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Biomedical subjects

R C Brownson

Publications and source records attributed to R C Brownson.

At least 91 records · Page 5Linked to original sources
PubMed1993

Saturated fat intake and lung cancer risk among nonsmoking women in Missouri.

BACKGROUND: Although the vast majority of lung cancer cases in women are caused by smoking, 9%-20% of cases occur in nonsmokers. Previous epidemiologic research on the relationship between lung cancer and diet has shown that fruit and vegetable consumption may confer a protective effect against lung cancer, while a diet rich in cholesterol and fat may increase risk. PURPOSE: The purpose of this case-control study was to examine the effects of a broad range of dietary factors on the risk of lung cancer in a population of nonsmoking white women 30-84 years of age. METHODS: A telephone-administered questionnaire was used to determine and/or verify eligibility with regard to age, gender, race, and smoking status. In a second interview at the participant's home, a widely used food frequency questionnaire was filled out, and logistic regression was subsequently used to analyze the responses. We obtained dietary information on 429 case subjects who had a diagnosis of lung cancer reported to the Missouri Cancer Registry between June 1, 1986, and June 1, 1991, and 1021 control subjects. If a case subject had died or was too ill to be interviewed, next-of-kin familiar with the woman's diet were interviewed instead. Of the 429 women with lung cancer, 211 (49%) had lung adenocarcinoma. RESULTS: A strongly increasing trend in lung cancer risk was observed with increased saturated fat consumption among these non-smoking women; the relative risk was more than sixfold greater for the highest quintile of consumption than for the lowest quintile. The effect of saturated fat was more pronounced for adenocarcinoma than for other cell types. Weekly servings of beans and peas were significantly related to decreased lung cancer risk, while citrus fruit and juice showed a twofold increase in risk; this trend was also significant. CONCLUSION: By focusing on non-smoking women with lung cancer, including a large number with adenocarcinoma, we observed a clear association with saturated fat consumption that may have been masked in earlier studies of lung cancer involving a high percentage of smokers.

Adult↗
PubMed1993

Cigarette smoking and adult leukemia. A meta-analysis.

BACKGROUND: Increasing evidence suggests that certain forms of adult leukemia may be related to cigarette smoking. METHODS: To evaluate the association between cigarette smoking and adult leukemia, we conducted a meta-analysis of available studies. Data were identified through an English-language MEDLINE search for the period 1970 through 1992 and through our knowledge of ongoing and unpublished studies. Among the studies identified, the meta-analysis included seven prospective studies and eight case-control studies. The US Surgeon General's criteria were used to assess the evidence for causality. RESULTS: A positive association between smoking and certain histologic types of leukemia was found in both prospective and case-control studies. The summary smoking-related risk derived from prospective studies (relative risk, 1.3; 95% confidence interval, 1.3 to 1.4) was greater than that based on case-control data (relative risk, 1.1; 95% confidence interval, 1.0 to 1.2). Prospective data suggested an elevated risk of myeloid leukemia associated with cigarette smoking (relative risk, 1.4; 95% confidence interval, 1.2 to 1.6). Pooled case-control data showed increased smoking-associated risk for acute nonlymphocytic leukemia (relative risk, 1.3; 95% confidence interval, 1.1 to 1.5). Risk of leukemia increased according to the number of cigarettes smoked per day. Population-attributable risk calculations suggested that approximately 14% of all US leukemia cases (including 17% of myeloid and 14% of acute nonlymphocytic leukemias) may be due to cigarette smoking. CONCLUSIONS: The consistency, temporality, and biologic plausibility of this relationship augment our findings, which support a causal relationship between cigarette smoking and certain forms of adult leukemia. Further studies are needed to examine risk among women, dose-response effects, and variation in risk by histologic type.

Adult↗
PubMed1993

Occupational risk factors for lung cancer among nonsmoking women: a case-control study in Missouri (United States).

Occupationally related risk of lung cancer among women and among nonsmokers has not been widely studied. A recently conducted population-based, case-control study in Missouri (United States) provided the opportunity to evaluate risk of lung cancer associated with several occupational factors. Incident cases (n = 429) were identified through the Missouri Cancer Registry for the period 1986 through 1991, and included 294 lifetime nonsmokers and 135 ex-smokers who had stopped at least 15 years prior to diagnosis or had smoked for less than one pack-year. Controls (n = 1,021) were selected through driver's license and Medicare files. Risk was elevated among women exposed to asbestos (ever: odds ratio [OR] = 3.5, 95 percent confidence interval [CI] = 1.2-10.0; > 9 yrs: OR = 4.6, CI = 1.1-19.2) and pesticides (ever: OR = 2.4, CI = 1.1-5.6; > 17.5 yrs: OR = 2.4, CI = 0.8-7.0). Risk also was elevated among dry cleaning workers (ever: OR = 1.8, CI = 1.1-3.0; > 1.125 yrs: OR = 2.9, CI = 1.5-5.4). Occupational risks for lung cancer among women merit further study.

Adult↗
PubMed1993

Family pesticide use and childhood brain cancer.

The relationship between family pesticide use and childhood brain cancer was examined in a case-control study. Telephone interviews were conducted from June 1989 through March 1990 with the natural mothers of 45 childhood brain cancer cases, 85 friend controls, and 108 cancer controls. In comparisons to friend controls, significant positive associations were observed for use of pesticides to control nuisance pests in the home, no-pest-strips in the home, pesticides to control termites, Kwell shampoo, flea collars on pets, diazinon in the garden or orchard, and herbicides to control weeds in the yard. In comparisons to cancer controls, significant positive associations were observed for use of pesticide bombs in the home, pesticides to control termites, flea collars on pets, insecticides in the garden or orchard, carbaryl in the garden or orchard, and herbicides to control weeds in the yard. In general, positive associations in comparisons to one control group were supported by elevated odds ratios in comparisons to the other control group. Several potentially important associations were identified in this study. However, small sample sizes, potential recall bias, multiple comparisons, and lack of detailed exposure verification require further research to confirm these findings.

Brain Neoplasms↗
PubMed1993

Cancer control knowledge and priorities among primary care physicians.

Primary care physicians can play a key role in prevention and early detection of cancer. To assess cancer control knowledge and priorities among primary care physicians in Missouri, we conducted a random survey of 207 physicians. Although reported knowledge of the role tobacco plays in cancer causation was high, activity in tobacco cessation counselling and referral was low. Respondents considered diet to be a relatively unimportant factor in cancer causation, whereas they viewed sun exposure, genetics/family history, and radiation exposure as large contributors to the cancer burden. Among cancer early detection tests, high activity was shown for the Pap test and breast examination. Conversely, low activity was reported for colon sigmoidoscopy. Inverse correlations were shown between age group of the physician and several cancer prevention and early detection practices. For each cancer prevention and screening practice, reported activity was higher for medical doctors than for doctors of osteopathic medicine. Possible barriers or controversies in cancer control included disagreement with the current recommendation for Pap testing, the cost of mammography, and patient fear of sigmoidoscopy. These findings suggest that primary care physicians are not achieving their full potential in cancer control and indicate areas where increased emphasis is warranted.

Attitude of Health Personnel↗
PubMed1993

Reliability of passive smoke exposure histories in a case-control study of lung cancer.

Despite the growing number of studies on the health effects of passive smoke exposure, few data exist on the quality of questionnaire data on passive smoking. To measure the reliability of passive smoking histories, re-interviews were conducted for 110 subjects (37 cases and 73 controls) as part of a larger study of lung cancer among non-smoking women in Missouri. Agreement was high both for parental smoking status (94% concordance; kappa = 0.82) and for spousal smoking status (84% concordance; kappa = 0.67). Concordance also was relatively high for cigarette pack-years of exposure due to the parents or spouse. Reliability tended to be somewhat higher among controls than among cases, and for exposure due to a parent or spouse than for that due to other household members. Questions on the perceived harmfulness of passive smoke exposure showed no differences between cases and controls. These findings indicate a high degree of repeatability in responses regarding passive smoking, but also suggest the potential for misclassification of passive smoke exposure status, the desirability of standardized questions on passive smoking, and the need for additional studies of reliability and validity.

Adult↗
PubMed1993

Estimating past exposure to indoor radon from household glass.

CR-39 plastic was attached to household glass objects to learn whether residual radioactivity from radon decay products could be measured and correlated with cumulative radon exposures over defined time periods. Such an approach could be used to increase the completeness of exposure data collected in epidemiologic studies of residential radon. Inability to estimate radon concentrations for all residences adversely effects statistical power and thus the ability to detect an effect of radon exposure on lung cancer risk. A feasibility study was performed to determine if affixing CR-39 surface monitors to selected glass, ceramic, or enameled objects provided comparable estimates of past residential radon exposure to those obtained from year-long ambient alpha track-etch measurements. The CR-39 measurements of alpha activity in the surface of selected objects correlated with ambient radon measurements (R2 = 0.48) provided that reliable information was obtained on the history and age of the objects. This technique has now been incorporated into an epidemiologic study of radon and lung cancer to more fully estimate past exposure to indoor radon.

Air Pollution, Indoor↗
PubMed1993

Racial differences in the prevalence of cardiovascular risk factors among persons with diabetes.

Persons with diabetes are at greater risk of numerous health complications including coronary heart disease and stroke. We used telephone survey data to assess racial variations in the level of cardiovascular risk factors among Missouri diabetics. The four risk factors included physical inactivity, obesity, hypertension, and cigarette smoking. Each risk factor except smoking was more common among persons with diabetes than among non-diabetics. In addition, these risk factors were more common among Blacks than among Whites. Our results suggest the need for expanded efforts at controlling diabetic complications among person at high-risk.

Black People↗
PubMed1993

Variations in three cardiovascular disease risk factors in Missouri, 1986-1992.

In 1991, cardiovascular disease claimed the lives of over 22,000 Missourians. Recent studies show that much of this mortality can be eliminated through risk factor reduction and early detection. This article examines the regional and demographic differences in three major cardiovascular disease risk factors and outlines some steps that physicians and other health care providers can take to reduce their prevalence.

Adult↗
PubMed1993

Exposure to environmental tobacco smoke among Missouri children.

Childhood exposure to environmental tobacco smoke (ETS) increases the risk of lower respiratory infections (e.g., bronchitis and pneumonia), exacerbates childhood asthma, and increases the prevalence of fluid in the middle ear. Using self-reported telephone survey data, we examined the attitudes and practices of Missouri residents related to ETS exposure of children. Ninety-five percent of all respondents believed that ETS exposure is harmful to children and the percentage was similar for households with children (96%) and without children (94%). ETS was present in 42% of households and the percentage was similar for households with children (41%) and without children (44%). Childhood exposure to ETS remains a problem in Missouri, despite widespread awareness of the hazards. More active intervention is needed to reduce ETS exposure in the home.

Adult↗
PubMed1993

Preventable mortality in Missouri: excess deaths from nine chronic diseases, 1979-1991.

For the period 1979-1991, 54% of the 644,045 deaths in Missouri were attributed to nine chronic diseases--cancers of the breast, uterine cervix, lung, colon/rectum; coronary heart disease; stroke; diabetes; chronic obstructive pulmonary disease; hepatic diseases/cirrhosis. Elimination of risk factors and screening have been shown to reduce the mortality caused by these diseases. To evaluate the range in excess mortality in the state, we calculated excess mortality by county and correlated these rates with three sociodemographic variables. Based on these analyses, an estimated 100,000 deaths may have been prevented through prevention and early detection activities.

Adult↗
PubMed1993

Patterns of obesity in Missouri.

Obesity is a major preventable health problem in Missouri and in the nation. Using survey data, we examined the prevalence of obesity in population subgroups and the overall trend. Prevalence of obesity was higher among blacks, middle-aged persons, and persons with less education or lower family income. Without additional attention, Missouri is unlikely to achieve the year 2000 objective of < or = 20% prevalence of obesity.

Adult↗
PubMed1993

Diabetes in Missouri: prevalence and high-risk populations.

Diabetes was reported as an underlying or contributory cause of 3,706 deaths among Missouri residents in 1991, and the estimated direct and indirect costs of the disease in the state exceeded $450 million. Behavioral Risk Factor Surveillance System data indicate that, although diabetes is prevalent throughout the state's population, it is more prevalent among females, elderly persons, minority races, and persons with low educational and income levels. Individual practitioners should emphasize the reduction of health risk factors among their diabetic patients. Through regular monitoring of risks for diabetic complications and early intervention, a significant number of diabetic complications can be prevented or delayed.

Adolescent↗
PubMed1992

Preexisting lung disease and lung cancer among nonsmoking women.

Preexisting lung disease was examined as a risk factor for lung cancer in a population-based, case-control study of nonsmoking women in Missouri conducted between June 1, 1986, and April 1, 1991. A history of lung disease was reported by approximately 41% of 618 cases and 35% of 1,402 controls (odds ratio (OR) = 1.2; 95% confidence interval (Cl) 1.0-1.5. The risk was more pronounced when next-of-kin interviews were excluded (OR = 1.5). Previous lung disease was significantly related both to adenocarcinoma (OR = 1.4), which accounted for 62% of the cancers, and to all other cell types of lung cancer combined (OR = 1.8). Despite having discontinued smoking for more than 15 years, long-term ex-smokers were at a 2.2-fold risk of lung cancer compared with lifetime nonsmokers. Among lifetime nonsmokers, significant risks were noted for asthma (OR = 2.7) and pneumonia (OR = 1.5). Emphysema (OR = 2.6) and tuberculosis (OR = 2.0) were also significantly related to lung cancer, but only among former smokers. Chronic bronchitis was linked to elevated risks of nonadenocarcinomas only (OR = 2.3). Pleurisy was not reported more frequently by cases than by controls. Approximately 16% of all lung cancers among nonsmoking women could be attributed to previous lung diseases, most notably asthma, pneumonia, emphysema, and tuberculosis.

Adult↗
PubMed1992

Family pesticide use in the home, garden, orchard, and yard.

This study examined family use of pesticides in the home, garden, orchard, and yard. Data were collected from 238 families in Missouri during telephone interviews from June 1989 to March 1990. Nearly all families (97.8%) used pesticides at least one time per year and two thirds used pesticides more than five times per year. More than 80% used pesticides during pregnancy and 70% used pesticides during the first 6 months of a child's life. The most common setting for family pesticide use was in the home, where 80% of families used pesticides at least once per year. This was followed by herbicide use to control yard weeds (57% of families) and insecticide use to control fleas and ticks on pets (50% of families). A substantial number of families also used pesticides in the garden or orchard (33%). Flea collars were the most popular pest control product (50% of families). Carbaryl or Sevin was also popular, with 28.2% of families reporting use. No-pest-strips (dichlorvos) and Kwell shampoo (lindane) were used by almost 10% of participating families. Examination of study data revealed that families limited exposure to pesticides for the mother during pregnancy and for children during the first 6 months of life. Families failed to recognize and reduce pervasive exposures associated with no-pest-strips and flea collars.

Animals↗