The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women

<p>Abstract</p> <p>Background</p> <p>In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.</p> <p>Methods</p> <p>We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.</p> <p>Results</p> <p>Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.</p> <p>Conclusion</p> <p>Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.</p

Young Poker Faces

Gambling is an activity that can be performed on-premise (slot machines in casinos, bars and restaurants) or off-premise (scratch cards and lottery tickets). Although the addictive potential may depend on the specific gambling product, early onset increases the likelihood for future pathological gambling. To delay the onset of gambling behavior and to reduce gambling-related problems, many countries have introduced age limits that should decrease the availability of gambling products to underage individuals. In this study we evaluated compliance to the legal age limit, making use of a mystery shopping method. We distinguished between (1) off-premise scratch cards (n = 51); (2) off-premise lottery tickets (n = 49); (3) on-premise slot machines in casinos (n = 88); and (4) on-premise slot machines in the catering industry (n = 100), and we focus on the factors, such as characteristics of the establishment, buyer, and vendor, that may account for possible differences. The 288 visits demonstrate that gambling products are highly available and accessible to under-aged customers; young customers are still able to gamble despite the legal regulations. The compliance rates fluctuate and appear to be related to the specific gambling product in question. Furthermore, age verification activities and certain outlet- and buyer characteristics, as well as characteristics associated with the purchase attempt, may influence compliance