Search

Background: Observational studies show high pre-diagnosis 25-hydroxyvitamin D is associated with lower mortality after colorectal cancer (CRC) diagnosis. Results from clinical trials suggest vitamin D supplementation may improve outcomes among CRC patients. Most studies included few Black Americans, who typically have lower 25-hydroxyvitamin D. We evaluated associations between serum 25-hydroxyvitamin D and mortality after CRC diagnosis among Black American cases. Methods: Data arose from 218 Black Americans from the Southern Community Cohort Study diagnosed with CRC during follow-up (age 40-79 at enrollment). Pre-diagnostic 25-hydroxyvitamin D was measured at enrollment and categorized as deficient (

Black Americans of low socioeconomic status (SES) have higher colorectal cancer incidence than other groups in the United States. However, much of the research that identifies colorectal cancer risk factors is conducted in cohorts of high SES and non-Hispanic White participants. Adult participants of the Southern Community Cohort Study (N = 75,182) were followed for a median of 12.25 years where 742 incident colorectal cancers were identified. The majority of the cohort are non-Hispanic White or Black and have low household income. Cox models were used to estimate HRs for colorectal cancer incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking, and physical activity. The association between Black race and colorectal cancer was consistent and not diminished by accounting for SES, access to healthcare, or healthy lifestyle [HR = 1.34; 95% confidence interval (CI),1.10–1.63]. Colorectal cancer screening was a strong, risk reduction factor for colorectal cancer (HR = 0.65; 95% CI, 0.55–0.78), and among colorectal cancer-screened, Black race was not associated with risk. Participants with high school education were at lower colorectal cancer risk (HR = 0.81; 95% CI, 0.67–0.98). Income and neighborhood-level SES were not strongly associated with colorectal cancer risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to ≥3 health behaviors had a 19% (95% CI, 1–34) decreased colorectal cancer risk compared with participants that reported ≤1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. Colorectal cancer screening, education, and a lifestyle that includes healthy behaviors lowers colorectal cancer risk. Racial disparities in colorectal cancer risk may be diminished by colorectal cancer screening.Prevention Relevance:Colorectal cancer risk may be reduced through screening, higher educational attainment and performing more health behaviors. Importantly, our data show that colorectal cancer screening is an important colorectal cancer prevention strategy to eliminate the racial disparity in colorectal cancer risk.See related Spotlight, p. 561

Black Americans of low socioeconomic status (SES) have higher colorectal cancer incidence than other groups in the United States. However, much of the research that identifies colorectal cancer risk factors is conducted in cohorts of high SES and non-Hispanic White participants. Adult participants of the Southern Community Cohort Study (N = 75,182) were followed for a median of 12.25 years where 742 incident colorectal cancers were identified. The majority of the cohort are non-Hispanic White or Black and have low household income. Cox models were used to estimate HRs for colorectal cancer incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking, and physical activity. The association between Black race and colorectal cancer was consistent and not diminished by accounting for SES, access to healthcare, or healthy lifestyle [HR = 1.34; 95% confidence interval (CI),1.10–1.63]. Colorectal cancer screening was a strong, risk reduction factor for colorectal cancer (HR = 0.65; 95% CI, 0.55–0.78), and among colorectal cancer-screened, Black race was not associated with risk. Participants with high school education were at lower colorectal cancer risk (HR = 0.81; 95% CI, 0.67–0.98). Income and neighborhood-level SES were not strongly associated with colorectal cancer risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to ≥3 health behaviors had a 19% (95% CI, 1–34) decreased colorectal cancer risk compared with participants that reported ≤1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. Colorectal cancer screening, education, and a lifestyle that includes healthy behaviors lowers colorectal cancer risk. Racial disparities in colorectal cancer risk may be diminished by colorectal cancer screening. Prevention Relevance: Colorectal cancer risk may be reduced through screening, higher educational attainment and performing more health behaviors. Importantly, our data show that colorectal cancer screening is an important colorectal cancer prevention strategy to eliminate the racial disparity in colorectal cancer risk. See related Spotlight, p. 561

Background: The association of aspirin use with prostate cancer has been investigated, but few studies included African-American men. Here, we analyzed the relationship of aspirin intake with prostate cancer risk and mortality among African-American men in the Southern Community Cohort Study (SCCS). Methods: SCCS recruited 22,426 African-American men between 2002 and 2009. Aspirin use was assessed at enrollment. Our exposures of interest were any aspirin use (regular strength, low-dose or baby aspirin, or half tablets of aspirin) and regular strength aspirin. Each exposure variable was compared with nonusers. Associations between aspirin use and prostate cancer risk and mortality were examined with Cox proportional hazards models. Results: At enrollment, 5,486 men (25.1%) reported taking any aspirin and 2,634 men (12.1%) reported regular strength aspirin use. During follow-up (median, 13 years), 1,058 men developed prostate cancer, including 103 prostate cancer–specific deaths. Aspirin use was not associated with prostate cancer development [adjusted HR, 1.07; 95% confidence interval (CI), 0.92–1.25 for any aspirin use and HR, 0.97; 95% CI, 0.78–1.19 for regular strength aspirin], but was suggestively associated with reduced prostate cancer mortality (HR, 0.66; 95% CI, 0.39–1.14 for any aspirin use and HR, 0.41; 95% CI, 0.17–1.00 for regular strength aspirin). Conclusions: Aspirin use at enrollment was tentatively associated with reduced prostate cancer mortality, but not risk, among African-American men in SCCS. Impact: Prospective SCCS data suggest that aspirin use may help prevent lethal prostate cancer among this high-risk group of men.

To test whether 2 conceptually overlapping constructs, dispositional optimism (generalized positive expectations) and optimistic bias (inaccurately low risk perceptions), may have different implications for smoking treatment engagement.Predominantly Black, low-income Southern Community Cohort study smokers (n = 880) self-reported dispositional optimism and pessimism (Life Orientation Test-Revised subscales: 0 = neutral, 12 = high optimism/pessimism), comparative lung cancer risk (Low/Average/High), and information to calculate objective lung cancer risk (Low/Med/High). Perceived risk was categorized as accurate (perceived = objective), optimistically-biased (perceivedobjective), or pessimistically-biased (perceivedobjective). One-way ANOVAs tested associations between dispositional optimism/pessimism and perceived risk accuracy. Multivariable logistic regressions tested independent associations of optimism/pessimism and perceived risk accuracy with cessation motivation (Low/High), confidence (Low/High), and precision treatment attitudes (Favorable/Unfavorable), controlling for sociodemographics and nicotine dependence.Mean dispositional optimism/pessimism scores were 8.41 (Dispositional optimism and lung cancer risk perception accuracy were unrelated. Dispositional optimism was associated with favorable engagement-related outcomes and optimistically-biased risk perception with unfavorable outcomes, reinforcing the distinctiveness of these constructs and their implications for smoking treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In a low-income cohort in the Southeastern United States, 5% of participants avoided emergency medical care during the coronavirus disease 2019 pandemic, primarily due to fear and visitor restrictions. Younger age, self-perceived lower health status, lack of a personal doctor, and decreased income were associated with greater likelihood of deferring emergency care.

Vaccination intent is foundational for effective COVID-19 vaccine campaigns. To understand factors and attitudes influencing COVID-19 vaccination intent in Black and White adults in the US south, we conducted a mixed-methods cross-sectional survey of 4512 adults enrolled in the Southern Community Cohort Study (SCCS), an ongoing study of racial and economic health disparities. Vaccination intent was measured as "If a vaccine to prevent COVID-19 became available to you, how likely are you to choose to get the COVID-19 vaccination?" with options of "very unlikely," "somewhat unlikely," "neither unlikely nor likely," "somewhat likely," and "very likely." Reasons for intent, socio-demographic factors, preventive behaviors, and other factors were collected. 46% of participants had uncertain or low intent. Lower intent was associated with female gender, younger age, Black race, more spiritual/religious, lower perceived COVID-19 susceptibility, living in a greater deprivation area, lower reading ability, and lack of confidence in childhood vaccine safety or COVID-19 vaccine effectiveness or safety (p < .05 for all). Most factors were present in all racial/gender groups. Contextual influences, vaccine/vaccination specific issues, and personal/group influences were identified as reasons for low intent. Reasons for higher intent included preventing serious illness, life returning to normal, and recommendation of trusted messengers. Hesitancy was complex, suggesting tailored interventions may be required to address low intent.

Background Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences. Design and methods To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled lowincome individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data. Results Among 4463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs Conclusions Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.

BackgroundCigarette smoking is a common risk factor for diseases and cancers. Oral microbiota is also associated with diseases and cancers. However, little is known about the impact of cigarette smoking on the oral microbiota, especially among ethnic minority populations.MethodsWe investigated cigarette smoking in relationship with the oral microbiota in a large population of predominately low-income and African-American participants. Mouth rinse samples were collected from 1616 participants within the Southern Community Cohort Study, including 592 current-smokers, 477 former-smokers and 547 never-smokers. Oral microbiota was profiled by 16S ribosomal RNA gene deep sequencing.ResultsCurrent-smokers showed a different overall microbial composition from former-smokers (p=6.62×10−7) and never-smokers (p=6.00×10−8). The two probiotic genera, Bifidobacterium and Lactobacillus, were enriched among current-smokers when compared with never-smokers, with Bonferroni-corrected p values (PBonferroni) of 1.28×10−4 and 5.89×10−7, respectively. The phylum Actinobacteria was also enriched in current-smokers when compared with never-smokers, with a median relative abundance of 12.35% versus 9.36%, respectively, and with a PBonferroni=9.11×10−11. In contrast, the phylum Proteobacteria was depleted in current smokers (PBonferroni=5.57×10−13), with the relative abundance being almost three times that of never-smokers (7.22%) when compared with that of current-smokers (2.47%). Multiple taxa within these two phyla showed differences in abundance/prevalence between current-smokers and never-smokers at PBonferroni ConclusionSmoking has strong impacts on oral microbial community, which was recovered after smoking cessation.

Background Prostate-specific antigen (PSA) measurement in midlife predicts long-term prostate cancer (PCa) mortality among white men. Objective To determine whether baseline PSA level during midlife predicts risk of aggressive PCa in black men. Design, setting, and participants Nested case-control study among black men in the Southern Community Cohort Study recruited between 2002 and 2009. A prospective cohort in the southeastern USA with recruitment from community health centers. A total of 197 incident PCa patients aged 40–64 yr at study entry and 569 controls matched on age, date of blood draw, and site of enrollment. Total PSA was measured in blood collected and stored at enrollment. Outcome measurements and statistical analysis Total and aggressive PCa (91 aggressive: Gleason ≥7, American Joint Committee on Cancer stage III/IV, or PCa-specific death). Exact conditional logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for PCa by category of baseline PSA. Results and limitations Median PSA among controls was 0.72, 0.80, 0.94, and 1.03 ng/ml for age groups 40–49, 50–54, 55–59, and 60–64 yr, respectively; 90th percentile levels were 1.68, 1.85, 2.73, and 3.33 ng/ml. Furthermore, 95% of total and 97% of aggressive cases had baseline PSA above the age-specific median. Median follow-up was 9 yr. The OR for total PCa comparing PSA >90th percentile versus ≤median was 83.6 (95% CI, 21.2–539) for 40–54 yr and 71.7 (95% CI, 23.3–288) for 55–64 yr. For aggressive cancer, ORs were 174 (95% CI, 32.3–infinity) for 40–54 yr and 51.8 (95% CI, 11.0–519) for 55–64 yr. A composite endpoint of aggressive PCa based on stage, grade, and mortality was used and is a limitation. Conclusions PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies. Patient summary Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.

We examined the associations of dietary cholesterol and egg intakes with cardiometabolic and all-cause mortality among Chinese and low-income Black and White Americans. Included were 47,789 Blacks, 20,360 Whites, and 134,280 Chinese aged 40–79 years at enrollment. Multivariable Cox models with restricted cubic splines were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes using intakes of 150 mg cholesterol/day and 1 egg/week as the references. Cholesterol intake showed a nonlinear association with increased all-cause mortality and a linear association with increased cardiometabolic mortality among Black Americans: HRs (95% CIs) associated with 300 and 600 mg/day vs. 150 mg/day were 1.07 (1.03–1.11) and 1.13 (1.05–1.21) for all-cause mortality (P-linearity = 0.04, P-nonlinearity = 0.002, and P-overall &lt, 0.001) and 1.10 (1.03–1.16) and 1.21 (1.08–1.36) for cardiometabolic mortality (P-linearity = 0.007, P-nonlinearity = 0.07, and P-overall = 0.005). Null associations with all-cause or cardiometabolic mortality were noted for White Americans (P-linearity ≥ 0.13, P-nonlinearity ≥ 0.06, and P-overall ≥ 0.05 for both). Nonlinear inverse associations were observed among Chinese: HR (95% CI) for 300 vs. 150 mg/day was 0.94 (0.92–0.97) for all-cause mortality and 0.91 (0.87–0.95) for cardiometabolic mortality, but the inverse associations disappeared with cholesterol intake &gt, 500 mg/day (P-linearity ≥ 0.12, P-nonlinearity ≤ 0.001, P-overall &lt, 0.001 for both). Similarly, we observed a positive association of egg intake with all-cause mortality in Black Americans, but a null association in White Americans and a nonlinear inverse association in Chinese. In conclusion, the associations of cholesterol and egg intakes with cardiometabolic and all-cause mortality may differ across ethnicities who have different dietary patterns and cardiometabolic risk profiles. However, residual confounding remains possible.

Introduction: Epidemiologic studies and controlled trials provide evidence that higher 25-hydroxyvitaminD is associated with improved survival in colorectal cancer (CRC), although there are limited data in African Americans (AAs), who are at greater risk for CRC mortality and vitamin D deficiency. Herein, we report associations between vitamin D serum biomarkers collected at cohort entry up to 15 years prior to CRC onset and CRC tumor subtypes defined by high expression of tumor markers (Ki67, p53, and COX2) that represent cellular processes (proliferation, apoptosis, and inflammation) affected by vitamin D. Importantly, higher expression of these markers reflects greater risk for metastasis and CRC-specific mortality. Methods: Data arise from the Southern Community Cohort Study, a cohort from the southeastern United States where the majority of participants are AA. Incident CRC cases with tumor sample were analyzed (n=104). Expression of cellular Ki67, p53, and COX2 (% positivity) were measured and categorized by literature-defined high vs. low cut-points (20%, 10%, and 20%, respectively). Logistic models adjusted for age, race, and sex were used to measure associations between vitamin D biomarkers: 25-hydroxyvitaminD, vitamin D binding protein (VDBP), and calculated free 25-hydroxyvitaminD (vitamin D not bound by VDBP) and the odds of a more aggressive tumor subtype, defined by higher cellular expression. Associations were assessed in the full sample and the subsample of AAs (n=70). Results: There were 52 tumors with high Ki67 expression, 37 with high p53, and 50 with high COX2. Fifteen tumors had high expression of all three markers. Cases were 55.8±0.4 (mean±SE) years at enrollment (range 40-79). The median 25-hydroxyvitaminD was lower in cases with high p53 expressing tumors compared to low expression (13.5 vs. 18.0 ng/mL, respectively, p = .03). Median values for other biomarkers were similar by tumor subtype (p &gt .05). 25-hydroxyvitaminD was not associated with having a tumor with high Ki67 expression (odds ratio (OR) per 1 SD increase [95% CI] = 1.29 [0.85-1.95], p-trend = .23), high p53 expression (0.80 [0.52-1.23], p-trend = .30), or high COX2 expression (1.29 [0.83-2.00], p = .25). We observed null associations for VDBP, and free 25-hydroxyvitaminD with all tumor subtypes. Results were similar in AAs, although higher VDBP was associated with lower odds of high Ki67 tumors (0.45 [0.21-0.97], p-trend = .04 per 1 SD increase). Conclusion: In this sample of predominantly AA CRC cases, we observed no association between vitamin D biomarkers in stored serum and subsequent more aggressive CRC molecular subtypes. More work is needed to characterize the relationship between vitamin D and expression of CRC tumor markers, which may help clarify the protective role of maintaining adequate vitamin D levels in association with CRC. Citation Format: Thomas Lawler, Timothy Su, Qiuyin Cai, Mark Steinwandel, Wei Zheng, William J. Blot, Shaneda Warren Andersen. Biomarkers of circulating vitamin D status and expression of tumor molecular markers Ki67, p53, and COX2 among colorectal cancer cases in the Southern Community Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 725.

Background: Various carotenoids in circulation, including isomers, may have different influences on cancer risk. Methods: We conducted a nested case–control study including 343 incident prostate cancer cases and 640 controls individually matched on age, race, study site, and time of blood collection. Carotenoids investigated were carotene, cryptoxanthin, lycopene, dihydrolycopene, lutein, anhydrolutein, and zeaxanthin, including α versus β configurations and cis versus trans isomers. General linear model and conditional logistic regression were applied to evaluate associations for prostate cancer risk, with adjustment for potential confounders. We conducted additional analyses with further stratification by race, multivitamin use, and smoking status. Results: Case–control differences were found in carotenoid subtype levels, although not all reached the multiple comparison adjusted threshold for significance. Plasma lycopene [ORT1 vs. T3 = 0.51; 95% confidence interval (CI), 0.29–0.87; Ptrend = 0.014], dihydrolycopene (ORT1 vs. T3 = 0.37; 95% CI, 0.18–0.74; Ptrend = 0.006), and cis-anhydrolutein (ORT1 vs. T3 = 0.57; 95% CI, 0.33–0.96; Ptrend = 0.037) were inversely, while β-trans-carotene (ORT1 vs. T3 = 2.13; 95% CI, 1.32–3.43; Ptrend = 0.002) and trans-lutein (ORT1 vs. T3, 1.86; 95% CI, 1.20–2.88; Ptrend = 0.006) were positively associated with prostate cancer risk. Stratified analyses showed inverse associations of lycopene, dihydrolycopene, and cis-anhydrolutein with prostate cancer risk in subjects without multivitamin use; lycopene and dihydrolycopene in African-Americans and current smokers; and dihydrolycopene in nonsmokers. Positive associations of β-trans-carotene and trans-lutein were observed in African-Americans, nonsmokers, and multivitamin users. Conclusions: The associations of carotenoids with risk of prostate cancer differed by carotenoid subtypes. Impact: Public health recommendations on carotenoid intakes for prostate cancer prevention should take subtypes and isomers into consideration.

Depression is a leading cause of disability in the United States, but its impact on mortality rates among racially diverse populations of low socioeconomic status is largely unknown. Using data from the Southern Community Cohort Study, 2002–2015, we prospectively evaluated the associations of depressive symptoms with all-cause and cause-specific mortality in 67,781 Black (72.3%) and White (27.7%) adults, a population predominantly with a low socioeconomic status. Baseline depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale. The median follow-up time was 10.0 years. Multivariate Cox regression was used to estimate hazard ratios and 95% confidence intervals for death in association with depressive symptoms. Mild, moderate, and severe depressive symptoms were associated with increased all-cause (hazard ratio (HR) = 1.12, 95% confidence interval (CI): 1.03, 1.22; HR = 1.17, 95% CI: 1.06, 1.29; HR = 1.15, 95% CI: 1.03, 1.28, respectively) and cardiovascular disease–associated death (HR = 1.23, 95% CI: 1.05, 1.44; HR = 1.18, 95% CI: 0.98, 1.42; HR = 1.43, 95% CI: 1.17, 1.75, respectively) in Whites but not in Blacks (P for interaction

OBJECTIVE: To investigate whether race (African American (AA) and white) is associated with sleep duration among adults from low socioeconomic (SES) strata and whether SES status, lifestyle behaviors, or health conditions are associated with sleep duration within race-sex groups. METHODS: This cross-sectional study includes 78,549 participants from the Southern Community Cohort Study (SCCS). Averaged daily sleep duration was assessed by weighted averages of self-reported sleep duration on weekdays and weekends. Adjusted odds ratios (ORs) of very short (

We thank Dr. Kenyon for his careful reading of our paper ([1][1], [2][2]). First, he speculated that the differences in relative abundance of the 13 most common taxa between European-Americans (EAs) and African-Americans (AAs) may be due to inadequate control of covariates. Then, he expressed

Background: Previous studies rarely evaluated the associations between vitamin D–binding protein and free vitamin D with colorectal cancer risk. We assessed these biomarkers and total 25-hydroxyvitamin D in relation to colorectal cancer risk in a sample of African Americans. Methods: Cases comprised 224 African American participants of the Southern Community Cohort Study diagnosed with incident colorectal cancer. Controls (N = 440) were selected through incidence density sampling and matched to cases on age, sex, and race. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between biomarker levels and colorectal cancer risk. Results: Vitamin D was inversely associated with colorectal cancer risk where the OR per-SD increase in total and free 25-hydroxyvitamin D were 0.82 (95% CI, 0.66–1.02) and 0.82 (95% CI, 0.66–1.01), respectively. Associations were most apparent among cases diagnosed >3 years after blood draw: ORs for the highest tertile versus the lowest were 0.69 (95% CI, 0.21–0.93) for total 25-hydroxyvitamin D and 0.71 (95% CI, 0.53–0.97) for free 25-hydroxyvitamin D. Inverse associations were seen in strata defined by sex, BMI, and anatomic site, although not all findings were statistically significant. Vitamin D–binding protein was not associated with colorectal cancer risk. Conclusions: Our findings suggest that total and free 25-hydroxyvitamin D may be inversely associated with colorectal cancer risk among African Americans. Impact: These findings highlight a potential role for vitamin D in colorectal cancer prevention in African Americans. Cancer Epidemiol Biomarkers Prev; 26(8); 1242–7. ©2017 AACR.

BACKGROUND: Choline-related nutrients are dietary precursors of a gut microbial metabolite, trimethylamine-N-oxide, which has been linked to cardiometabolic diseases and related death. However, epidemiologic evidence on dietary choline and mortality remains limited, particularly among nonwhite populations. OBJECTIVES: This study aimed to investigate the associations of choline-related nutrients with cardiometabolic and all-cause mortality among black and white Americans and Chinese adults. METHODS: Included were 49,858 blacks, 23,766 whites, and 134,001 Chinese, aged 40–79 y, who participated in 3 prospective cohorts and lived ≥1 y after enrollment. Cox regression models were used to estimate HRs and 95% CIs for cardiometabolic [e.g., ischemic heart disease (IHD), stroke, and diabetes] and all-cause deaths. To account for multiple testing, P values

Few studies have evaluated the relationship of oral microbiome with obesity. We investigated the oral microbiome among 647 obese and 969 non-obese individuals from the Southern Community Cohort Study, through 16S rRNA gene sequencing in mouth rinse samples. We first investigated 16 taxa in two probiotic genera, Bifidobacterium and Lactobacillus. Among them, eight showed nominal associations with obesity (P

Simple Summary Liver cancer incidence in the United States is higher among African Americans compared to White Americans. The determinants of racial disparities in liver cancer incidence are not clear. Using data from White and African Americans from low socioeconomic backgrounds, we compared the prevalence of known liver cancer risk factors by race and assessed factors associated with liver cancer incidence. Understanding liver cancer risk differences can assist prevention strategies that target people at high risk, potentially based on risk factors that differ by race. Abstract The purpose of this study was to examine differences in risk factors associated with hepatocellular carcinoma (HCC) among White and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC-adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for White and African Americans, separately. There were 294 incident HCC. The incidence rate ratio for HCC was higher (IRR = 1.4, 95%CI: 1.1–1.9) in African Americans compared to White Americans. White Americans saw a stronger association between self-reported hepatitis C virus (aHR = 19.24, 95%CI: 10.58–35.00) and diabetes (aHR = 3.55, 95%CI: 1.96–6.43) for the development of HCC compared to African Americans (aHR = 7.73, 95%CI: 5.71–10.47 and aHR = 1.48, 95%CI: 1.06–2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR = 2.91, 95%CI: 1.87–4.52) and heavy alcohol consumption (aHR = 1.59, 95%CI: 1.19–2.11) were significantly associated with HCC risk among African Americans only. In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among White and African Americans.

African Americans and low-income whites have higher mortality than the U.S. general population. This study prospectively investigated the combined influence of major lifestyle factors and poverty on mortality in this vulnerable population.Data were collected in 2002-2009 from 79,101 Southern Community Cohort Study participants, of which 67% were African American and 55% had household incomes$15,000. Mortality outcomes were identified from the National Death Index though December 31, 2011 (data analyzed in 2014-2015). Healthy behavior scores were created based on tobacco smoking, alcohol intake, diet, physical activity, and sedentary time. The primary analysis was performed based on the score created by counting each participant as having met/not met public health guidelines for each behavior.Healthy behavior scores were associated with reduced cancer, cardiovascular disease, and all-cause mortality. Associations were stronger for whites than African Americans: hazard ratios for all-cause mortality comparing participants meeting four or five guidelines versus participants meeting zero were 0.41 (95% CI=0.30, 0.55) for African American men; 0.36 (95% CI=0.24, 0.55) for white men; 0.46 (95% CI=0.36, 0.59) for African American women; and 0.27 (95% CI=0.18, 0.43) for white women. The association between healthy lifestyle and all-cause mortality was weaker among those with incomes$15,000 than those with higher income, particularly in men (p0.05 for interaction).This study demonstrates the importance of health behaviors on mortality among all groups, but highlights the need for additional research to identify factors contributing to high risk of mortality among low-income and African American populations.

Background: Lung cancer is a major health burden causing 160,000 and 1.6 million deaths annually in the United States and worldwide, respectively. Methods: While seeking to identify stable and reproducible biomarkers in noninvasively collected biofluids, we assessed whether previously identified metabolite urinary lung cancer biomarkers, creatine riboside (CR), N-acetylneuraminic acid (NANA), cortisol sulfate, and indeterminate metabolite 561+, were elevated in the urines of subjects prior to lung cancer diagnosis in a well-characterized prospective Southern Community Cohort Study (SCCS). Urine was examined from 178 patients and 351 nondiseased controls, confirming that one of four metabolites was associated with lung cancer risk in the overall case–control set, whereas two metabolites were associated with lung cancer risk in European-Americans. Results: OR of lung cancer associated with elevated CR levels, and adjusted for smoking and other potential confounders, was 2.0 [95% confidence interval (CI), 1.2–3.4; P= 0.01]. In European-Americans, both CR and NANA were significantly associated with lung cancer risk (OR = 5.3; 95% CI, 1.6–17.6; P= 0.006 and OR=3.5; 95% CI, 1.5–8.4; P= 0.004, respectively). However, race itself did not significantly modify the associations. ROC analysis showed that adding CR and NANA to a model containing previously established lung cancer risk factors led to a significantly improved classifier (P= 0.01). Increasing urinary levels of CR and NANA displayed a positive association with increasing tumor size, strengthening a previously established link to altered tumor metabolism. Conclusion and Impact: These replicated results provide evidence that identified urinary metabolite biomarkers have a potential utility as noninvasive, clinical screening tools for early diagnosis of lung cancer. Cancer Epidemiol Biomarkers Prev; 25(6); 978–86. ©2016 AACR.

Background: The American Cancer Society (ACS) publishes behavioral guidelines for cancer prevention, including standards on body weight, physical activity, nutrition, alcohol, and tobacco use. The impact of these guidelines has been rarely studied in low-income and African American populations.Methods: The study included 61,098 racially diverse, mainly low-income adults who participated in the Southern Community Cohort Study and were followed for a median of 6 years. Cox models were used to estimate HRs for cancer incidence associated with behaviors and with an ACS physical activity/nutrition 0-to-4 compliance score indicating the number of body weight, physical activity, healthy eating, and alcohol guidelines met.Results: During the study period, 2,240 incident cancers were identified. Significantly lower cancer incidence was found among never smokers and non/moderate alcohol drinkers, but not among those meeting guidelines for obesity, physical activity, and diet. The ACS compliance score was inversely associated with cancer risk among the 25,509 participants without baseline chronic disease. HRs for cancer incidence among those without baseline chronic diseases and who met one, two, three, or four guidelines versus zero guidelines were 0.93 (95% confidence intervals, 0.71–1.21), 0.85 (0.65–1.12), 0.70 (0.51–0.97), and 0.55 (0.31–0.99), respectively. Associations were consistent in analyses stratified by sex, race, household income, and smoking status.Conclusions: Meeting the ACS smoking and body weight/physical activity/dietary/alcohol guidelines for cancer prevention is associated with reductions in cancer incidence in low-income and African American populations.Impact: This study provides strong evidence supporting lifestyle modification to lower cancer incidence in these underserved populations. Cancer Epidemiol Biomarkers Prev; 25(5); 846–53. ©2016 AACR.

Background: Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease. Methods: We surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. Seven items assessed attitudes toward aspects of precision smoking treatment, from undergoing tests to acting on results. Items were dichotomized as favorable (5 = strongly agree/4 = agree) versus less favorable (1 = strongly disagree/2 = disagree/3 = neutral); a summary score reflecting generalized attitudes was also computed. Multivariable logistic regression tested independent associations of motivation (precontemplation, contemplation, and preparation) and confidence in quitting (low, medium, and high) with generalized attitudes, controlling for sociodemographic factors and nicotine dependence. Results: More than 70% of respondents endorsed favorable generalized attitudes toward precision medicine, with individual item favorability ranging from 64% to 83%. Smokers holding favorable generalized attitudes reported higher income and education (P < 0.05). Predicted probabilities of favorable generalized attitudes ranged from 63% to 75% across motivation levels [contemplation vs. precontemplation: adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI), 1.36–3.25, P = 0.001; preparation vs. precontemplation: AOR = 1.83, 95% CI, 1.20–2.78, P = 0.005; contemplation vs. preparation: AOR = 1.15, 95% CI, 0.75–1.77, P = 0.52] and from 59% to 78% across confidence (medium vs. low: AOR = 1.91, 95% CI, 1.19–3.07, P = 0.007; high vs. low: AOR = 2.62, 95% CI, 1.68–4.10, P < 0.001; medium vs. high: AOR = 0.73, 95% CI, 0.48–1.11, P = 0.14). Conclusions: Among disproportionately burdened community smokers, most hold favorable attitudes toward precision smoking treatment. Individuals with lower motivation and confidence to quit may benefit from additional intervention to engage with precision smoking treatment. Impact: Predominantly favorable attitudes toward precision smoking treatment suggest promise for future research testing their effectiveness and implementation.

Oral microbiome may play an important role in cancer pathogenesis. However, no study has prospectively investigated the association of the oral microbiome with subsequent risk of developing colorectal cancer (CRC). We conducted a nested case-control study including 231 incident CRC cases and 462 controls within the Southern Community Cohort Study with 75% of the subjects being African-Americans. The controls were individually matched to cases based on age, ethnic group, smoking, season-of-study enrollment and recruitment method. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Multiple bacterial taxa showed an association with CRC risk at p

PURPOSE: We prospectively examined associations of lung cancer risk with food intakes of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a low-income population of black and white adults in the southeastern US. METHODS: Within the Southern Community Cohort Study, we included 1,064 incident lung cancer cases among 68,236 participants aged 40–79 years at study enrollment. Food intakes and use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs). RESULTS: Folate and/or folic acid intakes from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with lowest quartile were 1.04 (0.87–1.24) for total dietary folate, 0.95 (0.80–1.13) for food folate, and 1.07 (0.90–1.27) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR=1.46, 95% CI=1.04–2.05 for the highest quartile compared with the lowest quartile, P-trend=0.02). Neither the use of folic acid-containing supplements nor food intakes of vitamin B(6), vitamin B(12) and riboflavin were associated with lung cancer risk. CONCLUSIONS: Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a low-income population of black and white adults in the southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.

This cohort study examines the associations of colorectal cancer screening and modalities with colorectal cancer incidence and mortality by race and socioeconomic status among southern US adults., Key Points Question What are the associations between colorectal cancer screening modalities with colorectal cancer risk and mortality among African American individuals and individuals with low socioeconomic status, who more often face barriers to screening and experience colorectal cancer health disparities? Findings In this cohort study of 47 596 adults, colorectal cancer screening was significantly associated with reduced colorectal cancer risk and mortality. Use of colonoscopy was associated with a 45% reduced incidence of colorectal cancer, use of sigmoidoscopy with a 34% reduced incidence, and stool-based tests with a 25% reduced incidence compared with no screening. Meaning The large colorectal cancer disparities experienced by individuals with low socioeconomic status and African American individuals may be lessened by improving access to and uptake of colorectal cancer screening., Importance Colorectal cancer (CRC) screening is rarely studied in populations who may face additional barriers to participate in cancer screening, such as African American individuals and individuals with low socioeconomic status (SES). Objective To examine the associations of CRC screening and modalities with CRC incidence and mortality by race and SES. Design, Setting, and Participants This cohort study used data from the Southern Community Cohort Study, which enrolled more than 85 000 participants from community health centers or stratified random sampling of the general population in 12 states in the southeastern United States. The present study included data from cohort members who were eligible for CRC screening as recommended by expert organizations based on age and family history. Participants completed questionnaires from 2002 to 2009 and were contacted again from 2008 to 2012. Linkages to state cancer registries and the National Death Index as of December 31, 2016, identified incident CRC and vital status. Data analysis was performed from January 1, 2018, to October 30, 2019. Main Outcomes and Measures Incident CRC (n = 632) and mortality (n = 10 003). Cox proportional hazards regression models evaluated associations between screening modalities and CRC risk and mortality. Information on fecal occult blood test use was only obtained on the follow-up questionnaire. Self-identified race was measured as African American/black, white, or other, and SES was defined by household income. Results This study included 47 596 participants (median baseline age, 54 years [interquartile range, 10 years]; 32 185 [67.6%] African American; 28 884 [60.7%] female; and 26 075 [54.8%] with household income

Background: Pancreatic cancer (PC) is one of the deadliest malignancies. Lab based research suggests that two types of polyunsaturated fatty acids (PUFA), n-3 and n-6 PUFA, may have opposing effects on PC carcinogenesis. However, human evidence on the role of dietary PUFA intake in PC risk is inconsistent. Previous epidemiological studies on this topic were conducted primarily among Whites and included few individuals from low socioeconomic status (SES). The exposure patterns of n-3 and n-6 PUFA differ across racial groups, with African Americans (AAs) in the high end and Asians in the low end of range. To better characterize the associations of PUFA with PC risk, we conducted a nested case-control study focusing on understudied Asians and low SES AAs and Whites. Methods: We performed a nested case-control study within three population-based prospective cohort studies: the Shanghai Women’s Health Study (SWHS), Shanghai Men’s Health Study (SMHS), and Southern Community Cohort Study (SCCS). Dietary PUFA intakes and other variables were collected from the baseline dietary and other questionnaires. Participants were followed up through annual linkage to cancer registries. Controls were matched to cases on age, sex, and blood sample availability in SWHS/SMHS, and age, sex, race, and enrollment location in SCCS, using incidence density sampling (case-to-control ratio:1:4). Included in the study are 244 cases and 973 controls of Asian females in SWHS, 189 cases and 755 controls of Asian males in SMHS, and 307 cases and 1,228 controls in SCCS (including 219 cases and 876 controls of AAs). The PUFA intake was adjusted for total energy intake using the residual method. Conditional logistic regression analyses were performed to estimate the association of PC risk with dietary PUFA consumption after adjusting for potential covariates. Results: The average dietary intake (mean ± SD; g/day) of n-3 and n-6 PUFA were 1.0 ± 0.5 and 6.3 ± 3.1, 1.1 ± 0.5 and 7.2 ± 3.0, and 2.0 ± 1.2 and 19.3 ± 11.7 in the controls of SWHS, SMHS and SCCS, respectively. We observed that in Chinese men, high intakes of certain n-3 PUFA were significantly associated with increased PC risk. The adjusted odds ratio (OR) (95% confidence interval (CI)) comparing the highest versus lowest quartile of docosapentaenoic acid (DPA) was 1.79 (1.10-2.93), with a p for trend across quartiles of 0.02. For docosahexaenoic acid (DHA), the OR 4th vs. 1st quartile (95% CI) = 1.71 (1.06-2.78) (p for trend = 0.04). For marine n-3 PUFA, the OR 4th vs. 1st quartile (95% CI) = 1.69 (1.03-2.76) (p for trend = 0.04). There was no significant association for n-6 PUFA. No significant association was observed for n-3 or n-6 PUFA with PC risk in SWHS or SCCS. Conclusions: In a nested case-control study, we observed that in Chinese men, the dietary intake of overall marine n-3 PUFA, DPA, and DHA were positively associated with PC risk. Such associations were not observed in Chinese women or low SES AAs/Whites. Citation Format: Lang Wu, Wei Zheng, William J. Blot, Mark D. Steinwandel, Wanqing Wen, Yong-Bing Xiang, Yu-Tang Gao, Hong-Lan Li, Rachael Stolzenberg-Solomon, Harvey J. Murff, Xiao-Ou Shu. Dietary polyunsaturated fatty acids intake and pancreatic cancer risk in understudied populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 639.

Background and Objective The oral microbiome may help to maintain systemic health, including how it affects blood glucose levels; however, direct evidence linking the oral microbiome with diabetes is lacking. Material and Methods We compared the oral microbiome profiles of 98 participants with incident diabetes, 99 obese non-diabetics and 97 normal weight non-diabetics, via deep sequencing of the 16S rRNA gene. Results We found that the phylum Actinobacteria was present significantly less abundant among patients with diabetes than among the controls (p = 3.9 × 10−3); the odds ratio (OR) and 95% confidence interval (CI) was 0.27 (0.11–0.66) for those individuals who had relative abundance higher than the median value. Within this phylum, five families and seven genera were observed, and most of them were less abundant among patients with diabetes. Notably, genera Actinomyces and Atopobium were associated with 66% and 72% decreased risk of diabetes with p-values of 8.9 × 10−3 and 7.4 × 10−3, respectively. Stratified analyses by race showed that most taxa in this phylum were associated with diabetes in both black and white participants. This phylum was also less abundant among non-diabetic obese subjects compared to normal weight individuals, particularly genera Mobiluncus, Corynebacterium and Bifidobacterium, which showed p < 0.05. Conclusion Our study revealed that multiple bacteria taxa in the phylum Actinobacteria are associated with the risk of type 2 diabetes. Some are also associated with the prevalence of obesity, suggesting that the oral microbiome may play an important role in diabetes etiology.

Objectives. We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors. Methods. We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension. Results. Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR]=1.07; 95% confidence interval [CI]=0.95, 1.20); women: OR=1.13, 95% CI=1.04, 1.22). Conclusions. Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race.

Background: Baseline prostate specific antigen (PSA) levels measured in midlife predict future prostate cancer mortality among white men. There are minimal data on whether a baseline PSA in African-American men, who experience the highest incidence and mortality of this disease, predicts future aggressive prostate cancer. Methods: We undertook a nested case-control study among African-American men age 40 to 64 years who gave prediagnostic blood at enrollment in the Southern Community Cohort Study between 2002-2009 and were followed a median of 9 years for cancer incidence and mortality through 2015. Baseline total and free PSA levels were available for 197 prostate cancer cases (55 aggressive cases, Gleason ≥4+3=7, AJCC Stage III or IV, or cancer-specific death) and 569 age-matched controls. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between baseline PSA levels and risk of total and aggressive prostate cancer. Results: Median PSA among controls was 0.72, 0.80, 0.94, and 1.03 ng/mL for men aged 40 to 49, 50 to 54, 55 to 59, and 60 to 64 years, respectively. Relative risk of total prostate cancer was strongly associated with baseline PSA levels in midlife: ORs (95% CIs) comparing PSA levels in the >90th percentile vs. ≤median were 93.7 (22.5-390) at 40 to 54 years and 77.0 (24.9-238) at 55 to 64 years. Risk of aggressive prostate cancer was also strongly associated with baseline PSA levels in midlife: ORs (95% CIs) comparing PSA levels in the >90th percentile vs. ≤median were 80.8 (14.7 to infinity) at 40-54 years Citation Format: Mark Preston, Travis Gerke, Sigrid V. Carlsson, Lisa Signorello, Daniel D. Sjoberg, Sarah C. Markt, Adam S. Kibel, Quoc-Dien Trinh, Mark Steinwandel, William Blot, Andrew J. Vickers, Hans Lilja, Lorelei A. Mucci, Kathryn M. Wilson. Baseline prostate-specific antigen (PSA) levels in midlife predict aggressive prostate cancer in African-American men [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr B28.

Background A healthy diet, as defined by the US Dietary Guidelines for Americans (DGA), has been associated with lower morbidity and mortality from major chronic diseases in studies conducted in predominantly non-Hispanic white individuals. It is unknown whether this association can be extrapolated to African-Americans and low-income populations. Methods and Findings We examined the associations of adherence to the DGA with total and cause-specific mortality in the Southern Community Cohort Study, a prospective study that recruited 84,735 American adults, aged 40–79 y, from 12 southeastern US states during 2002–2009, mostly through community health centers that serve low-income populations. The present analysis included 50,434 African-Americans, 24,054 white individuals, and 3,084 individuals of other racial/ethnic groups, among whom 42,759 participants had an annual household income less than US$15,000. Usual dietary intakes were assessed using a validated food frequency questionnaire at baseline. Adherence to the DGA was measured by the Healthy Eating Index (HEI), 2010 and 2005 editions (HEI-2010 and HEI-2005, respectively). During a mean follow-up of 6.2 y, 6,906 deaths were identified, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. A higher HEI-2010 score was associated with lower risks of disease death, with adjusted hazard ratios (HRs) of 0.80 (95% CI, 0.73–0.86) for all-disease mortality, 0.81 (95% CI, 0.70–0.94) for cardiovascular disease mortality, 0.81 (95% CI, 0.69–0.95) for cancer mortality, and 0.77 (95% CI, 0.67–0.88) for other disease mortality, when comparing the highest quintile with the lowest (all p-values for trend < 0.05). Similar inverse associations between HEI-2010 score and mortality were observed regardless of sex, race, and income (all p-values for interaction > 0.50). Several component scores in the HEI-2010, including whole grains, dairy, seafood and plant proteins, and ratio of unsaturated to saturated fatty acids, showed significant inverse associations with total mortality. HEI-2005 score was also associated with lower disease mortality, with a HR of 0.86 (95% CI, 0.79–0.93) when comparing extreme quintiles. Given the observational study design, however, residual confounding cannot be completely ruled out. In addition, future studies are needed to evaluate the generalizability of these findings to African-Americans of other socioeconomic status. Conclusions Our results showed, to our knowledge for the first time, that adherence to the DGA was associated with lower total and cause-specific mortality in a low-income population, including a large proportion of African-Americans, living in the southeastern US., In a prospective cohort study, Wei Zheng and colleagues study the association between adherence to dietary guidelines and mortality in low-income US adults, two thirds of whom are African-Americans., Editors' Summary Background Certain parts of the population, including women, children, ethnic and racial minorities, and poor people, are often underrepresented in clinical trials and in epidemiological studies (which examine the patterns, causes, and effects of health and disease conditions). In the US population, the link between diet and health has mostly been studied in non-Hispanic white individuals from middle- and high-income households. Such studies formed the basis for the Dietary Guidelines for Americans (DGA), and more recently have shown that adherence to the DGA is associated with lower levels of obesity, as well as lower risks for diabetes, cardiovascular disease (such as heart attacks and strokes), and certain cancers. To measure adherence to the DGA, the Center for Nutrition Policy and Promotion at the US Department of Agriculture developed the Healthy Eating Index (HEI) in 1995. The DGA and the HEI have been updated several times, and the HEI-2010—the latest version—reflects the 2010 DGA. Why Was This Study Done? Because research participants are often not representative of the entire US population, it is unknown whether the results of many studies are valid for all Americans. To remedy this situation, efforts have been made to recruit participants from previously underrepresented parts of the population and to address important health questions in such groups. For this study, the researchers wanted to examine whether adherence to the DGA was associated with better health outcomes in poor people and African-Americans, consistent with the results in wealthier non-Hispanic white individuals. What Did the Researchers Do and Find? The researchers analyzed data from the Southern Community Cohort Study (SCCS). The SCCS was funded by the National Cancer Institute and was initiated in 2001 with the goal of addressing unresolved questions about the causes of cancer and other chronic diseases, as well as reasons for health disparities. The SCCS recruited most of its participants from community health centers in 12 states in the southeastern US. These centers serve predominantly poor and uninsured people, including many African-Americans. Of approximately 85,000 SCCS participants, over two-thirds were African-American, and over half were poor, with an annual household income of less than US$15,000. For this study, the researchers used a food frequency questionnaire that was designed to capture foods commonly consumed in the southeastern US, and from this calculated HEI-2010 scores for each participant. They also collected other health- and lifestyle-related information. They then followed all participants for whom they had complete information (over 77,000) for a number of years (half of them for over 6.2 years). During that period, 6,906 participants died; including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. When the researchers tested for a possible association between HEI-2010 and death (controlling for other relevant factors such as age, weight, exercise, smoking, and the presence of specific chronic diseases), they found that participants with a higher HEI-2010 score (reflecting better adherence to the DGA) had a lower risk of dying in the follow-up period. Participants with the healthiest diet (those in the top one-fifth of HEI-2010 scores) had only about 80% of the risk of death of those with the unhealthiest diets (those in the bottom one-fifth of HEI-2010 scores). This reduction in the risk of death by approximately 20% was true for death from any disease, death from cancer, and death from cardiovascular disease. What Do These Findings Mean? The results support the validity of the DGA for healthy eating across the US population. However, the study had some limitations. For example, participants were asked only once—when they first joined the SCCS—about their diet, their household income, and other factors that can change over time, such as exercise habits and diseases they have been diagnosed with. Besides such changes, there could be other factors not captured in the study that might influence the association between diet and death. Despite these uncertainties, the findings suggest that adherence to the DGA is associated with lower total mortality and mortality from cancer or cardiovascular disease in poor US Americans in general, and in low-income African-Americans. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001830. Information is available online about the Southern Community Cohort Study The US Department of Agriculture’s Center for Nutrition Policy and Promotion has information on the Healthy Eating Index, which is based on the Dietary Guidelines for Americans The World Health Organization provides information on diet as part of its global strategy for diet, physical activity, and health, as well as a factsheet on healthy diet Wikipedia has a page on race and health in the US (note that Wikipedia is a free online encyclopedia that anyone can edit)

Purpose: Animal and cell line studies provide biologic plausibility that circulating vitamin D may reduce colorectal cancer risk. However, studies in humans have been inconclusive, and few have considered the role of vitamin D binding protein and free vitamin D. We comprehensively evaluated whether vitamin D biomarkers predict risk of colorectal cancer by measuring circulating level of vitamin D binding protein, and total and free 25-hydroxyvitamin D in pre-diagnostic blood serum samples. We used data from a nested case-control study that includes a large number of African Americans, who typically have lower levels of total vitamin D than those of European descent, and who have been understudied in previous investigations. Methods: Participants of the nested case-control study were drawn from the Southern Community Cohort Study, a prospective cohort study primarily comprised of low-income white and African Americans. Participants aged 40-79 were enrolled into the study from 2002 to 2009, and provided information on lifestyle factors and demographics. Cases were participants who were diagnosed with an incident colorectal cancer after study enrollment and donated a blood sample for the study. Controls were selected through incidence density sampling of the cohort members who had donated a blood sample and were free of any cancer except skin cancer at the time of the case's diagnosis. Controls were individually matched to cases by age at diagnosis, sex, and race at a ratio of two controls for each case. A total of 298 cases and 580 controls were included in the current study. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between vitamin D biomarker levels and colorectal cancer risk. Results: ORs for the associations between total and free 25-hydroxyvitamin D with colorectal cancer risk indicated inverse associations, although all confidence intervals crossed unity. More apparent associations were observed among cases with greater than three years between blood draw and diagnosis. Among these subjects, the adjusted ORs for the comparison between participants in the highest tertile of free 25-hydroxyvitamin D levels compared to those in the lowest tertile were 0.65 (95%CI: 0.38,1.11) for all subjects and 0.46 (95%CI: 0.25,0.84) for African Americans. In participants with greater than three years between blood draw and diagnosis, the inverse association pattern was seen in all strata defined by sex, body mass index, and anatomic site, although not all analyses reached significance at P ≤ 0.05. Small samples size in analyses restricted to whites resulted in unstable estimates. Vitamin D binding protein was not associated with colorectal cancer risk. Conclusions: In our study, total and free 25-hydroxyvitamin D are inversely associated with colorectal cancer risk, particularly in African Americans, suggesting a potential role of vitamin D in colorectal cancer prevention. Citation Format: Shaneda Warren Andersen, Xiao-Ou Shu, Qiuyin Cai, Mark Steinwandel, William J. Blot, Wei Zheng. Total and free vitamin D, vitamin D binding protein, and colorectal cancer risk in the Southern Community Cohort Study. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr B34.

Background: Public health and cancer prevention guidelines recommend healthy behaviors to decrease overall cancer risk. The impact of cancer prevention guidelines on cancer incidence has been rarely studied in low-income Whites and African Americans. Design: We quantified the association of meeting current American Cancer Society cancer prevention guidelines, as measured by non-smoking, none to moderate alcohol intake, higher diet quality, and regular physical activity with total and site-specific cancer incidence. Data were obtained at enrollment from 73,022 adults age 40-79, without a previous cancer diagnosis, participating in the Southern Community Cohort Study. The Southern Community Cohort Study is a prospective cohort study that enrolled participants during 2002-2009, in 12 southeastern US states via Community Health Centers (86%) or stratified random sampling of the general population (14%). Fifty-six percent of the cohort has a household income Exposures: We created a healthy guidelines score by counting the number of cancer prevention guidelines each participant met for tobacco smoking, alcohol intake, diet, and physical activity. Outcomes: Breast (N = 503), prostate (N = 479), lung (N = 621), colorectal (N = 333), other (N = 1374), and total cancer incidence (N = 3,310) were identified from state cancer registries through December 31, 2011. Results: Meeting fewer cancer prevention guidelines was associated with increased cancer incidence: hazard ratios (HRs) for overall cancer incidence comparing participants with four guidelines met vs three, two, one, or zero guidelines were 1.04 (95% confidence interval (CI): 0.79-1.38), 1.23 (0.94-1.61), 1.52 (1.16-1.98), and 1.86 (1.40-2.46), respectively. Tests for interactions with race and sex were not statistically significant. The association between the healthy guidelines score and total cancer incidence was most apparent in participants with normal weight (body mass index 18.5-24.9 kg/m2) (P-interaction = 0.02). The strongest association was observed for lung cancer risk largely attributable to the sizable numbers of current smokers in the cohort; the HR for participants meeting no guideline recommendations compared to participants meeting three or four healthy guidelines was 6.78 (95%CI: 4.24-10.84). Weaker and non-significant associations were observed between the healthy guidelines score and breast, colorectal, and prostate cancer risk (all P-trends>0.10). Conclusions: Meeting current public health guidelines is associated with substantial reductions in cancer incidence. This study provides support for individual lifestyle modification to reduce cancer incidence in this under-served population. Citation Format: Shaneda N. Warren Andersen, Jennifer Sonderman, Xiao-Ou Shu, Danxia Yu, Mark Steinwandel, Joesph K. McLaughlin, Margaret K. Hargreaves, William J. Blot, Wei Zheng. The association between cancer prevention guidelines and cancer risk in the Southern Community Cohort Study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 861. doi:10.1158/1538-7445.AM2015-861

Objective: To assess potential health risks associated with work in a large motion picture film-processing facility. Methods: A retrospective cohort mortality study was conducted during 1960-2000 among 2646 film workers. Job family categories, created from detailed employee work history information, were used to evaluate chemical exposure patterns. Results: Overall mortality was as expected (standardized mortality ratio [SMR] = 1.1; 95 % confidence interval [CIJ = 1.0-1.2). Statistically significant associations were found for suicides (SMR = 2.0; 95% CI = 1.2-3.0) among the hourly workers and AIDS (SMR = 5.3; 95 % CI = 1. 7-12.3) among the administrative workers. Film developers had increases of respiratoty cancer (SMR = 1.9; 95% CI = 1.1-3.0) and suicides (SMR = 2.4; 95% CI = 1.0-4.7), whereas film assemblers had an increase in suicides (SMR = 2.4; 95% CI = 1.2-4.4) only. Conclusions: Excess deaths resulting from suicides and AIDS among the workforce suggest that non occupational influences may be involved in the mortality of this cohort and warrant further investigations.