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Residential clusters of non-communicable diseases are a source of enduring public concern, and at times, controversy. Many clusters reported to public health agencies by concerned citizens are accompanied by expectations that investigations will uncover a cause of disease. While goals, methods and conclusions of cluster studies are debated in the scientific literature and popular press, investigations of reported residential clusters rarely provide definitive answers about disease etiology. Further, it is inherently difficult to study a cluster for diseases with complex etiology and long latency (e.g., most cancers). Regardless, cluster investigations remain an important function of local, state and federal public health agencies. Challenges limiting the ability of cluster investigations to uncover causes for disease include the need to consider long latency, low statistical power of most analyses, uncertain definitions of cluster boundaries and population of interest, and in- and out-migration. A multi-disciplinary Workshop was held to discuss innovative and/or under-explored approaches to investigate cancer clusters. Several potentially fruitful paths forward are described, including modern methods of reconstructing residential history, improved approaches to analyzing spatial data, improved utilization of electronic data sources, advances using biomarkers of carcinogenesis, novel concepts for grouping cases, investigations of infectious etiology of cancer, and "omics" approaches.

Objective: This study examines associations between self-reported drinking and driving or being a passenger of a drinking driver and risk and protective factors in a general population of adolescents. Method: We used a two-staged sampling procedure to survey 2,955 students in Washington State public schools in Grades 9-12. Students were asked if they were a passenger of, or had been, a drinking driver in the previous month. They were also asked about individual, parent, school and community risk and protective factors. Comparisons were made using hierarchical polychotomous logistic regression, entering age and gender and parent, school and community protective factors at the first step and individual risk factors at the second step. Results: Driving after drinking in the previous month was reported by 12.1% of respondents and riding with a drinking driver was reported by an additional 17.6% of respondents. At the first step, driving after drinking was more likely and riding with a drinking driver was less likely among youth who were age 16 or older, and male students were more likely than female students to report driving after drinking. Parent, school and community support were each significantly associated with less driving after drinking, and school support was significantly associated with less riding with drinking drivers. At the second step, higher quantity and frequency of drinking, more smoking cigarettes and drug use and less seat belt use were each associated with both drinking and driving and riding with drinking drivers. Gun carrying was also associated with driving after drinking. Conclusions: Drinking and driving behaviors were associated with risk and protective factors in the community, school, family and individual. Pilot prevention programs should test the effectiveness of reducing drinking and driving involvement by addressing such factors. (J. Stud. Alcohol 65: 213-216, 2004), PROGRESS IN REDUCING alcohol-related traffic fatalities appeared to have leveled out or reversed in 20002001 after nearly two decades of improvement (National Highway Traffic Safety Commission, 2002a). Although youths 16-20 [...]

Introduction: Obesity, hypertension, and high cholesterol are risk factors for cardiovascular disease, which accounts for approximately 20% of deaths in Washington State. For most states, self-reports from the Behavioral Risk Factor Surveillance System (BRFSS) provide the primary source of information on these risk factors. The objective of this study was to compare prevalence estimates of self-reported obesity, hypertension, and high cholesterol with examination-based measures of obesity, hypertension, and high-risk lipid profiles., Methods: During 2006-2007, the Washington Adult Health Survey (WAHS) included self-reported and examination-based measures of a random sample of 672 Washington State residents aged 25 years or older. We compared WAHS examination-based measures with self-reported measures from WAHS and the 2007 Washington BRFSS (WA-BRFSS)., Results: The estimated prevalence of obesity from WA-BRFSS (27.1%; 95% confidence interval [CI], 26.3%-27.8%) was lower than estimates derived from WAHS physical measurements (39.2%; 95% CI, 33.6%-45.1%) (P < .001). Prevalence estimates of hypertension based on self-reports from WA-BRFSS (28.1%; 95% CI, 27.4%-28.8%) and WAHS (33.4%; 95% CI, 29.4%-37.7%) were similar to the examination-based estimate (29.4%; 95% CI, 25.8%-33.4%). Prevalence estimates of high cholesterol based on self-reports from WA-BRFSS (38.3%; 95% CI, 37.5%-39.2%) and WAHS (41.8%; 95% CI, 35.8%-48.1%) were similar; both were lower than the examination-based WAHS estimate of high-risk lipid profiles (59.2%; 95% CI, 54.2%-64.2%) (P < .001)., Conclusion: Self-reported heights and weights underestimate the prevalence of obesity. The prevalence of self-reported high cholesterol is significantly lower than the prevalence of high-risk lipid profiles. Periodic examination-based measurement provides perspective on routinely collected self-reports.