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PubMed1993

Recent trends in the incidence of in situ and invasive breast cancer in the Detroit metropolitan area (1975-1988).

BACKGROUND: Over the past two decades, breast cancer incidence rates have increased dramatically for women in all age groups. METHODS: Breast cancer incidence trends were evaluated in a population-based study of data from the Metropolitan Detroit Cancer Surveillance System, a participant in the Surveillance Epidemiology and End Results Program of the National Cancer Institute. Incidence rates from 1975 through 1988 were evaluated, based on tumor size, age at diagnosis, and race. RESULTS: Age-adjusted rates for all breast cancers have increased since 1975, with the largest change occurring since 1983. Age-adjusted incidence rates for ductal carcinoma in situ (DCIS) and cancers smaller than 2.0 cm were higher in white women than black women, whereas age-adjusted incidence rates for larger tumors (> or = 2.0 cm) have been higher in black women since 1985. The rate of increase in incidence as measured by the average interval percentage change was highest for DCIS and small invasive tumors (< 1.0 cm) for all age groups of women. CONCLUSIONS: The more rapid increase in incidence of early breast cancer in the population suggests that the observed increase in breast cancer incidence over the last 2 decades may have resulted, at least in part, from a screening effect.

Adult↗
PubMed1994

Trends in cervical cancer incidence among young black and white women in metropolitan Detroit.

BACKGROUND: Although the overall incidence of invasive cervical cancer in the United States has declined over the past several decades, recent studies suggest that rates for both invasive and in situ cervical cancer are rising among younger women. METHODS: Trends in cervical cancer incidence among females between the ages of 15 and 39 years were evaluated using data from the Metropolitan Detroit Cancer Surveillance System, a population-based registry and founding participant in the SEER Program of the National Cancer Institute. Age-adjusted and age-specific rates for all black and white women in this age group were evaluated as well as rates for married and single women for the period 1973-1991. RESULTS: Incidence trends vary by race and marital status. A nonlinear increasing trend was evident (P < 0.01), for in situ cervical cancer among white women, with rates for single white women exhibiting the largest increase. Rates among black women for in situ cervical cancer exhibited a nonlinear decreasing trend (P < 0.01), with rates for married black women declining by 75%. Among single white women, invasive cervical cancer exhibited an increasing linear trend (P < 0.01), although the number of cases was small. CONCLUSIONS: Differences in trends among black and white women may reflect a combination of greater exposure to risk factors associated with cervical carcinoma as well as differential access to diagnostic and treatment services. Appropriate groups should be targeted for educational, screening, and follow-up services.

Adolescent↗
PubMed2004

Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis. Outcome-related variables at two Detroit hospitals.

This retrospective study reviews the medical records of 77 fetuses and babies with congenital diaphragmatic hernia (CDH) referred to two hospitals in Detroit from 1986 through 2000. The aims were to examine the effects on outcome of multiple variables, especially the type of CDH, associated anomalies, and ultrasound prognostic parameters. Ultrasound measurements of head (HC), chest (CC), and abdominal circumferences (AC) were obtained from videotapes. ANOVA and chi-square analysis were used to determine statistical significance between groups and proportions. Eighty-nine percent (65/73) of pregnancies resulted in live births, and 54% (35/65) of patients survived past 30 days. Liveborn patients with low APGAR scores were less likely to survive. Forty-three percent (30/70) had major associated anomalies, with cardiac anomalies constituting about 52% (33/64) of the major associated anomalies. Seventy percent of patients with isolated CDH survived versus 36% of patients with both CDH and cardiac anomalies. Sixty-seven percent (8/12) of fetuses antenatally diagnosed before 25 weeks of gestation survived past 30 days of birth. The survival rate of right-sided CDH with liver herniation was 80% (8/10), compared with 29% (4/14) for left-sided CDH with liver herniation (p=0.088). There was a significant linear relationship (r=0.603, p =0.029) between CC/AC and CC/HC among patients with CDH; survivors had higher CC/AC and CC/HC values than nonsurvivors. These results support the utility of CC/AC and CC/HC measurements and the presence of liver herniation as important prognostic factors that can be used in antenatal counseling and in planning clinical trials.

Abnormalities, Multiple↗
PubMed2005

Racial differences in breast cancer survival in the Detroit Metropolitan area.

African American (AA) women have poorer breast cancer survival compared to Caucasian American (CA) women. The purpose of this analysis was to determine whether socioeconomic status (SES) and treatment differences influence racial differences in breast cancer survival. The study population included 9,321 women (82% CA, 18% AA) diagnosed with local (63%) or regional (37%) stage disease between 1988 and 1992, identified through the Metropolitan Detroit SEER registry. Data on SES were obtained through linkage with the 1990 Census of Population and Housing Summary Tape and cases were geocoded to census block groups. Pathology, treatment and survival data were obtained through SEER. Cox proportional hazards models were used to compare survival for AA versus CA women after adjusting for age, SES, tumor size, number of involved lymph nodes, and treatment. AA women were more likely to live in a geographic area classified as working poor than were CA women (p<0.001). AA women were less likely to have lumpectomy and radiation and more likely to have mastectomy with radiation (p<0.001). After multivariable adjusted analysis, there were no significant racial differences in survival among women with local stage disease, although AA women with regional stage disease had persistent but attenuated poorer survival compared to CA women. After adjusting for known clinical and SES predictors of survival, AA and CA women who are diagnosed with local disease demonstrate similar overall and breast cancer-specific survival, while race continues to have an independent effect among women presenting at a later stage of disease.

Adult↗
PubMed2006

Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle Urban Research Centers.

In order to address the social, physical and economic determinants of urban health, researchers, public health practitioners, and community members have turned to more comprehensive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received considerable attention over the past decade, and numerous publications have described theoretical underpinnings, values, principles and practice. Issues related to the long-term sustainability of partnerships and activities have received limited attention. The purpose of this article is to examine the experiences and lessons learned from three Urban Research Centers (URCs) in Detroit, New York City, and Seattle, which were initially established in 1995 with core support from the Centers for Disease Control and Prevention (CDC). The experience of these Centers after core funding ceased in 2003 provides a case study to identify the challenges and facilitating factors for sustaining partnerships. We examine three broad dimensions of CBPR partnerships that we consider important for sustainability: (1) sustaining relationships and commitments among the partners involved; (2) sustaining the knowledge, capacity and values generated from the partnership; and (3) sustaining funding, staff, programs, policy changes and the partnership itself. We discuss the challenges faced by the URCs in sustaining these dimensions and the strategies used to overcome these challenges. Based on these experiences, we offer recommendations for: strategies that partnerships may find useful in sustaining their CBPR efforts; ways in which a Center mechanism can be useful for promoting sustainability; and considerations for funders of CBPR to increase sustainability.

Centers for Disease Control and Prevention, U.S.↗
PubMed1983

Heredity, stress and blood pressure, a family set approach: the Detroit Project revisited.

Earlier conclusions from the Detroit Project utilizing an innovative "family sets" approach indicated that unspecified environmental factors, rather than genes, are the main determinants of blood pressure variation in blacks and whites. We report new estimates of the fraction of variation in blood pressure associated with genetic differences among individuals obtained under two methodologies: the method originally proposed for family sets and a maximum likelihood method. The family sets estimates of heritability were significant for systolic and diastolic blood pressure in both blacks and whites. Estimates for both the likelihood analysis and family sets method are within the range of estimates reported in other studies. In the present study all sets collected were included, the sets were stratified only by race and a different estimate of variance for the family sets estimate of heritability was used. The discrepancies between results presented here and the original study are attributed to these three factors.

Adult↗
PubMed1983

Trends in cancer incidence in metropolitan Detroit, 1937--1977: leads for prevention.

Cancer incidence among the black and white male and female population of metropolitan Detroit is presented for the years 1937, 1948, 1969--1971, and 1973--1977. These trends reveal increases in lung cancer among all four groups over time, while stomach cancers have decreased among each of the four groups. For black and white men lung cancer has the highest incidence in the two recent time periods, while cancer of the prostate was highest in the two earlier time periods. Among women, uterine cancer had the highest incidence for both blacks and whites in the earlier time periods, but breast cancer occurred among women more frequently than any other cancer in the most recent time period. These trends reveal the changing incidence patterns over time within an urban, industrialized population. Population-based cancer incidence data provide the most complete and accurate assessment of the occurrence of cancer within a population. Such data are particularly useful for proper planning of screening programs and for evaluating the need for preventive measures. As an example, the continuous increase in lung cancer in all four groups across all time periods clearly reveals the need for more effective measures to reduce cigarette smoking in this population.

Black or African American↗
PubMed2004

Characterization and identification of the Detroit River mystery oil spill (2002).

In this paper, a case study of the Detroit River mystery oil spill (2002) is presented that demonstrates the utility of detailed and integrated oil fingerprinting in investigating unknown or suspected oil spills. The detailed diagnostic oil fingerprinting techniques include determination of hydrocarbon groups and semi-quantitative product screening, analysis of oil-characteristic biomarkers and the extended suite of parent and alkylated polycyclic aromatic hydrocarbons (PAHs), and quantitative determination of a variety of diagnostic ratios of "source-specific marker" compounds. The detailed chemical fingerprinting data and results highlight the followings: (1) The spill samples were largely composed of used lube oil mixed with smaller portion of diesel fuel. (2) The diesel in the samples had been weathered and degraded. (3) Sample 3 collected from N. Boblo Island on 14 April was more weathered (most probably caused by more evaporation and water-washing) than samples 1 and 2. (4) All fingerprinting results clearly demonstrated oils in three samples were the same, and they came from the same source. (5) Most PAH compounds were from the diesel portion in the spill samples, while the biomarker compounds were largely from the lube oil. (6) Input of pyrogenic PAHs to the spill samples was clearly demonstrated. The pyrogenic PAHs were most probably produced from combustion and motor lubrication processes, and the lube oil in these spill samples was waste lube oil.

Michigan↗
PubMed2005

Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district.

The purpose of this descriptive study was to examine the nonmedical use of prescription pain medications in a sample of public school students in the Detroit metropolitan area. The Web-based survey occurred during a two-week period in May 2003 and drew on a diverse population between the ages of 10 and 18 years. An 87% response rate was achieved, providing a final sample of 1017 students. Twenty-two percent of girls and 10% of boys reported lifetime nonmedical use of a pain medication (chi2 = 25.2, d.f. = 1, p < 0.001). Fifteen percent of girls and 7% of boys reported past year nonmedical use (chi2 = 12.7, d.f. = 1, p < 0.01). Compared to nonusers, nonmedical users of prescription pain medication were seven times more likely to smoke cigarettes, five times more likely to drink alcohol and smoke marijuana, almost four times more likely to binge drink, and eight times more likely to have used other illicit drugs. Of those reporting lifetime nonmedical use of prescription pain medication, 70% noted how they obtained the drugs; 34% reported getting the drugs from a family member, 17% from a friend and 14% from a dealer or theft.

Adolescent↗
PubMed2006

Lead levels in blood and saliva in a low-income population of Detroit, Michigan.

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

Adolescent↗
PubMed2005

Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit's eastside.

Patterns of mental health are clearly associated with life circumstances, including educational and economic opportunities, access to safe and supportive neighborhoods, socially structured exposures to stressors and to supportive relationships. In this article, we examine the social and economic correlates of depressive symptoms among African American women residing within a predominantly African American urban neighborhood in Detroit, USA, with relatively few economic resources. We identify distinct stressors associated with financial strain, neighborhood social disorder (concern about police responsiveness, safety stress), and experiences of discrimination. We test the extent to which each of these stressors mediates relationships between household income, length of residence in the neighborhood, social support and depressive symptoms. Our results suggest that for women in this racially segregated area with a high concentration of poverty, relationships between household income and symptoms of depression are partially mediated by financial stress and social support, but that stressors associated with neighborhood disorder and discrimination influence depressive symptoms independent of household income. Furthermore, we find that length of residence in the neighborhood is negatively associated with financial stress and positively associated with police stress and social support, with no significant net effect on symptoms of depression. We conclude that higher household income may help reduce symptoms of depression by reducing financial stress and strengthening social support even within neighborhoods with high concentrations of poverty. However, increased household income does not protect African American women residing in a high poverty community from distress associated with neighborhood disorder or experiences of discrimination.

Adult↗
PubMed2000

Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area.

This article examines the cumulative effects of multiple stressors on women's health, by race and area of residence. Specifically, we examine socioeconomic status, experiences of unfair treatment and acute life events by race and residential location, and their cumulative effects on the health status of African American and white women living within the city of Detroit and in the surrounding metropolitan area. African American women, regardless of whether they live inside or outside the city, report more frequent encounters with everyday unfair treatment than white women. African American women who live in the city report a greater number of acute life events than white women who live outside the city. Regression analyses used to examine the cumulative effects of exposure to these stressors by race and area of residence show that: (1) socioeconomic status, everyday experiences with unfair treatment and acute life events each make a significant contribution to differences in health status; and (2) the contribution of each of these variables to explaining variations in health status varies by area of residence. We suggest that differences in socioeconomic status, exposure to unfair treatment or discrimination and experiences of acute life events make significant contributions to racial differences in women's health status.

Adolescent↗
PubMed2001

Exhaust emissions from engines of the Detroit Diesel Corporation in transit buses: a decade of trends.

In the U.S.A., exhaust emissions from city buses fueled by diesel are not characterized well because current emission standards require engine tests rather than tests of whole vehicles. Two transportable chassis dynamometer laboratories developed and operated by West Virginia University (WVU) have been used extensively to gather realistic emission data from heavy-duty vehicles, including buses, tested in simulated driving conditions. A subset of these data has been utilized for a comprehensive introspection into the trends of regulated emissions from transit buses over the last 7 years, which has been prompted by continuously tightening restrictions on one hand, along with remarkable technological progress, on the other hand. Two widely used models of diesel engines manufactured by the Detroit Diesel Corporation (DDC) have been selected as a case-study for such an overview, based on full-scale, on-site testing of actual city buses, driven in accordance with the SAE J1376 standard of a Commercial Business District (CBD) cycle. The results provide solid, quantitative evidence that most regulated emissions from engines produced by DDC have declined over the years, especially with the transition from the 6V-92TA to the Series 50 models. This improvement is remarkable mainly for the emissions of particulate matter (PM), that are lower by over 70%, on average, for the Series 50 engines, though the emissions of nitrogen oxides (NOx) exhibit a reversed trend, showing a degradation of about 6%, on average, with the transition from 6V-92TA to the Series 50 engines. The expected trend of decreasing emission levels with the model year of the engine is clear and consistent for particulate matter (PM), hydrocarbons (HC), carbon monoxide (CO), and nitrogen oxides (NOx), starting with the 1990 models, although it is not conclusive for carbon dioxide (CO2) emissions.

Air Pollution↗
PubMed2003

Plasma-associated halogenated phenolic contaminants in benthic and pelagic fish species from the Detroit River.

Halogenated phenolic contaminants (HPCs), polychlorinated biphenyls (PCBs), and other organochlorine (OC) contaminants (DDTs, chlordanes, HCH, and octachlorostyrene (OCS)) were determined (ng/g, wet wt basis) in the blood plasma of 6 piscivorous/pelagic- and 7 benthic-feeding fish species from the Detroit River. Seven to twelve hydroxylated (OH) PCB congeners with pentachloro- to nonachloro-substitution, pentachlorophenol (PCP) and 4-OH-heptachlorostyrene (4-OH-HpCS), as well as a number of other unidentified HPCs, were detected in all the fish species studied. The concentrations of sigma-OH-PCB (0.57-129.5 ng/ g), 4-OH-HpCS (0.02-0.31 ng/g), and PCP (0.05-3.42 ng/ g) in comparison to other major polychlorinated contaminants (sigma-PCB (10.4-909.0 ng/g), sigma-chlordane (0.72-8.68 ng/g), sigma-DDT (2.10-66.57 ng/g), and sigma-HCH (0.04-0.84 ng/g)) demonstrate the importance of HPCs, especially OH-PCBs, as plasma-associated contaminants. OH-PCBs are most likely metabolites of PCBs, and 4-OH-HpCS is a likely metabolite of OCS. Our findings indicate that metabolic biotransformation is a factor in the bioaccumulation, pharmacokinetics, and fate of OCS and highly chlorinated PCB congeners that are generally more recalcitrant in fish. Target tissue exposure to circulating OH-PCBs was variable, and thus potential OH-PCB-mediated toxicological activity and effects (e.g., endocrine-related) and health risks are different among the fish species.

Animals↗
PubMed2004

Direct identification of trace metals in fine and ultrafine particles in the Detroit urban atmosphere.

Exposure to airborne particulates containing low concentrations of heavy metals, such as Pb, As, and Se, may have serious health effects. However, little is known about the speciation and particle size of these airborne metals. Fine- and ultrafine particles with heavy metals in aerosol samples from the Detroit urban area, Michigan, were examined in detail to investigate metal concentrations and speciation. The characterization of individual particles was completed using high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM) combined with conventional high-resolution TEM techniques. The trace elements, Pb, As, La, Ce, Sr, Zn, Cr, Se, Sn, Y, Zr, Au, and Ag, were detected, and the elemental distributions were mapped in situ atthe nanoscale. The crystal structures of the particles containing Pb, Sr, Zn, and Au were determined from their electron diffraction patterns. Based on the characterization of the representative trace element particles, the potential health effects are discussed. Most of the trace element particles detected in this study were within a range of 0.01-1.0 microm in size, which has the longest atmospheric residence time (approximately 100 days). Increased chemical reactivity owing to the size of nanoparticles may be expected for most of the trace metal particles observed.

Aerosols↗
PubMed2003

Survival analysis of distant prostate cancer by decade (1973-1997) in the Detroit Metropolitan Surveillance, Epidemiology and End Results (SEER) Program registry: has outcome improved? (United States).

OBJECTIVE: The purpose of this study is to examine differences in survival after diagnosis with distant stage prostate cancer by decade of diagnosis. METHODS: Subjects are 3337 Caucasian and 1947 African-American men with newly diagnosed primary distant stage prostate cancer between 1973 and 1997, with follow-up through 2001, from the Detroit SEER registry. The proportion of men within each category of each variable of interest is calculated. Relative survival is used to examine survival patterns over time. Kaplan-Meier and Cox proportional hazard models are also used to examine the relationship between decade of diagnosis and survival between short term (< or = 24 months) and long term (> 24 months) survivors. RESULTS: Relative survival has increased over the past three decades although this trend is not statistically significant. Relative survival is similar by race and decreases with increasing grade of tumor. Survival for men living < or = 24 months after diagnosis is similar over time. However, for men living > 24 months after diagnosis, there is a significant difference over time (p < 0.0001). CONCLUSION(S): In general, relative survival has been improving over the past three decades. However, it is the long term survivors (> 24 months) that are the primary contributors to this difference in survival by decade of diagnosis.

Adult↗
PubMed1998

Factors affecting participation in a mammography screening program among members of an urban Detroit health maintenance organization.

Breast cancer mortality rates remain disproportionately high among black women despite recent improvements in mammography screening utilization. We conducted a telephone survey among a sample of women (N = 202) participating in a randomized controlled trial investigating the effectiveness of a mammography reminder letter that was one component of a breast cancer control intervention strategy. The objectives of the survey were to ascertain the extent to which the letter reminder was received and acted upon, and to determine attitudes and breast cancer control practices in the target population. The study was conducted among members of a large health maintenance organization serving predominantly black women in Detroit, Michigan. Forty-eight percent of the participants completed a mammogram during the year after the letter was sent. While 72% of the women remembered receiving the letter reminder, only 5% responded to the recommendations in the letter. Important predictors of mammography completion included past mammogram utilization (OR: 2.49; 95% CI: 1.05-5.93), a prior physician recommendation for a mammogram (OR: 1.99; 95% CI: 1.00-3.95) and subject's knowledge of her primary physician's name (OR: 2.05; 95% CI: 0.91-4.60). Letter reminders promoting primary care visits were relatively ineffective since few women reported being prompted by the letter recommendation. Strategies which target physician mammography referral behavior may have an important impact on mammography utilization among inner-city women.

Adult↗
PubMedDate not supplied

An investigation of elevated blood lead levels in Detroit children.

The findings of this report are based on data from 1309 children living near three heavily traveled streets in Detroit. This study was designed to determine the most probable reasons for elevated blood lead levels in young children. The authors used a linear multivariate regression to evaluate the effects of distance from the highway, age and sex of the child, and housing condition. The authors found that the distance the child lived from the highway did not have a measurable affect on blood lead level. Housing condition played the most important role in determining blood lead level. Poorer housing caused a higher average blood lead level and caused the blood lead distribution to skew, giving a significantly greater number of blood leads over 40 micrograms/100 ml. Age also was important in determining blood lead level. There was a decrease of about 1 micrograms/100 for each increase of one year in the child's age. Sex also appeared to play a small role. In all three areas of the study, blood lead levels were slightly higher in girls than in boys. This study shows, as many have before, that the primary cause of the lead problem with children can be greatly diminished by improved housing.

Age Factors↗