Cancer Incidence in World Trade Center Rescue and Recovery Workers, 2001–2008

Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed ≥ 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders

Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans

Objectives. We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs)

Les politiques anti-tabac en milieu de travail : les attitudes des travailleurs et les rôles de la direction et des syndicats

Afin de mieux comprendre la réticence chez beaucoup de travailleurs et de syndicats à appuyer les politiques antitabac et les programmes d'éducation sur les lieux de travail, les auteurs ont fait enquête auprès des membres d'un syndicat national de travailleurs dans des industries à haut risque. L'article présente les résultats de deux enquêtes. Quatre répondants sur dix se sont déclarés fumeurs, mais neuf sur dix fumeurs ont déclaré qu'ils aimeraient arrêter de fumer. Quoique les non-fumeurs ont montré une tendance plus forte à appuyer des restrictions antitabac sur les lieux de travail, trois sur quatre fumeurs ont aussi appuyé des restrictions. Le pourcentage des répondants qui appuyait la préoccupation de l'entreprise et du syndicat pour l'usage du tabac en dehors du milieu du travail et le pourcentage qui s'y opposait était à peu près égal. En général, les répondants qui croyaient que l'employeur et le syndicat travaillaient pour améliorer la santé et la sécurité au travail ont montré une tendance plus forte à appuyer des politiques antitabac. Les auteurs discutent des implications de ces résultats pour leurs hypothèses et pour les programmes d'éducation antitabac sur les lieux de travail.To better understand the reluctance of many workers and unions to support workplace smoking policies and education programs, the authors surveyed members of a national union of workers in high-risk industries. The article presents findings from two surveys. Four out of every ten respondents reported being current smokers, but nine out of ten smokers said they would like to quit. Although nonsmokers were more likely to support restrictions against smoking at work, three out of four smokers also supported restrictions. About equal percentages of respondents supported and opposed the company and the union being concerned with whether workers smoke off the job. In general, respondents who believed that management and unions were trying to improve workplace health and safety were more likely to support workplace smoking policies. The authors discuss the implications of the findings for their hypotheses and for workplace smoking education programs.Para comprender mejor el desgano de muchos trabajadores y sindicatos para apoyar políticas y programas de educación antitabaco en los lugares de trabajo, el autor observó a los miembros de sindicatos nacionales de trabajadores en industrias de alto riesgo. El artículo presenta los resultados de dos observaciones. Cuatro de cada diez encuestados son fumadores habituales, pero nueve de cada diez fumadores dicen que les gustaría dejarlo. Aunque los no fumadores fueron probablemente más mayoritarios en apoyar las restricciones de fumar en el trabajo, tres de cada cuatro fumadores apoyaron también las restricciones. Un porcentaje más o menos igual de encuestados a favor y en contra, tanto de la compañía como del sindicato estaban interesados en si los trabajadores fuman fuera del trabajo. En general, los encuestados que creían que los dirigentes y los sindicatos tratan de mejorar la salud y la seguridad de los lugares de trabajo fueron más proclives a apoyar las políticas anti-tabaco en los lugares de trabajo. Los autores discuten las implicaciones de los resultados en relación a sus propias hipótesis y a los programas de educación anti-tabaco para los lugares de trabajo

Cancer incidence in World Trade Center rescue and recovery workers, 2001-2008

Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed = 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders