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Background: The association between the use of nonsteroidal antiinflammatory drugs (NSAID) and large bowel cancer was examined in a hospital-based case-control study of 511 patients with colorectal cancer and 500 age-sex matched control subjects., Methods: Regular NSAID use was defined as at least 3 times per week for 1 or more years before the date of hospital admission. Odds ratios (OR) were calculated by the duration of NSAID use and according to the medical reasons given for taking NSAIDs., Results: The prevalences of regular NSAID use were 15% for male patients, 8% for female patients, and 20% for control subjects. Overall, NSAID use was associated with a statistically significant risk reduction in men (OR = 0.64; 95% confidence interval [CI], 0.42-0.97) and in women (OR = 0.32; 95% CI, 0.18-0.57). The estimate decreased with duration among men but increased with duration among women. The risk reduction among patients who took NSAIDs to prevent heart disease was 0.67 (95% CI, 0.38-1.13) for men and 0.43 (95% CI, 0.12-1.59) for women. For treating headache pain, the OR was 0.5 (95% CI, 0.23-1.09) for men and 0.64 (95% CI, 0.25-1.62) for women. The use of NSAID was not found to be associated with the stage of cancer at diagnosis. The OR for daily acetaminophen use was 1.07 (95% CI, 0.35-3.23) for men and 0.59 (95% CI, 0.27-1.25) for women., Conclusions: The regular use of NSAIDs was associated with an overall significant risk reduction of colorectal cancer in men and in women. Among female patients, the greater protective effect associated with short term NSAID use compared with long term NSAID use may reflect a sampling bias.

Heterocyclic aromatic amines and polycyclic aromatic hydrocarbons are mutagens that are produced in highly cooked meats. A case-control study of 511 patients with colorectal cancer and 500 matched control subjects examined whether consumption of well-done cooked beef is related to the risk of developing large bowel cancer. Approximately 16% of men and women consumed well-done beef, and 50% ate medium-cooked beef. For both sexes, there was no association between consumption of well-done or medium-cooked beef and colorectal cancer. This paper discusses whether questionnaire data accurately reflect dietary intake of heterocyclic aromatic amines and polycyclic aromatic hydrocarbons.

The prevalence and interrelationship of high blood cholesterol levels with other cardiovascular disease risk factors were studied in a biracial suburb of New York City. Participants in community-based screenings to determine blood cholesterol levels have been predominantly white women in older age groups, highly educated and nonsmokers. To reach a more representative segment of a local population and promote healthy lifestyle behaviors, cholesterol screenings were conducted within an ongoing health promotion program in Mount Vernon, NY. Plasma cholesterol levels were determined for 5,011 participants, including 2,308 whites and 1,778 blacks. Of the men, 29 percent had high cholesterol levels; among women, it was 27 percent. Of the men with high levels, half had levels greater than 200 milligrams per deciliter, as did 55 percent of the women. After statistical adjustments were made for age and other risk factors for high blood cholesterol, mean cholesterol levels were higher for whites than blacks. The level for white men was 204 milligrams per deciliter; for women, 212. For black men, the level was 199 milligrams per deciliter; for women, 208, P < .10. Hispanic men had levels of 199, P < .10. The levels for Hispanic women (203 milligrams per deciliter) were significantly lower than that of white women. Among whites who smoked more than 1 pack of cigarettes per day, mean cholesterol levels were 11 milligrams per deciliter higher than for those who never smoked or were light smokers (0, 1-20 cigarettes per day, P < .10). There were too few who smoked more than 1 pack to test this association adequately among blacks. The mean cholesterol levels for hypertensive black men were 10 milligrams per deciliter greater than for black men with normal blood pressure (P<.10).

Data from a hospital-based case-control study between 1985-1990 were used to examine the effects of tobacco, alcohol, asbestos, and other occupational exposures on laryngeal cancer risk in 194 white men with primary cancer of the larynx and 184 age-matched control subjects. A dose-dependent effect for current cigarette smoking was observed, with higher relative risks (RR) for supraglottic cancer (RR, 21.6 to 68) than for cancer of the glottis (RR, 5.5 to 20.7). Elevated RR for ex-smokers (RR, 4.8) and pipe and cigar smokers (RR, 4.3) did not vary by subsite. The effects of alcohol also showed dose-dependent effects, with higher RR for cancer of the supraglottis than glottis for heavy drinkers (207 ml or more/daily; RR, 9.6 versus 2.5) and binge drinkers (RR, 28.4 versus 8.3). A slightly elevated but not significant association was seen for asbestos exposure and glottic cancer (RR, 1.3). The RR did not increase linearly with the number of years employed in asbestos-related occupations. No relationship was observed between asbestos and cancer of the supraglottis. When examining the data for a synergistic effect of cigarette smoking and asbestos exposure, no excess risk was found. A significantly elevated risk was found for men exposed to diesel fumes (RR, 5.2). Elevated but not significant RR were seen for men chronically exposed to rubber (RR, 6.4) and wood dust or employed as construction laborers, auto mechanics, and other jobs. A significant inverse trend with body mass was observed for cancer of the supraglottis.

A competition was conducted between Jackson, MS and Lansing, MI to reduce blood cholesterol levels among self-selected individuals who were generally at high risk for elevated coronary heart disease. Baseline plasma cholesterol levels were measured and risk factor data were recorded for 13,710 participants in Jackson and 6,719 in Lansing (6.8% and 5.1% of the total populations, respectively). A six month educational campaign was conducted in both cities which included nutritional seminars, television shows, newspaper advertisements etc. From Jackson, 6,244 participants returned for the follow-up screening, and 2,404 from Lansing (46% and 36%). Subjects who reported changes in their diets had an average cholesterol reduction of 19 mg/dl (9%) in Jackson, and 2 mg/dl (1%) in Lansing (after adjustment for sex, baseline level, and age, P less than 0.01). In Lansing, participants were less likely to have college degrees, and were more likely to have participated because of concern with previously determined elevated cholesterol levels than Jackson participants.

Vitamin supplement histories were taken from a sample of approximately 3,600 individuals (2,461 men and 1,181 women) from a hospital-based population. Multivitamin preparations were the most commonly used vitamin supplements (32% of men, 37% of women) followed by vitamins C (men 11%; women 16%) and E (men 17%; women 23%). The most common combination of supplements among the multi-users was vitamins C and E. Vitamin supplement use was positively associated with education in both sexes. Among women, there was a negative association between vitamin supplement consumption and Quetelet Index. No association was found between vitamin use and smoking status or alcohol use or amount of alcohol consumed.

An epidemiological study was conducted to characterize adult, domestic homicides committed with firearms and to determine the role of alcohol intoxication in the likelihood of becoming a homicide victim. Data on 129 homicides in Ohio occurring between 1982 and 1985 were collected from police departments of major cities, the Ohio Department of Rehabilitation and Corrections, and county medical examiners. Forty-eight offenders were interviewed. Temporal and geographical patterns are discussed, as well as offender-victim relationships and the characteristics of the firearms used. High levels of blood alcohol in the victims suggest that alcohol is a risk factor for becoming a homicide victim, although data on alcohol consumption patterns in the population are necessary to advance this association.

In a hospital-based case-control study of 124 (105 male and 19 female) histologically confirmed malignant mesothelioma cases and age- and sex-matched controls, the role of cigarette smoking and the risk of asbestos exposure was investigated. Exposure to asbestos for at least 1 year was likely for 78% of male cases and 16% of female cases, and 90% of males were possibly exposed. Male cases worked predominantly in the ship-building industry, construction, or insulation trades. Elevated risks were found for males employed in asbestos-related industries [odds ratio (OR) 8.1; 95% confidence interval (CI) 4.9-13.5], e.g., shipyards (OR 82.9, 95% CI 25.5-269.1), construction/maintenance (OR 8.3, 95% CI 4.6-14.8), and other asbestos-related jobs (OR 3.2, 95% CI 1.4-7.2), and for males who self-reported exposure to asbestos or insulation (OR 50.9, 95% CI 21.7-119.8). A statistically significant trend was found for the risk of mesothelioma with increasing years employed in non-shipyard asbestos-related occupations. Among women, only one case worked in an asbestos-related industry and two reported domestic contact with asbestos. No association between cigarette smoking and mesothelioma was found for either men or women. We also report the occurrence of mesothelioma in occupations which have not been previously reported.

In a hospital-based case-control study, consumption of lactose-containing (dairy) foods and foods containing beta-carotene by 71 women with epithelial cancer of the ovary and 141 matched controls was investigated. No significant differences were found between cases and controls in the frequency of consumption of dairy foods or in the amount of lactose consumed. Consumption of carrots was found to decrease risk. Logistic regression analyses indicated a protective effect of high beta-carotene intake (odds ratio = 0.3, 95% confidence interval = 0.1-0.8), after adjusting for body mass, smoking, and lactose consumption.

A population-based, case-control study was conducted to examine whether infrequent breast self-examination (BSE) is associated with the detection of breast cancer at a later stage of disease. A group of 435 women with newly diagnosed, regional or distant breast carcinoma from Connecticut were interviewed and compared with 887 age-frequency-matched women without breast cancer. A case-control method eliminates lead time bias that may have been present in prior studies that evaluated BSE efficacy. Cases were found to have practiced monthly BSE more frequently than controls (27 vs. 21%). No differences in frequency of BSE was found between cases and controls after controlling for the potentially confounding effects of breast cancer risk factors and mammography (OR = 1.26; 95% CI, 0.77 to 2.07).

Plasma cholesterol levels were determined for 51,723 participants of community-based cholesterol screenings in 10 United States cities during 1988. Among white adult men and women under the age of 60 without other cardiovascular disease risk factors, a dose-response relationship was found between the number of cigarettes smoked per day and increasing levels of plasma cholesterol. In men aged 18 to 60 years, average plasma cholesterol increased by 0.33 mg/dl for each cigarette smoked (p less than 0.001); in women aged 31 to 50 years, average plasma cholesterol increased by 0.48 mg/dl for each cigarette smoked (p less than 0.001). Plasma cholesterol levels among ex-smokers were found to be similar to those of nonsmokers. No association between cigarette smoking and levels of plasma cholesterol was observed in men and women over age 60. Possible mechanisms for this observed relationship include an antiestrogenic effect of cigarette smoking that makes the observation more noticeable in younger female cohorts, enhanced lipolysis that increases levels of plasma free fatty acids, or differences in dietary intake between smokers and nonsmokers.

We describe an unusual case of metastatic poorly differentiated laryngeal carcinoma to the pleura resembling pleural mesothelioma in a patient with a positive history of exposure to asbestos. This case not only describes an unusual presentation of metastatic laryngeal carcinoma, but also highlights the need for special pathological techniques to distinguish nonmesothelial tumors from primary pleural mesotheliomas.

Plasma cholesterol was measured in 7,338 participants of a cholesterol screening in Miami, Florida. They were typically health conscious as evidenced by the low prevalence of current cigarette smoking (16%). However, more than 30% of males and 49% of females over age 50 had cholesterol levels in excess of 240 mg/dl, placing them at moderate to high risk for coronary artery disease. Results revealed a dose response relationship between cigarette smoking and cholesterol in men of all age groups and in women of premenopausal age; whereas the average cholesterol was similar in exsmokers and never smokers. Risk analysis revealed a strong positive association between cholesterol and the period prevalence of myocardial infarction in men and women. Male and female patients with newly diagnosed hypercholesterolemia reduced their cholesterol an average of 13 and 10 mg/dl, respectively, under care of a physician. These results indicate that cholesterol screening coupled with physician follow-up and treatment can lower cholesterol and its attendant risk of cardiovascular disease.

Childhood homicide deaths in Ohio from 1974 to 1984 were examined using Ohio Vital Statistics records and US Census Data. Homicide rates varied from 25/100,000 for Black infant males to 0.8/100,000 for White females ages 5-9. Child battering was the leading cause of death for children less than 5 years. Firearms accounted for 56 per cent of homicide deaths for children 10-14 years of age. The childhood homicide rates in the four largest Ohio cities were substantially higher in areas with low socioeconomic indicators.

Inferences concerning the etiology of disease in human populations are derived from complex quantitative and biologic data. Interpreting these inferences in toxic tort litigation poses difficult problems for courts. Fundamental differences exist between courtroom and scientific criteria of causation. These differences need not be irreconcilable if courts understand the nature, strengths, and limitations of scientific evidence. We discuss the interpretation of basic scientific principles of disease causation in the context of legal rules of evidence, and develop an epidemiologic evidentiary standard for toxic tort litigation.