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Importance: Disasters experienced by an entire community provide opportunities to understand individual differences in risk for adverse health outcomes over time. DNA methylation (DNAm) differences may help to distinguish individuals at increased risk following large-scale disasters., Objective: To examine the association of epigenetic age acceleration with probable posttraumatic stress disorder (PTSD) and PTSD symptom severity in women., Design, Setting, and Participants: This prospective cohort study examined data from participants in the Women and Their Children's Health cohort, who were characterized longitudinally following the Deepwater Horizon oil spill (DHOS) in 2010 and through numerous hurricanes in the Gulf Coast region of the US. Wave 1 occurred August 6, 2012, through June 26, 2014, and wave 2 occurred September 2, 2014, through May 27, 2016. Data were analyzed between August 18 and November 4, 2023. Address-based sampling was used to recruit women aged 18 to 80 years and residing in 1 of the 7 Louisiana parishes surrounding the DHOS-affected region. Recruitment consisted of 2-stage sampling that (1) undersampled the 2 more urban parishes to maximize probability of participant oil exposure and (2) proportionally recruited participants across census tracts in the 5 other parishes closest to the spill., Exposure: Posttraumatic stress subsequent to the DHOS., Main Outcome and Measures: Epigenetic age acceleration was measured by DNAm assayed from survey wave 1 blood samples. Posttraumatic stress disorder was assessed using the PTSD Checklist for DSM-5 at survey wave 2, and lifetime trauma exposure was assessed using the Life Events Checklist for DSM-5. General linear models were used to examine the association between wave 1 DNAm age and wave 2 probable PTSD diagnosis and symptom severity., Results: A total of 864 women (mean [SD] age, 47.1 [12.0] years; 328 Black [38.0%], 19 American Indian [2.2%], 486 White [56.3%], and 30 of other racial groups, including uknown or unreported [3.5%]) were included. Black and American Indian participants had a higher age acceleration at wave 1 compared with White participants (β = 1.64 [95% CI, 1.02-2.45] and 2.34 [95% CI, 0.33-4.34], respectively), and they had higher PTSD symptom severity at wave 2 (β = 7.10 [95% CI, 4.62-9.58] and 13.08 [95% CI, 4.97-21.18], respectively). Epigenetic age acceleration at wave 1 was associated with PTSD symptom severity at wave 2 after adjusting for race, smoking, body mass index, and household income (β = 0.38; 95% CI, 0.11-0.65)., Conclusions and Relevance: In this cohort study, epigenetic age acceleration was higher in minoritized racial groups and associated with future PTSD diagnosis and severity. These findings support the need for psychoeducation about traumatic responses to increase the likelihood that treatment is sought before years of distress and entrenchment of symptoms and comorbidities occur.

Competing Interests: None.

During the coronavirus disease 2019 (COVID-19) pandemic, navigating the implementation of public health measures in a politically charged environment for a large state entity was challenging. However, Louisiana State University (LSU) leadership developed and deployed an effective, multi-layered mitigation plan and successfully opened in-person learning while managing cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the fourth surge. We describe the plan to provide a framework for other institutions during this and future responses. The goals were 3-fold: maintain a quality learning environment, mitigate risk to the campus community, and ensure that LSU operations did not contribute to health-care stress. As of September 2022, LSU has achieved high compliance with interventions and relatively low virus activity on campus compared with peer institutions. This university model can serve as a template for similar implementation plans in the context of complex socio-political and economic considerations.

Background: The overall survival rate of prostate cancer (PCa) has improved over the past decades. However, huge socioeconomic and racial disparities in overall and prostate cancer-specific mortality exist. The neighborhood-level factors including socioeconomic disadvantage and lack of access to care may contribute to disparities in cancer mortality. This study examines the impact of neighborhood deprivation on mortality among PCa survivors., Methods: North Carolina-Louisiana Prostate Cancer Project (PCaP) data were used. A total of 2113 men, 1046 AA and 1067 EA, with PCa were included in the analysis. Neighborhood deprivation was measured by the Area Deprivation Index (ADI) at the census block group level using data from the US Census Bureau. Quintiles of ADI were created. Cox proportional hazards and competing risk models with mixed effects were performed to estimate the effect of neighborhood deprivation on all-cause and PCa-specific mortality adjusted for age, race, study site, insurance status, and comorbidities., Results: Participants living in the most deprived neighborhoods had an increased risk for all-cause mortality (quintiles 4 + 5: adjusted hazard ratio [aHR] = 1.51, 95% confidence interval [CI] = 1.16-1.96) compared to those in the least deprived (quintile 1) neighborhoods. The risk of prostate cancer-specific mortality was also higher among those living in the deprived neighborhoods (quintiles 4 + 5: aHR = 1.90, 95% CI = 1.10-3.50) than those in the least deprived neighborhood., Conclusions: The findings suggest neighborhood-level resources or health interventions are essential to improve survival among men with PCa. Additional research should focus on the mechanisms of how the neighborhood environment affects mortality., (© 2022 The Authors. The Prostate published by Wiley Periodicals LLC.)

Purposes: Our study aimed to examine the impact of diabetes, smoking and BMI on pancreatic cancer survival in a population-based setting by adjusting both sociodemographic and clinical factors and measuring their attributable risk., Methods: Data on pancreatic adenocarcinoma patients diagnosed in 2011-2017 were acquired from the Louisiana Tumor Registry. Diabetes, smoking, height, and weight were abstracted from medical records and linked with Hospital Inpatient Discharge Data to enhance the completeness of the diabetes data. The Cox regression model was used to assess effect sizes of diabetes, smoking, and BMI on cancer-specific survival and survival rate. The partial population attributable risk was employed to measure the attributable risk of these risk factors., Results: Of the 3,200 eligible patients, 34.6% were diabetics, 23.9% were current smokers, and 52.3% had BMI ≥ 25 kg/m 2 . After adjusting for sociodemographic and clinical factors, diabetic patients had an increased cancer-specific death risk of 15% (95% CI, 1.06-1.25), 36% (95% CI, 1.19-1.44) for current smokers, and 24% (95% CI, 1.00-1.54) for patients with a BMI ≥ 40 when compared to their counterparts. Diabetic current smokers had significantly lower 2- and 3-year adjusted cancer-specific survival rates, 13.1% and 10.5%, respectively. By eliminating diabetes and modifiable risk factors, an estimated 16.6% (95% CI, 6.9%-25.9%) of the cancer-specific deaths could be avoided during a nine-year observational period between 2011 and 2019., Conclusions: Diabetes and smoking contributed substantially to the reduction of pancreatic cancer survival even after controlling for sociodemographic and clinical factors; however, BMI ≥ 35 was observed to increase risk of mortality among stage III-IV patients only., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

We investigated the association between the 5As (Ask, Advise, Assess, Assist, and Arrange) clinical protocol and stage of change among African American smokers who are eligible for low-dose computed tomography screening. In 2019, 60 African American daily smokers aged 55 years or older were recruited in a large hospital in New Orleans, Louisiana. Smokers who received assistance for smoking cessation were more likely to be in the preparation stage than those who did not receive any assistance. Assistance from health professionals is an essential form of support and may substantially enhance smokers' motivation to quit smoking in this population that is at higher risk for mortality from lung cancer.

Background: While the primary role of central cancer registries in the United States is to provide vital information needed for cancer surveillance and control, these registries can also be leveraged for population-based epidemiologic studies of cancer survivors. This study was undertaken to assess the feasibility of using the NCI's Surveillance, Epidemiology, and End Results (SEER) Program registries to rapidly identify, recruit, and enroll individuals for survivor research studies and to assess their willingness to engage in a variety of research activities., Methods: In 2016 and 2017, six SEER registries recruited both recently diagnosed and longer-term survivors with early age-onset multiple myeloma or colorectal, breast, prostate, or ovarian cancer. Potential participants were asked to complete a survey, providing data on demographics, health, and their willingness to participate in various aspects of research studies., Results: Response rates across the registries ranged from 24.9% to 46.9%, with sample sizes of 115 to 239 enrolled by each registry over a 12- to 18-month period. Among the 992 total respondents, 90% answered that they would be willing to fill out a survey for a future research study, 91% reported that they would donate a biospecimen of some type, and approximately 82% reported that they would consent to have their medical records accessed for research., Conclusions: This study demonstrated the feasibility of leveraging SEER registries to recruit a geographically and racially diverse group of cancer survivors., Impact: Central cancer registries are a source of high-quality data that can be utilized to conduct population-based cancer survivor studies., (©2020 American Association for Cancer Research.)

Background: Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms., Methods: To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes., Results: Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis., Limitations: This study was limited by use of self-reported data and one-time assessment of PTSD symptoms., Discussion: Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS)., Methods: The Women and Their Children's Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress., Results: After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed., Conclusion: A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183-190).

Purpose: Smoking in young adults identifies the population at risk for future tobacco-related disease. We investigated smoking in a young adult population and within high-risk groups using emergency department (ED) data in a metropolitan area., Methods: Using the electronic health record, we performed a retrospective study of smoking in adults aged 18-30 years presenting to the ED., Results: Smoking status was available for 55,777 subjects (90.9% of the total ED cohort); 60.8% were women, 55.0% were black, 35.3% were white, and 8.1% were Hispanic; 34.4% were uninsured. Most smokers used cigarettes (95.1%). Prevalence of current smoking was 21.7% for women and 42.5% for men. The electronic health record contains data about diagnosis and social history that can be used to investigate smoking status for high-risk populations. Smoking prevalence was highest for substance use disorder (58.0%), psychiatric illness (41.3%) and alcohol use (39.1%), and lowest for pregnancy (13.5%). In multivariable analyses, male gender, white race, lack of health insurance, alcohol use, and illicit drug use were independently associated with smoking. Smoking risk among alcohol and drug users varied by gender, race, and/or age., Conclusions: The ED provides access to a large, demographically diverse population, and supports investigation of smoking risk in young adults., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We compared geographic information system (GIS)- and Census-based approaches for measuring the physical and social neighborhood environment at the census tract-level versus and audit approach on associations with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Data were used from the 2012-2014 Women and Their Children's Health (WaTCH) Study ( n =940). Generalized linear models were used to obtain odds ratios (ORs) for BMI (≥30 kg/m 2 ), WC (>88 cm), and WHR (>0.85). Using an audit approach, more adverse neighborhood characteristics were associated with a higher odds of WC (OR: 1.10; 95% CI: 1.05, 1.15) and WHR (OR: 1.09; 95% CI: 1.05, 1.14) after adjustment for age, race/ethnicity, income, and oil spill exposure. There were no significant associations between GIS- and Census- based measures with obesity in adjusted models. Quality aspects of the neighborhood environment captured by audits at the individual-level may be more relevant to obesity than physical or social aspects at the census-tract level., Competing Interests: Conflict of interest None declared.

This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.

Purpose: The severity of the stress response to experiencing disaster depends on individual exposure and background stress prior to the event. To date, there is limited research on the interaction between neighborhood environmental stress and experiencing an oil spill, and their effects on depression. The objective of the current study was to assess if the association between exposure to the Deepwater Horizon Oil Spill (DHOS) and depressive symptoms varied by neighborhood characteristics., Methods: US Census data (2010) and longitudinal data collected in two waves (2012-2014 and 2014-2016) from female residents [N = 889 (Wave I), 737 (Wave II)] of an area highly affected by the DHOS were analyzed. Multilevel and individual-level negative binomial regressions were performed to estimate associations with depressive symptoms in both waves. An interaction term was included to estimate effect modification of the association between DHOS exposure and depressive symptoms by neighborhood characteristics. Generalized estimating equations were applied to the negative binomial regression testing longitudinal associations., Results: Census tract-level neighborhood characteristics were not associated with depressive symptoms. Exposure to the DHOS and neighborhood physical disorder were associated with depressive symptoms cross-sectionally. There was no evidence of effect modification; however, physical/environmental exposure to the DHOS was associated with increased depressive symptoms only among women living in areas with physical disorder. Exposure to the DHOS remained associated with depressive symptoms over time., Conclusions: Findings support the enduring consequences of disaster exposure on depressive symptoms in women and identify potential targets for post-disaster intervention based on residential characteristics.

Purpose: The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill., Participants: Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016., Findings to Date: 2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children., Future Plans: WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The mental health consequences of disasters, including oil spills, are well known. The goal of this study is to examine whether social capital and social support mediate the effects of exposure to the Deepwater Horizon oil spill on depression among women. Data for the analysis come from the first wave of data collection for the Women and Their Children's Health Study, a longitudinal study of the health effects of women exposed to the oil spill in southern Louisiana, USA. Women were interviewed about their exposure to the oil spill, depression symptoms, structural social capital (neighborhood organization participation), cognitive social capital (sense of community and informal social control), and social support. Structural equation models indicated that structural social capital was associated with increased levels of cognitive social capital, which were associated with higher levels of social support, which in turn were associated with lower levels of depression. Physical exposure to the oil spill was associated with greater economic exposure, which in turn was associated with higher levels of depression. When all variables were taken into account, economic exposure was no longer associated with depression, and social support and cognitive social capital mediated the effect of economic exposure on depression, explaining 67% of the effect. Findings support an extension of the deterioration model of social support to include the additional coping resource of social capital. Social capital and social support were found to be beneficial for depression post-oil spill; however, they were themselves negatively impacted by the oil spill, explaining the overall negative effect of the oil spill on depression. A better understanding of the pathways between the social context and depression could lead to interventions for improved mental health in the aftermath of a disaster., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Cancer is the leading cause of death among Hispanics. The burden of cancer mortality within Hispanic groups has not been well quantified. Methods: Cancer mortality rates for 2008-2012 in Florida were computed on the basis of race, ethnicity, and birthplace, specifically focusing on major Hispanic groups-Mexicans, Puerto Ricans, Cubans, Central Americans, South Americans, and Dominicans. Age-adjusted mortality rate ratios derived from negative binomial regression were used to compare Hispanics, aggregated and by group, to nonHispanic whites (NHW). Results: A total of 205,369 cancer deaths from 2008-2012 were analyzed, of which 22,042 occurred in Hispanics. Overall cancer mortality rates were lower for Hispanics, 159 and 100 per 100,000 in males and females, respectively, compared with 204 and 145 per 100,000 in NHWs, largely driven by relatively low rates of lung and breast cancers among Hispanics. However, Hispanics had a higher risk of death from stomach and liver cancers, both infection-related. Of all Hispanic groups, Mexicans had the lowest mortality, whereas Cubans had the highest, with significantly higher mortality for colorectal, endometrial, and prostate cancers. Conclusions: Compared with other Hispanic groups, Cubans and Puerto Ricans had significantly higher rates. For these longer-established populations in the United States, increases in diet and obesity-related cancers are evident. Some groups show excesses that clearly fall out of the common Hispanic patterns, with implications for public health: Cubans for colorectal cancer, Puerto Ricans for liver cancer, and Dominicans for prostate cancer. Impact: Cancer mortality outcomes in Hispanics vary between ethnic groups. Research and public health strategies should consider this heterogeneity. Cancer Epidemiol Biomarkers Prev; 26(3); 376-82. ©2017 AACR ., (©2017 American Association for Cancer Research.)

Introduction: Oil spill exposures are associated with increased levels of depression, which is often measured using continuous scores or dichotomous cut points on screening tools in population-based studies. Latent profile analysis can overcome analytic limitations such as 1) masking of heterogeneity in outcomes among people within dichotomous categories and 2) loss of information about symptom patterns among those with the same continuous score. This study examined variation in depressive symptoms and assessed the associations between depressive symptomatology and oil spill exposure, socioeconomic risk factors, and social capital., Methods: Between 2012 and 2014, we interviewed 2852 women in southeastern Louisiana. We performed latent profile analysis then tested the adjusted associations between sociodemographic characteristics, oil spill exposure and latent class membership., Results: Results indicated a three-class solution in which classes varied by symptom severity as the best fit. The strongest associations were among women with the most severe depressive symptoms, who were less educated, were more economically vulnerable, and had the least social support compared to women with no depressive symptoms., Limitations: This study is limited by its cross-sectional design and the self-reported nature of exposures and depressive symptoms, but results are consistent with prior literature., Conclusions: Our results support the conventional use of screening tools to estimate depressive symptomatology. Nevertheless, the identification of subgroups within study participants highlights an important finding: the subgroups were comprised of characteristically different women with varying levels of depressive symptoms, a discovery that would have been overlooked if the CES-D was used conventionally., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Although many studies have reported associations between characteristics of the neighborhood environment and obesity, little is understood about the pathways or mechanisms through which these associations operate. The purpose of this study was to examine possible behavioral and stress pathways hypothesized to mediate the association between neighborhood environments and obesity and whether pathways contribute to different obesity outcomes. Cross-sectional data were used from the 2012-2014 Women and Their Children's Health Study (WaTCH) in Louisiana (N = 909). Participants' neighborhoods, body mass index (BMI) and waist circumference (WC) were objectively measured. The causal inference approach to mediation analysis was used to obtain indirect estimates for self-reported measures of physical activity, low access to food, and depression. The mean BMI was 32.0 kg/m(2) and the mean WC was 98.6 cm. The (adverse) neighborhood environment was significantly associated BMI (β = 0.17 kg/m(2); 95% Confidence Interval (CI): 0.03, 0.31) and WC (β = 0.64; 95% CI: 0.34, 0.95, after adjusting for covariates. Neither depression, physical activity, nor low food access mediated those associations. Further research that investigates and uses better measures of the behavioral and stress pathways through which the neighborhood environment influences obesity is warranted.

International meetings on various aspects of cancer- its etiology, its diagnosis, its treatment, its palliation, and its prevention and control are held frequently. Many have similar themes, and many seek and receive the same speakers and audiences. A fundamental question arises: what difference does any individual meeting/congress/ conference make or add to our understanding of the relevant issues? While many meetings conduct evaluations at the end of the Congress, few use evaluation as a tool to guide design, implementation, and evaluation of both short and long term impacts, and address the question of "what difference did the Congress make". The International Cancer Control Congresses, which are held biennially in different regions of the world, took the opportunity to use evaluation in this way, and ask the relevant questions. This paper describes that evaluation session of the ICCC4, held in Seoul, Korea in November 2011, which was part of the larger evaluation issue.

Background: Cancer survival is a key indicator of the effectiveness and social justice of health services. However, little is known about cancer survival among Hispanics, how it varies by Hispanic subgroup (Mexicans, Puerto Ricans, Cubans, and Others), and how their survival patterns relate to the Hispanic Paradox., Methods: We studied all 1.2 million cancer cases diagnosed during 1995-2003, in two states, Florida and Texas, according to three categories of outcome: highly fatal outcome, poor outcome, and moderate outcome. All were followed up until December 31, 2006. We calculated survival rates for each Hispanic subgroup, and using Cox regression, we studied the risk of death for each Hispanic subgroup compared with non-Hispanic Whites, adjusted for age, cancer site, and stage at diagnosis., Results: Important differences in cancer survival were found according to Hispanic subgroup. For cancers of moderate outcome, the adjusted risk of death was higher among all Hispanic populations in comparison with non-Hispanic Whites: 6% higher for Cubans, 11% for Puerto Ricans, and 13% for US-born Mexicans. Foreign-born Mexicans, even with incomplete follow-up, had a 24% higher risk of death. For foreign-born Hispanics, except Cubans, the mortality follow-up of cancers of highly fatal outcome was insufficient, resulting in missing deaths and thus unrealistically high survival rates., Conclusions: No evidence of a Hispanic advantage was found in cancer survival. Improvement in mortality follow-up procedures for Latinos, especially for those without a valid social security number, is critical. By considering Hispanics as a whole rather than by subgroup, existing survival disparities are being missed.

Developing and maintaining a comprehensive cancer control program are two distinct entities. Key issues related to building and sustaining cancer control programs include how to integrate initiatives and efforts across multiple constituencies addressing components of the implementation of cancer control and non-communicable disease programs, the processes used in different resource settings to achieve effective drug budgeting, health technology assessment and health economics, and how countries can support public and societal engagement. There are promising examples in both resource-rich and resource-challenged countries of constituencies that have developed programs which can contribute to comprehensive cancer control. Some take advantage of newer technology and information services, while others are more people and patient focused. Critical issues and factors for establishing and maintaining population-based comprehensive cancer control programs are identified and reviewed.

Background: The diversity among Hispanics/Latinos, defined by geographic origin (e.g., Mexico, Puerto Rico, Cuba), has been neglected when assessing cancer morbidity. For the first time in the United States, we estimated cancer rates for Cubans, Mexicans, Puerto Ricans, and other Latinos, and analyzed changes in cancer risk between Hispanics in their countries of origin, U.S. Hispanics in Florida, and non-Hispanic Whites in Florida., Methods: Florida cancer registry (1999-2001) and the 2000 U.S. Census population data were used. The Hispanic Origin Identification Algorithm was applied to establish Hispanic ethnicity and subpopulation., Results: The cancer rate of 537/100,000 person-years (95% confidence interval, 522.5-552.5) for Hispanic males in Florida was lower than Whites (601; 595.4-606.9). Among women, these rates were 376 (365.6-387.1) and 460 (455.6-465.4), respectively. Among Florida Hispanics, Puerto Ricans had the highest rates, followed by Cubans. Mexicans had the lowest rates. Rates for Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin, as reported by the IARC., Conclusion: Substantial variability in cancer rates occurs among Hispanic subpopulations. Cubans, unlike other Hispanics, were comparable with Whites, especially for low rates of cervical and stomach cancers. Despite being overwhelmingly first generation in the U.S. mainland, Puerto Ricans and Cubans in Florida showed rates of colorectal, endometrial, and prostate cancers similar to Whites in Florida. Because rates are markedly lower in their countries of origin, the increased risk for cancer among Cubans, Mexicans, and Puerto Ricans who move to the United States should be further studied.

Childhood exposure to ultraviolet radiation from the sun and a history of sunburns are risk factors for skin cancer. Because children spend time outdoors when they are at school, school sun protection policies are an important health issue, particularly in areas of the country with year-round warm and sunny climates, such as Florida. To better understand the sun protection policies and practices in South Florida schools, a sample (n = 51) of elementary and middle schools in Miami-Dade County public schools were surveyed as part of a CDC-funded cancer control program at the University of Miami. Of the principals and teachers surveyed, most (78%) knew about the county school system's guidelines for avoiding excessive heat exposure, which include two sun protection measures. Two-thirds reported that they shared these guidelines with teachers; 21% shared them with parents. Few schools monitor implementation of the guidelines, although 70% schedule outdoor activities to avoid peak sun hours. No schools required sunscreen, hats, or protective clothing. Physical education teachers and students spend an average of 4.5 and 0.6 hours per day outdoors, respectively. Improved school sun protection policies and monitoring of such policies is needed to reduce sun exposure and skin cancer risk for both students and staff.

Objective: To assess the immediate and intermediate outcome consequences of defunding a successful tobacco use prevention program., Methods: A four-survey repeated cross-sectional design is employed. Two surveys were completed while the program was fully operational, one after program dismantling was initiated and another about 6 months after the campaign was completely dismantled. Survey to survey trends for five immediate and six intermediate outcomes are analyzed. Changes in measures are tested employing chi-square estimated using SAS 8., Results: Each immediate outcome measure declined significantly from the third to the fourth survey except one, and this measure declined from the second to the third survey when it was eliminated. All intermediate outcomes showed significant change from the third or second to the fourth survey. These include two measures of openness to smoking, three attitude/belief scales and one measure of intention to smoke., Conclusions: Defunding a successful tobacco-use prevention campaign results in rapid erosion of program messages, parallel increases in susceptibility, a rapid and sharp re-emergence of pro-tobacco attitudes/beliefs and a marked rise in intentions to smoke.

Although cancer is a leading cause of morbidity and premature death among Latinos, there is limited knowledge of cancer-related issues and priorities of greatest significance to the Latino population, the largest minority group in the nation. This information is vital in helping to guide Latino cancer research, training, and awareness efforts at national, regional, and local levels. To help identify cancer issues of greatest relevance to Latinos, Redes En Accion, The National Hispanic/Latino Cancer Network, a major network among the National Cancer Institute's Special Populations Networks, conducted a survey of 624 key opinion leaders from around the country. Respondents were asked to rank the three cancer sites most important to Latinos in their region and the five issues of greatest significance for this population's cancer prevention and control. Recommendations were prioritized for three specific areas: 1) research, 2) training and/or professional education, and 3) awareness and/or public education. Among cancers, breast carcinoma was ranked number one, followed in order by cervical and lung carcinomas. The issues of greatest significance to Latinos were 1) access to cancer screening and care, 2) tobacco use, 3) patient-doctor communication, 4) nutrition, and 5) risk communication. This survey solicited information from scientists, health care professionals, leaders of government agencies, professional and community-based organizations, and other stakeholders in Latino health. The results laid the foundation for a national Redes En Accion Latino cancer agenda, thus providing a useful tool for individuals and organizations engaged in cancer prevention and control efforts among the Hispanic-Latino population.

Objectives: To identify multi-item attitude/belief scales associated with the theoretical foundations of an anti-tobacco counter-marketing campaign and assess their reliability and validity., Methods: The data analyzed are from two state-wide, random, cross-sectional telephone surveys [n(S1)=1,079, n(S2)=1,150]. Items forming attitude/belief scales are identified using factor analysis. Reliability is assessed with Chronbach's alpha. Relationships among scales are explored using Pearson correlation. Validity is assessed by testing associations derived from the Centers for Disease Control and Prevention's (CDC) logic model for tobacco control program development and evaluation linking media exposure to attitudes/beliefs, and attitudes/beliefs to smoking-related behaviors. Adjusted odds ratios are employed for these analyses., Results: Three factors emerged: traditional attitudes/beliefs about tobacco and tobacco use, tobacco industry manipulation and anti-tobacco empowerment. Reliability coefficients are in the range of 0.70 and vary little between age groups. The factors are correlated with one-another as hypothesized. Associations between media exposure and the attitude/belief scales and between these scales and behaviors are consistent with the CDC logic model., Conclusions: Using reliable, valid multi-item scales is theoretically and methodologically more sound than employing single-item measures of attitudes/beliefs. Methodological, theoretical and practical implications are discussed.

Background: Personal health behaviors play a fundamental role in premature cancer morbidity and mortality. However, routine risk factor data on Latino groups are lacking. Knowledge of cancer risk prevalence by ethnoregional groups is particularly important for development of effective prevention and control strategies., Methods: Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer (NHLIC): En Acción, this paper examines prevalence of six cancer risk factors among Mexican, Puerto Rican, Cuban, and Central American adult males in eight U.S. cities. Data were collected through two telephone surveys. The 1993-1994 sample consisted of 4170 males (2041 <40 years and 2120 > or =40 years). The 1997-1998 sample consisted of 4486 males (2286 <40 years and 2200 > or =40 years)., Results: Clear differences exist in risk factor prevalence among Latino subgroups. Overall, riskiest behaviors were found among Mexican American men in Texas, more of whom smoked, engaged in acute alcohol drinking, and had poorer diets and higher obesity levels than other Latino men., Conclusions: Root causes of these ethnoregional differences are likely due to both economic and cultural factors. Cancer prevention and control strategies and programs should be tailored to address specific needs of each population group.

Objectives: A nested case-control study was conducted in Miami, Fla, to determine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among injection drug users., Methods: The study identified 21 incident cases of HIV-1 infection and 76 unmatched controls from two longitudinal cohorts of injection drug users. One cohort consisted of individuals who originally had been recruited from treatment centers; a second cohort was recruited from the "street." Logistic regression analyses that adjusted for age, gender, and race were performed., Results: The final model determined that the primary independent risk factor that best explained the risk for seroconversion was sharing injection equipment in the year prior to conversion; a marginal risk factor was presence of sexually transmitted disease during this same period., Conclusions: Both an injection component and a sexual component play a role in seroconversion among injection drug users, although the injection component is much stronger.

Background: There are very limited data on cancer among U.S. Hispanics. The data that are available seldom appear outside individual registry reports. Without coalescing and assessing such information, the epidemiology of cancer among Hispanics cannot be understood., Purpose: This article presents an overall view of the epidemiology of cancer among Hispanic populations in the United States., Methods: Major types of cancer were reviewed from geographic areas with 1) large Hispanic/Latino populations and 2) population-based cancer registries that cover 68% of the U.S. Hispanic population. Age-standardized rates, standardized rate ratios, and ranks of the top cancers are presented for Hispanics and non-Hispanics by sex., Results: Hispanic men had consistently lower rates of cancers of the lung, prostate, colon, rectum, and oral cavity as well as of melanoma and non-Hodgkin's lymphoma than non-Hispanic men. Among Hispanic men, higher rates were observed for cancers of the stomach, liver, and gallbladder. Compared with the rates in non-Hispanic women, Hispanic women had consistently lower rates of cancers of the breast, colon, rectum, endometrium, lung, ovary, and oral cavity, non-Hodgkin's lymphoma, and melanoma and higher rates of cancers of the uterine cervix, stomach, liver, and gallbladder. Perhaps more importantly, however, was that, within U.S. Hispanic populations, the top five sites of cancer for women were breast, colon, lung, cervix, and uterine corpus. For men, the top sites were usually prostate, lung, colon, stomach, and rectum. Furthermore, some geographic areas showed differences in the order of importance within these five sites, while in other areas, the top five cancers for Hispanic men included kidney and bladder cancers, liver cancer, and non-Hodgkin's lymphomas. For women, other leading cancers mentioned were ovarian cancer, non-Hodgkin's lymphoma, and gallbladder cancer., Conclusions: Hispanics had consistently lower rates of breast, lung, prostate, and colon cancers than non-Hispanics. In some geographic regions, however, differences in cancer incidence rates with respect to specific sites existed between the heterogenous Hispanic populations. Furthermore, the rankings demonstrated that, even if Hispanics have lower rates of the most common cancers than non-Hispanics, such sites are still the most important cancers among Hispanic populations., Implications: Cancer is a major problem among U.S. Hispanic populations. The information given in this article can be used to develop etiologic studies and cancer control interventions. Data limitations and recommendations for improving data quality are presented.

Background: One of the possible assumptions for the higher mortality from cancer of blacks versus whites is that blacks tend to be diagnosed relatively more often with later stage disease. This study examined the stages at diagnosis for female breast cancer and other gynecologic cancers among blacks, non-Hispanic whites, and Hispanic whites., Methods: Data for Dade County were analyzed in this study, which was based on the tumor registry data from the Florida Cancer Data System from 1981-1989. The stages at diagnosis were classified as in situ, local, regional, and distant according to the International Classification of Diseases for Oncology coding rules., Results: The percentage of early stage diagnoses (in situ and local stage) was significantly lower among blacks and Hispanic whites than among non-Hispanic whites, but only for breast and cervical cancer. There was a significant increase in the percentage of early stage diagnoses of breast cancer among all three groups during 1981-1989, whereas this increase was found only in Hispanic whites for cervical cancer. The percentage of in situ cervical cancers was much lower in women older than age 45, especially among women older than age 65, in all three groups., Conclusions: These data suggest that screening programs need to be targeted differently for specific age and ethnic groups.

Background: Cancer incidence varies among race and ethnic subgroups. Relatively little information exists on cancer among Hispanics, and none of it it stratified by race., Methods: To explore and compare cancer incidence rates of each site of cancer among white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic women in Dade County, South Florida, we accessed 9 years of cancer incidence data. Dade County's Hispanic population is the second largest of any US county. For each site, incidence rates, rate ratios, and 95% confidence intervals are presented., Results: Among white Hispanics, there were statistically significant lower rates of cancers of the oral cavity, esophagus, colon, pancreas, lung, breast, ovary, bladder, kidney, melanoma, Kaposi's sarcoma, and non-Hodgkin's lymphoma than among white non-Hispanics. Black Hispanics had significantly lower rates of cancers of the oral cavity, stomach, rectum, lung, cervix, and bladder than black non-Hispanics. However, white Hispanic women had significantly higher rates of cancers of the liver, gallbladder, and uterine cervix than white non-Hispanic women. No in situ breast cancer cases among blacks of either ethnic subgroup was found., Conclusion: Both white Hispanic and black Hispanic women generally had lower rates of cancer than their race-specific non-Hispanic counterparts. However, incidence rates among Hispanics differ substantially by race; failure to distinguish them may lead to erroneous conclusions.

Epidemiologic data on the average daily human dietary intake of the trace elements nickel, cadmium, molybdenum and silicon are scarce, worldwide, primarily because foods consumed vary widely over days and seasons. Available full year food allocation records for farmers in rural areas of China provide an unique opportunity to estimate dietary trace elements. In 1988, we measured the concentration of zinc, copper, iron, cadmium, nickel, molybdenum, silicon and selenium in different foods by using food samples collected from 232 villages (distributed among 21 communes). These measurements, combined with the food consumption information from existing food allocation records in each commune for an entire year, allowed us to estimate the average daily consumption of these trace elements by Chinese farmers. With one exception (an association of zinc and esophageal cancer), the variation of dietary trace elements did not show any association with mortality from several common diseases. The estimates for some of the dietary trace elements from some subpopulations were either less or more than current recommendations. No increases in mortality were found, however, from diseases normally associated with either dietary deficiencies or excesses of these elements.

Background: Dade County (Florida) is the largest county in the United States in which a majority of the population is Hispanic. To describe and compare cancer incidence among white and black Hispanic and non-Hispanic males in South Florida and to identify those sites showing important racial-ethnic differences between sub-groups, incidence rates were determined from 9 years of prospective population-based cancer surveillance data., Methods: All incident cancer cases diagnosed among male residents of Dade County for the period January 1, 1981, through December 31, 1989, were obtained from the statewide tumor registry for Florida, the Florida Cancer Data System. Race- and ethnic-specific age-standardized incidence rates and standardized rate ratios to compare rates among racial-ethnic subgroups for each site are presented., Results: Compared with white non-Hispanics, white Hispanic males had significantly higher rates of cancers of the liver, gallbladder, nasal cavity, penis, and thyroid; acute lymphocytic leukemia; and Kaposi's sarcoma. Significantly lower rates were found for cancers of the esophagus, stomach, colon, rectum, pancreas, lung, testes, bladder, and kidney, and for mesothelioma, melanoma, non-Hodgkin's lymphoma, and chronic lymphocytic leukemia. Black Hispanics had significantly lower rates only of cancers of the esophagus, lung, and prostate than did black non-Hispanics., Conclusion: Differences were found in incidence rates by race-ethnicity; while incidence rates for most sites among white Hispanic males were lower than among white non-Hispanics, higher rates for several sites are of particular concern and merit further investigation to determine differences in risk factors and exposures.

In 1985, residents of a suburban community in South Florida became concerned when several young women were diagnosed with breast cancer. First as individuals, then through a community-based effort, they attempted to gain attention and action on what they believed to be a cluster of breast cancer. Through their efforts to find out whether some agent or toxic exposure existed in the community that might have caused breast cancer, the women formed a community-based organization. This paper describes the activism of the women to resolve the issue through an epidemiologic study of the breast cancer occurrence in their community. Furthermore, it substantiates the need and role of rational community response in resolving community threats and concerns.

To explore cancer incidence among Hispanic women living in Dade County, Florida, data were analyzed from the statewide cancer registry. For all but three sites, Hispanics had lower rates of the 15 most prevalent cancers than non-Hispanics. However, higher rates of cancer among Hispanics were noted for cancers of the gallbladder, liver, and heart and soft tissue. Subgroups of women had significantly higher rates of cervical cancer and thyroid cancer. Lower rates among Hispanics were observed for cancers of the esophagus, vagina, breast, colon, buccal cavity and pharynx, and malignant melanoma. These data suggest that most cancer sites traditionally higher among US Latino women were not higher among Dade Hispanics, and that sites more common among non-Hispanics have not yet shown an increased incidence among Hispanic women in Dade County.

To assess cancer incidence among Hispanic males in Dade County, Florida, data were analyzed from the statewide tumor registry. For all cancer sites (combined), the age standardized rate among Hispanic males was 308.75 cases per 100,000 person-years, compared with 349.55 among non-Hispanics (standardized rate ratio [SRR] = 0.88; 95% confidence interval [CI] = 0.84-0.93). Hispanics experienced significantly greater rates of cancers of the larynx (SRR = 1.58; 1.19-2.09), thyroid (SRR = 3.12; 1.18-8.26), and gallbladder (SRR = 5.45; 1.55-19.15), compared with non-Hispanics, but significantly lower rates of testicular cancer (SRR = 0.17; 0.09-0.37), melanoma (SRR = 0.20; 0.12-0.34), esophagus (SRR = 0.52; 0.49-0.55), stomach (SRR = 0.61; 0.43-0.87), pancreas (SRR = 0.65; 0.45-0.94), kidney and renal pelvis (SRR = 0.68; 0.48-0.97), colon (SRR = 0.79; 0.67-0.94), lung (SRR = 0.82; 0.73-0.94), and Kaposi's sarcoma (SRR = 0.03; 0.00-0.25). These data suggest that Dade Hispanic males have not experienced the cancers traditionally elevated among US Latinos, or those common among non-Hispanics.

The relation between age at first birth and the occurrence of fibrocystic breast disease of different atypia subtypes was evaluated using data from a cohort study of the health effects of oral-contraceptive use. Multivariate case-control analysis was performed on 218 parous women with biopsied fibrocystic disease and 928 parous controls. Fibrocystic breast disease, as a whole and as atypia subtypes, was found to be unrelated to age at first birth. Furthermore, the estimated effect of age at first birth did not vary from one atypia subtype to another. Women with high parity were found to be at decreased risk of fibrocystic breast disease compared to those with low parity. Age at completion of education, used as an indicator of socioeconomic status, was found to be moderately associated with fibrocystic breast disease. The estimated effect of parity and age at completion of education also did not vary among subtypes. More epidemiologic studies specific to histopathologic classifications of benign breast disease are called for.

In 1970 a questionnaire was sent to 97,300 married women aged 25-50 years residing in eastern Massachusetts information was requested on use of oral contraceptives (OC), education, and gynecologic and reproductive histories. Subsequent questionnaires were sent in 1973 and 1979 to a subset of the original cohort (37,000) to obtain recent information. Surveillance of 34 hospitals disclosed 622 cases of breast cancer among respondents diagnosed in a 6 1/2-year period. The rate ratio of breast cancer associated with any use of OC was 0.84 (95% confidence limits: 0.7, 1.1). Although certain subgroups users experienced significantly lower rates of hospitalization for breast cancer than did nonusers (including users aged 25-29, those for whom less than or equal to 5 yr had passed since first use, women with ages at birth of first child either before 25 or after 30, and women who first used OC after the birth of the first child), the risk of breast cancer OC after the birth of the first child), the risk of breast cancer was not consistently lower among users of OC. Among nulliparous women, the rate ratio associated with use of OC was 2.1 (0.9, 5.0).

A prospective cohort study of approximately 97 300 women was conducted in eastern Massachusetts. Information on use of oral contraceptives, and on gynaecological and reproductive histories was sought through mailed questionnaires, while newly diagnosed cases of cancer of the endometrium were identified from records of 34 area hospitals. Oral contraceptive (OC) use was associated with some increase in endometrial cancer rates (standardized rate ratio = 1.4; 95% confidence interval = 0.9-2.4), although the risk did not vary consistently by length of use, years since first use, or age at initial use. Although some subgroups of users had rates of disease higher than among nonusers, there was little to suggest a consistent association between OC use and incidence of endometrial cancer.