For scenarios with a low response rate, the performance of this estimator improved with an increase in the proportion of jumpers in the domain. The smoothed estimators that we studied performed well in scenarios with non-informative weights, but can become markedly biased when the weights are informative, irrespective of response rate. We also studied the performance of the ’doubled half’ bootstrap method for variance estimation. We illustrated an application of the methods in a real business survey.

Because premenopausal women experience cyclic fluctuations of plasma carotenoids and their lipoprotein carriers, it is hypothesized that carotenoid concentrations in lipoprotein fractions fluctuate by phase of the menstrual cycle. Nine women ate a standard set of carotenoid-rich foods daily for two cycles under isoenergetic conditions. In the second cycle, hormones and carotenoids in lipoprotein fractions were measured in the early and late follicular and luteal phases. ([Alpha]-Carotene concentrations in the LDL fraction were lower in the early than in the late follicular phase (P = 0.03) on the basis of regression analysis. [Beta]-carotene concentrations in the LDL fraction and the [HDL.sub.2] subfraction were higher in the late follicular than in the luteal phase (P = 0.02 and P = 0.04, respectively). Lutein/zeaxanthin concentrations in the LDL and HDL fractions were higher in the late follicular than in the luteal phase (P = 0.03 and P = 0.02, respectively). In each phase, 80% of [Alpha]-carotene, 82% of [Beta]-carotene, 85% of lycopene, and 64% of lutein/zeaxanthin were distributed in the LDL fraction. Among the hydrocarbon cartenoids, 18% of [Alpha]-carotene and of [Beta]-carotene and 13% of lycopene were distributed in the HDL fraction, with slightly more in the [HDL.sub.2] than in the [HDL.sub.3] subfraction. In contrast 34% of lutein/zeaxanthin was distributed in the HDL fraction with more concentrated in the [HDL.sub.3].than in the [HDL.sub.2] subfraction. Less than 4% of any carotenoid was found in the VLDL+IDL (intermediate-density-lipoprotein) fractions. Thus, the hydrocarbon carotenoids were highly concentrated in the LDL fraction and xanthophyll was more evenly distributed in the LDL and HDL fractions. The cyclic fluctuations of these carotenoids in lipoprotein fractions add another dimension to the understanding of their transport and physiologic function. Am J Clin Nutr 1998;67:81-7.

Relations between maternal anthropometric status during pregnancy and infant feeding practices and growth from birth through the first 6 mo of life were examined in a cohort of 351 Israeli mother-infant pairs of North African descent. Maternal weight, height, and triceps skinfold thicknesses were determined at 6 and 9 mo of pregnancy, while infants' weights and lengths were measured at birth and at 1, 2, 3, and 6 mo of age with concurrent collection of age-specific maternal-reported infant feeding data. On the basis of multiple-linear-regression analysis that adjusted for potential covariates, mean maternal weight at the first prenatal visit and at 6 and 9 mo of pregnancy were positively associated with birth length (P for trend in all cases [is less than] 0.0001) and with linear growth between birth and 1, 3, and 6 mo of age. Maternal skinfold thickness at 9 mo of pregnancy and maternal height were also significantly associated with birth length. Moreover, maternal height, weight, and skinfold thickness at 6 and 9 mo of pregnancy were positively associated with mean birth weight. After adjustment for morbidity in the past month and other covariates, infants breast-fed exclusively had greater attained weight and weight gain in the first 3 mo compared with infants who were bottle-fed exclusively, breast-fed and bottle-fed, or solid-fed exclusively. These findings underscore the need for programs that improve the nutritional status of women before, during, and after pregnancy, and encourage exclusive breast-feeding of infants for at least the first 3 mo of life.

This is the first controlled diet study to examine the fluctuation of plasma carotenoids, lipoproteins, and serum hormone concentrations by phase of the menstrual cycle. Nonsmoking, premenopausal women (n = 12) with confirmed ovulatory cycles were given a standard diet with 10 mg total carotenoids/d for two cycles under isoenergetic conditions. Blood was drawn for simultaneous measurement of carotenoids, lipoproteins, and hormones on menses days 1-2, 4-6, 11 through 1 d after the luteinizing hormone surge, and 7-8 d after the surge, representing the menses, early and late follicular, and midluteal phases, respectively. Regression modeling with adjustment for plasma cholesterol concentrations was used to compare mean individual and total plasma carotenoid concentrations by phase of the cycle. Plasma carotenoid concentrations were at their lowest at menses and significantly higher thereafter, except for [alpha]-carotene. Compared with plasma concentrations at menses, [beta]-carotene peaked (increased by 9%, P = 0.01) in the late follicular phase. Plasma lutein/zeaxanthin and anhydrolutein concentrations were higher by 8-11% (P [less than or equal to] 0.006) and by 15-31% (P [less than or equal to 0.02), respectively, during the last three phases. Plasma lycopene and phytofluene concentrations peaked (increased by 12%, P = 0.004; and by 21%, P = 0.006, respectively) at the midluteal phase. This cyclic fluctuation may affect the estimation of the plasma carotenoid-disease relation in studies of premenopausal women.

This 6-mo controlled dietary study compared the effect of 30 g alcohol/d for three menstrual cycles with three alcohol-free cycles on plasma carotenoid concentrations in 18 nonsmoking, premenopausal women. Participants were randomly allocated within a crossover design to either phase and consumed [double tilde] 6 mg total carotenoids/d under isoenergetic conditions. Blood was drawn during the third menstrual cycle of each alcohol phase. After adjustment for the mean daily specific carotenoid and energy intakes for each alcohol phase, the paired differences in mean plasma [alpha]- and [beta]-carotene concentrations were significantly higher by 19% (P = 0.027) and 13% (P = 0.034), respectively, during the alcohol-intake phase of the study. The paired difference in mean plasma lutein/zeaxanthin concentration was significantly lower by 17% (P = 0.031) when the participants consumed alcohol than when they did not. This is the first reported study in women to document the independent effect of alcohol on plasma carotenoid concentrations without the potential interaction of smoking under controlled dietary conditions.

After 10 y of urban settlement, 680 Bedouin Arab children, who had had anthropometric assessment from birth (1981-1982) through early childhood, were reassessed in 1991-1992 to compare the rates of stunting in early and later childhood as well as to describe the factors influencing current height-for-age. Stunting had dropped from 32.7% at 18 mo to 7.2% at 10 y in the 1981 birth cohort and dropped from 17.5% at 9 mo to 8.2% at 9 y in the 1982 birth cohort. Based on a multiple-linear-regression analysis, height in early childhood and maternal height were statistically significantly and positively associated with current mean height-for-age in both cohorts. In the 1982 cohort socioeconomic status in early childhood was positively and current family size was negatively and significantly associated with current mean height-for-age. Thus, conditions that were present in early childhood had the largest influence on current height. In 1992, 10% and 6% of the infant siblings of the 1981 and 1982 cohorts, respectively, were stunted compared with 17% and 1% of the siblings aged 1-2 y of the respective cohorts. Therefore, the high rates of early childhood stunting in 1981-1982 appeared to be a birth cohort-specific phenomenon. Am J Clin Nutr 1995;61; 495-500

We examined the association of percent energy intake from fat with subsequent weight change in 2580 men and 4567 women, using data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS). Weight change was defined as the difference between the follow-up weight (NHEFS, 1982--1984) and the baseline weight (NHANES I, 1971--1974). Fat intake was estimated from a 24-h dietary recall obtained at baseline. Regression analyses adjusted for potential confounders showed no significant association of percent fat energy with weight change in men. Among women aged

The diet-plasma relationships for carotenoids were examined in a group of 98 nonsmoking premenopausal women who participated in the cross-sectional phase of the National Cancer Institute (NCI)-US Department of Agriculture (USDA) diet study on alcohol-hormone metabolism, 1988-90. With use of the newly developed USDA-NCI carotenoid food-composition database, the mean daily intakes of carotenoids were significantly higher when estimated from the food-frequency questionnaire (FFQ) than from the 7-d diet records. Lycopene ([chi][bar] = 0.58 mmol/L), lutein plus zeaxanthin ([chi][bar] = 0.46 mmol/L), and [beta]-carotene [chi][bar] = 0.34 mmol/L) were the major plasma carotenoids. After adjustment for body mass index, energy and alcohol intakes, and total plasma cholesterol concentration, the following significant correlations (P < 0.05) were observed between the diet record and the FFQ-estimated carotenoid intakes and their respective plasma concentrations: acarotene (r = 0.58 vs 0.49), [beta]-carotene (r = 0.51 vs 0.49), [beta]-cryptoxanthin (r = 0.49 vs 0.36), lutein plus zeaxanthin (r = 0.31 vs 0.37), lycopene (r = 0.50 vs 0.26), and total carotenoids (r = 0.57 vs 0.49). These data indicate that plasma carotenoid concentrations are reflective of dietary intake, but the magnitude of the correlation varies depending on the specific carotenoid and on the dietary assessment tool. Am J Clin Nutr 1994;60:223-30.

A newly available carotenoid food-composition database providing specific carotenoid values for > 2300 foods was linked to dietary data on 57 male nonsmokers to examine the association between dietary carotenoid intake and plasma carotenoid concentrations over 3 wk when free-living. Carotenoid intake was estimated from a food-frequency questionnaire (FFQ) and 7 d of food diaries with concurrent analysis of plasma carotenoid concentrations. After adjustment for energy intake, percentage of energy from alcohol, and plasma lipid concentrations, significant diet-plasma correlations for the FFQ and the food diaries (FD) included [alpha]-carotene (r = 0.29 and 0.43), [beta]-carotene (r = 0.36 FFQ only), [beta]-cryptoxanthin (r = 0.46 and 0.44), lutein (r = 0.44 FD only), and lycopene (r =0.53 FD only). Dietary carotenoid intakes were associated with plasma carotenoid concentrations for all the carotenoids except for [beta]-carotene when food diaries were used whereas the diet-plasma correlation for the provitamin A carotenoids were consistently significant when the FFQ was used.

The objective of this study was to evaluate methods of using maternal weight and height in studies of pregnancy outcome for Hispanic women. Reference anthropometric data came from 1166 Mexican-American women in the Hispanic Health and Nutrition Examination Survey (HHANES). Prospective data on maternal anthropometry and infant birth weight came from 1362 Hispanic women in the Kaiser-Permanente Contraceptive Drug Study and 12 786 women in the Guatemalan Cooperative Perinatal Study. Five methods of standardizing weight for height were evaluated, including power-type indexes and weights relative to HHANES reference data. In linear- and logistic-regression analyses, these methods were practically interchangeable, with no evident advantage of Hispanic reference data. However, if weight was not height-standardized the. effect of height was underestimated; if height was omitted and weight was not height-standardized the effects of weight were exaggerated. Therefore, analyses of pregnancy outcome should include both height and height-standardized weight. Am J Clin Nutr 1993;58:145-51.

Pregnant women who smoke and are over age 35 appear to increase the infant's risk of being small-for-gestational age (SGA) while those who smoke and have previously given birth appear to increase the infant's risk of low birth weight (LBW) and premature delivery. A Swedish study of 538,829 births found that overall, the highest rates of LBW, SGA and preterm delivery were among mothers over age 35 and the lowest were among mothers aged 25 to 29. Rates of LBW, SGA and premature delivery increased with the number of cigarettes smoked per day. Early infant deaths were highest among infants born to women who smoked, were over 35 and had not previously given birth. Age was more of a risk factor for adverse pregnancy outcomes among women who had never given birth than among those who had previously given birth. Smoking, however, increased the risks of LBW and preterm delivery more among women who had previously given birth than among those who had not.

Anemia, as indicated by low values of hemoglobin and hematocrit, involves a decreased ability of the blood to bring oxygen to body tissues. It has been suggested that anemia is associated with premature birth, but since hematocrit (the proportion of total blood volume that consists of red blood cells) increases steadily throughout the last trimester of pregnancy, comparisons are misleading if they are made between women giving birth prematurely and women delivering on schedule. To learn more about the association between hematocrit and the duration of pregnancy, data were analyzed from 26,901 pregnant women enrolled in a large health maintenance organization. Information concerning subjects' hematocrits and deliveries was available: the final random sample included premature births (defined as a live birth between 24 and 36 weeks' gestational age) to 94 Asian women, 159 black women, 200 Mexican women, and 274 white women. Each of these women (cases) was matched to a woman from the same ethnic group who delivered an infant after 36 weeks' gestation (controls). Criteria for diagnosing anemia are described; generally, a hematocrit below the tenth percentile for the ethnic group was considered to indicate anemia. Results showed that hematocrit values began to fall at the beginning of the second trimester, reaching their lowest point at between 26 and 28 weeks' gestation. They began to increase at 31 to 33 weeks' gestation, and then rose steeply to a maximum at 40 weeks. Black women had values that were 2 percent lower than white women for the last six months. Anemia occurring any time between 13 and 26 weeks' gestation (the second trimester) was associated with an increased risk of premature delivery (odds ratio, 1.9), while anemia occurring closer to term was linked to a decreased risk of premature birth. Some possible explanations are discussed for the finding that anemia in the second trimester, but not in the last trimester, is associated with prematurity. It is noted that anemia may be linked to socioeconomic deprivation, and the latter may be the cause of preterm birth (rather than the anemia itself). (Consumer Summary produced by Reliance Medical Information, Inc.)

IMPORTANCE: Although emphasis has recently been placed on the importance of high-protein diets to overall health, a comprehensive analysis of long-term cause-specific mortality in association with the intake of plant protein and animal protein has not been reported. OBJECTIVE: To examine the associations between overall mortality and cause-specific mortality and plant protein intake. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from 416 104 men and women in the US National Institutes of Health–AARP Diet and Health Study from 1995 to 2011. Data were analyzed from October 2018 through April 2020. EXPOSURES: Validated baseline food frequency questionnaire dietary information, including intake of plant protein and animal protein. MAIN OUTCOMES AND MEASURES: Hazard ratios and 16-year absolute risk differences for overall mortality and cause-specific mortality. RESULTS: The final analytic cohort included 237 036 men (57%) and 179 068 women. Their overall median (SD) ages were 62.2 (5.4) years for men and 62.0 (5.4) years for women. Based on 6 009 748 person-years of observation, 77 614 deaths (18.7%; 49 297 men and 28 317 women) were analyzed. Adjusting for several important clinical and other risk factors, greater dietary plant protein intake was associated with reduced overall mortality in both sexes (hazard ratio per 1 SD was 0.95 [95% CI, 0.94-0.97] for men and 0.95 [95% CI, 0.93-0.96] for women; adjusted absolute risk difference per 1 SD was −0.36% [95% CI, −0.48% to −0.25%] for men and −0.33% [95% CI, −0.48% to −0.21%] for women; hazard ratio per 10 g/1000 kcal was 0.88 [95% CI, 0.84-0.91] for men and 0.86 [95% CI, 0.82-0.90] for women; adjusted absolute risk difference per 10 g/1000 kcal was −0.95% [95% CI, −1.3% to −0.68%] for men and −0.86% [95% CI, −1.3% to −0.55%] for women; all P &lt; .001). The association between plant protein intake and overall mortality was similar across the subgroups of smoking status, diabetes, fruit consumption, vitamin supplement use, and self-reported health status. Replacement of 3% energy from animal protein with plant protein was inversely associated with overall mortality (risk decreased 10% in both men and women) and cardiovascular disease mortality (11% lower risk in men and 12% lower risk in women). In particular, the lower overall mortality was attributable primarily to substitution of plant protein for egg protein (24% lower risk in men and 21% lower risk in women) and red meat protein (13% lower risk in men and 15% lower risk in women). CONCLUSIONS AND RELEVANCE: In this large prospective cohort, higher plant protein intake was associated with small reductions in risk of overall and cardiovascular disease mortality. Our findings provide evidence that dietary modification in choice of protein sources may influence health and longevity.

Volatile organic compounds (VOCs) are major components of air pollution and tobacco smoke, two known risk factors for cardiovascular diseases. VOCs are ubiquitous in the environment and originate from a wide range of sources, including the burning of biomass, fossil fuels, and consumer products. Direct evidence for associations between specific VOCs and ischemic heart disease (IHD) mortality in the general population is scarce.

Methodology to assess state-based intervention studies from routinely collected data over the course of program evaluation of intervention is depicted. The pooled cross-sectional time-series model based techniques allowed modeling covariates and provided a framework to statistically test characteristics of the pattern of outcomes over time.

ObjectivesLead is a suspected carcinogen that has been inconsistently associated with kidney cancer. To clarify this relationship, we conducted an analysis of occupational lead exposure within a population-based study of kidney cancer using detailed exposure assessment methods.MethodsStudy participants (1217 cases and 1235 controls), enrolled between 2002 and 2007, provided information on their occupational histories and, for selected lead-related occupations, answered questions regarding workplace tasks, and use of protective equipment. Industrial hygienists used this information to develop several estimates of occupational lead exposure, including probability, duration and cumulative exposure. Unconditional logistic regression was used to compute ORs and 95% CIs for different exposure metrics, with unexposed subjects serving as the reference group. Analyses were also conducted stratifying on several factors, including for subjects of European ancestry only, single nucleotide polymorphisms in ALAD(rs1805313, rs1800435, rs8177796, rs2761016), a gene involved in lead toxicokinetics.ResultsIn our study, cumulative occupational lead exposure was not associated with kidney cancer (OR 0.9, 95% CI 0.7 to 1.3 for highest quartile vs unexposed; ptrend=0.80). Other lead exposure metrics were similarly null. We observed no evidence of effect modification for the evaluated ALADvariants (subjects of European ancestry only, 662 cases and 561 controls) and most stratifying factors, although lead exposure was associated with increased risk among never smokers.ConclusionsThe findings of this study do not offer clear support for an association between occupational lead exposure and kidney cancer.

Large-scale health surveys conducted by government agencies record information on a large number of health-related variables. We review the use of these data for performing analyses that address cancer-related objectives. After describing the conduct of a large-scale health survey (the third National Health and Nutrition Examination Survey [NHANES III]), we discuss some of the issues involved in analyzing data collected in such a survey. In particular, the use of sample weights in the analysis and the importance of accounting for the complex survey design when estimating standard errors are discussed. Six applications are then presented that involve the following: 1) estimating demographic factors associated with snuff use, 2) estimating the association of type of health insurance with the probability of receiving a digital rectal examination, 3) estimating the association of body iron stores with the probability of later developing cancer, 4) estimating the changing rates of mammography screening in the United States between 1987 and 1992, 5) evaluating smoking and alcohol consumption as risk factors for digestive cancer by use of a population-based, case-control study, and 6) evaluating a randomized community-intervention experiment to encourage smoking cessation. These applications use data from the National Health Interview Survey, the NHANES I Epidemiologic Followup Study, the 1986 National Mortality Followback Survey, and the Community Intervention Trial for Smoking Cessation. The availability of public-use data files is discussed for surveys sponsored by the U.S. government that collect health-related information. We demonstrate that statistical methods and computer software are available for analyzing public-use data files of surveys to address different types of cancer-related objectives. [J Natl Cancer Inst 1999;91: 1005-16]

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The majority of U.S. older adults consume alcoholic beverages. The older population is projected to almost double by 2050. Substantially more drinkers are likely. To describe gender‐specific trends (1997 to 2014) in prevalence of drinking status (lifetime abstention, former drinking, current drinking [including average volume], and binge drinking) among U.S. adults ages 60+ by age group and birth cohort. In the 1997 to 2014 National Health Interview Surveys, 65,303 respondents ages 60+ (31,803 men, 33,500 women) were current drinkers; 6,570 men and 1,737 women were binge drinkers. Prevalence estimates and standard errors were computed by age group (60+, 60 to 64, 65 to 69, 70 to 74, 75 to 79, 80+) and birth cohort (<1925, 1925 to 1935, 1936 to 1945, 1946 to 1954). Trends were examined using joinpoint regression and described as average annual percent change (AAPC; overall change 1997 to 2014) and annual percent change (APC; in‐between infection points). Primary analyses were unadjusted. All analyses (unadjusted and adjusted for demographics/lifestyle) were weighted to produce nationally representative estimates. Statistical procedures accounted for the complex survey design. Among men ages 60+, unadjusted prevalence of current drinking trended upward, on average, 0.7% per year (AAPC,p= 0.02); average volume and prevalence of binge drinking remained stable. Adjusted results were similar. Among women age 60+, unadjusted prevalence of current drinking trended upward, on average, 1.6% per year (AAPC,p< 0.0001), but average volume remained stable; prevalence of binge drinking increased, on average, 3.7% per year (AAPC,p< 0.0001). Adjusted results were similar. Trends varied by age group and birth cohort. Among men born 1946 to 1954, unadjusted prevalence of current drinking trended upward, on average, 2.4% per year (AAPC,p= 0.02); adjusted results were nonsignificant. Our finding of upward trends in drinking among adults ages 60+, particularly women, suggests the importance of public health planning to meet future needs for alcohol‐related programs. Most older Americans consume alcoholic beverages. The US older population is projected to almost double by 2050, suggesting substantially more future drinkers. We examined trends in drinking among US adults ages 60+ using 1997–2014 National Health Interview Survey data. Prevalence of current (past 12 month) drinking trended upward among both men and women, though more strongly among women. Binge drinking also trended upward among women. Public health planning is needed to meet the future alcohol‐related needs of older Americans.

ObjectivesTrichloroethylene, a chlorinated solvent widely used for metal degreasing, is classified by the International Agency for Research on Cancer as a kidney carcinogen. Other chlorinated solvents are suspected carcinogens, most notably the cleaning solvent perchloroethylene, although it is unclear whether they are associated with kidney cancer. We investigated kidney cancer associations with occupational exposure to 6 chlorinated solvents (trichloroethylene, perchloroethylene, 1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride) within a case–control study using detailed exposure assessment methods.MethodsCases (n=1217) and controls (n=1235) provided information on their occupational histories and, for selected occupations, on tasks involving potential exposure to chlorinated solvents through job-specific interview modules. Using this information, an industrial hygienist assessed potential exposure to each solvent. We computed ORs and 95% CIs for different exposure metrics, with unexposed participants as the referent group.Results1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride were not associated with kidney cancer. Among jobs with high exposure intensity, high cumulative hours exposed to perchloroethylene was associated with increased risk, both overall (third tertile vs unexposed: OR 3.1, 95% CI 1.3 to 7.4) and after excluding participants with ≥50% exposure probability for trichloroethylene (OR 3.0, 95% CI 0.99 to 9.0). A non-significant association with high cumulative hours exposed to trichloroethylene was observed (OR 1.7, 95% CI 0.8 to 3.8).ConclusionsIn this study, high exposure to perchloroethylene was associated with kidney cancer, independent of trichloroethylene. Additional studies are needed to further investigate this finding.

Familial or family aggregation of a disease is important for studying possible genetic etiology of a disease. A popular and useful measure of family aggregation is recurrence risk. Household health surveys with (family) network sampling, which surveyed individuals report about disease status of themselves and specified relatives, have been shown to be useful for estimating prevalence of diseases and more recently for estimating recurrence risk of disease using nonparametric classical survey methods. Because these surveys have complex sample designs with sample weighting for differential sample selection rates, this paper extends the composite-likelihood estimation and hypothesis of parameters of the quadratic exponential model (QEM) for simple random samples to data from these complex sample designs. In addition, the QEM is extended to simultaneously estimate and test parameters and recurrence risk for multiple family relationships, for comparing recurrence risk across family-level covariates (e.g. race) and utilizing propensity score weighting to adjust for confounding by individual-level covariates (e.g. age). Simulations are used to study the finite sample properties of the parameter estimation, variance estimation and level and power of hypothesis testing based on derived Wald and Quasi-Score tests for these extended QEMs. Finally, our methods are illustrated using the 1976 National Health Interview Survey diabetes data set.

IMPORTANCE: An improved model for risk stratification can be useful for guiding public health strategies of breast cancer prevention. OBJECTIVE: To evaluate combined risk stratification utility of common low penetrant single nucleotide polymorphisms (SNPs) and epidemiologic risk factors. DESIGN, SETTING, AND PARTICIPANTS: Using a total of 17 171 cases and 19 862 controls sampled from the Breast and Prostate Cancer Cohort Consortium (BPC3) and 5879 women participating in the 2010 National Health Interview Survey, a model for predicting absolute risk of breast cancer was developed combining information on individual level data on epidemiologic risk factors and 24 genotyped SNPs from prospective cohort studies, published estimate of odds ratios for 68 additional SNPs, population incidence rate from the National Cancer Institute-Surveillance, Epidemiology, and End Results Program cancer registry and data on risk factor distribution from nationally representative health survey. The model is used to project the distribution of absolute risk for the population of white women in the United States after adjustment for competing cause of mortality. EXPOSURES: Single nucleotide polymorphisms, family history, anthropometric factors, menstrual and/or reproductive factors, and lifestyle factors. MAIN OUTCOMES AND MEASURES: Degree of stratification of absolute risk owing to nonmodifiable (SNPs, family history, height, and some components of menstrual and/or reproductive history) and modifiable factors (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], menopausal hormone therapy [MHT], alcohol, and smoking). RESULTS: The average absolute risk for a 30-year-old white woman in the United States developing invasive breast cancer by age 80 years is 11.3%. A model that includes all risk factors provided a range of average absolute risk from 4.4% to 23.5% for women in the bottom and top deciles of the risk distribution, respectively. For women who were at the lowest and highest deciles of nonmodifiable risks, the 5th and 95th percentile range of the risk distribution associated with 4 modifiable factors was 2.9% to 5.0% and 15.5% to 25.0%, respectively. For women in the highest decile of risk owing to nonmodifiable factors, those who had low BMI, did not drink or smoke, and did not use MHT had risks comparable to an average woman in the general population. CONCLUSIONS AND RELEVANCE: This model for absolute risk of breast cancer including SNPs can provide stratification for the population of white women in the United States. The model can also identify subsets of the population at an elevated risk that would benefit most from risk-reduction strategies based on altering modifiable factors. The effectiveness of this model for individual risk communication needs further investigation.

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The value of hypothesis testing, and the frequent misinterpretation of p-values as a cornerstone of statistical methodology, continues to be debated. In 2019, the President of the American Statistical Association (ASA) convened a Task Force to write a succinct statement about the use of statistical methods in scientific studies, specifically hypothesis tests and p-values, and their connection to replicability. [ABSTRACT FROM AUTHOR]

Obesity is a risk factor for renal cell (or renal) cancer. The increasing prevalence of obesity may be contributing to the rising incidence of this cancer over the past several decades. The effects of early-age obesity and change in body mass index (BMI) on renal cancer have been studied less thoroughly, and the influence of race has never been formally investigated.