A Report of Florida’s Cancer History, Risk Factors, and Screening Behaviors: Data from the National Health Interview Survey

To target populations at greatest risk ofdeveloping cancer, it is vital to understand the patterns ofrisk factors and screening behaviors along with cancer surveillance data. This study provides data on the prevalence of self-reported cancer history, can- cer risk factors, and cancer screening behaviors in Florida and compares them to rates in the rest ofthe U.S. Data were ob- tained from the National Health Interview Survey (NHIS), an annual, cross-sectional household survey of the U.S. civilian non-institutionalized population. We analyzed pooled data from the 2000 and 2005 Cancer Control Modules. Compared to the rest ofthe U.S., Floridians reported a lower prevalence ofcurrent smoking, risky drinking, and obesity, and a greater pre- valence ofProstate Specific Antigen (PSA) testing. However, Floridians reported a greater prevalence ofcancer history and a lower prevalence of physical activity, concern for sun protection, lifetime colorectal cancer screening, lifetime breast exam, life- time mammography screening, and lifetime and past year Pap test. The data indicate that Florida lags behind the rest of the U.S. in several areas, particularly cancer screening, and falls short ofthe Healthy People 2020 objectives for health behaviors and screening. These results provide information for key stakeholders and public health policy makers to effectively target Flor- ida residents at greatest risk for cancer and those not receiving recommended cancer screenings. This study also represents a model ofvaluable state-level evaluations that can be conducted using NHIS data. These types ofanalyses can provide a great- er understanding of state-level variations and lead to more effective public health interventions aimed at reducing cancer bur- den

Prevalence of the Metabolic Syndrome Among U.S. Workers

This is the final version of the article. Available from American Diabetes Association via the DOI in this record.OBJECTIVE: Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may have a greater risk for metabolic syndrome, a precursor of CVD. The objective of this study was to assess the differences in prevalence and risk of metabolic syndrome among occupational groups using nationally representative data of U.S. workers. RESEARCH DESIGN AND METHODS: Data from 8,457 employed participants (representing 131 million U.S. adults) of the 1999-2004 National Health and Nutrition Examination Survey were used. Unadjusted and age-adjusted prevalence and simple and multiple logistic regression analyses were conducted, adjusting for several potential confounders (BMI, alcohol drinking, smoking, physical activity, and sociodemographic characteristics) and survey design. RESULTS: Of the workers, 20% met the criteria for the metabolic syndrome, with "miscellaneous food preparation and food service workers" and "farm operators, managers, and supervisors" having the greatest age-adjusted prevalence (29.6-31.1%) and "writers, artists, entertainers, and athletes," and "engineers, architects, scientists" the lowest (8.5-9.2%). In logistic regression analyses "transportation/material moving" workers had significantly greater odds of meeting the criteria for metabolic syndrome relative to "executive, administrative, managerial" professionals (odds ratio 1.70 [95% CI 1.49-2.52]). CONCLUSIONS: There is variability in the prevalence of metabolic syndrome by occupational status, with "transportation/material moving" workers at greatest risk for metabolic syndrome. Workplace health promotion programs addressing risk factors for metabolic syndrome that target workers in occupations with the greatest odds may be an efficient way to reach at-risk populations.This research was supported in part by the National Institute on Occupational Safety and Health (grant R01-0H-03915)

Exposure and Effect Assessment of Aerosolized Red Tide Toxins (Brevetoxins) and Asthma

addresses: National Science Foundation National Institute of Environmental Health Sciences Oceans and Human Health Center, University of Miami Rosenstiel School of Marine and Atmospheric Sciences, Miami, Florida 33136, USA. [email protected]: PMCID: PMC2717136types: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.'Reproduced with permission from Environmental Health Perspectives'Copyright © 2009 National Institute of Environmental Health SciencesIn previous studies we demonstrated statistically significant changes in reported symptoms for lifeguards, general beach goers, and persons with asthma, as well as statistically significant changes in pulmonary function tests (PFTs) in asthmatics, after exposure to brevetoxins in Florida red tide (Karenia brevis bloom) aerosols

Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. METHODS: In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. RESULTS: Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. CONCLUSIONS: Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the collection and assessment of environmental and occupational research data.This study was supported in part by the National Institute for Occupational Safety and Health (NIOSH)'s Deep South Educational Research Center at the University of Alabama (sub-contract: 288477-10) as a Graduate Student Pilot Grant Award; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) grant F31AR057687 and the National Institute for Occupational Safety and Health (NIOSH) grant R01 OH003915

Working with Cancer: Health Disparities Among Working Cancer Survivors

Cancer is the second leading cause of mortality in the United States, affecting more than 13 million individuals it has impacted the lives of a significant proportion of the population. With improvements in detection and treatment there have been more early diagnoses and improved prognosis for many survivors. These positive changes have led to an increase in the number of survivors that continue to work through diagnosis and treatment and or return to work. There are an estimated 7.5 million working survivors in the US, though their proportions vary by occupational sectors. With occupational differences in workplace accommodations and perceived disparities in the motivation for re-entering the workforce, this dissertation examined health disparities among cancer survivors in the US workforce. Focusing on the under-explored associations among this special US worker population, we investigated disparities in health behaviors pertinent to health post diagnosis, such as cancer screening; and examined differences in indicators of health ( such as; functional limitation, psychological distress, number of days in bed and reported health status). Most importantly differences were stratified by occupation and health insurance which are the main factors reinforcing health behaviors and return to work among survivors. Using data from the 1997-2010 National Health Interview Survey (NHIS), we found that approximately 91.0% of working survivors reported having health insurance. This is higher than the 86.0% of insured persons without a history of cancer. We also found that while a large proportion of persons without a history of cancer reported having private insurance (71.1%) compared to working survivors (62.6%), adjustments for increased age associated with diagnosis decreased the difference between both working groups. Health insurance appears to partially mediate the relationship between cancer status and employment, as such, understanding the distribution of the type of insurance available to workers within occupational sectors is important to wellness-programs targeting this special group of workers. The Patient Protection and Affordable Care Act (H.R. 3590), passed by the 111th US Congress under President Barack Obama in December 2009 has shown promise of being beneficial to cancer survivors. With exclusions for preexisting conditions such as cancer and insurance rates based accordingly, this bill will allow working cancer survivors to secure health insurance in new jobs that are more amenable to their physical and mental capabilities post diagnosis. With a multitude of studies on working survivors concentrated on European populations, this dissertation sought to fill a research gap in exploring the existing health disparities among working cancer survivors within the US. Recognizing the diverse population of working survivors in the US and cognizant of the health disparities that exist among occupational sectors the findings from this research can further inform public policy aimed at the this worker population

Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

Abstract Background Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. Methods In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. Results Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Conclusions Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the collection and assessment of environmental and occupational research data.</p

Abstract 1883: Smoking and lung cancer in the United States: Geographic variations by state over time

Abstract Introduction: Years of research have confirmed a causal association between lung cancer and chronic exposure to tobacco products. It is estimated that active smoking is responsible for approximately 90 % of lung cancer cases. In 2009, lung cancer accounted for approximately 28% of all cancer deaths. However, there have been significant improvements in controlling population exposures to these carcinogens. Our research reviewed the implementation of smoking bans across the United States and correlated prevalence and incidence rates of lung cancers across states over the last six years. Methods: Lung cancer data were obtained from the Cancer in North America (CINA) database. Prevalence and incidence of current smokers by state, race, and gender were obtained from the CDC's morbidity and mortality weekly report (MMWR) for the years 2004, 2006 and 2008 as well as other websites. Current smokers were defined as individuals who smoked more than 100 cigarettes in their lifetime and currently smoke every day or some days. ArcGIS 9.3 was used to spatially display tobacco and lung cancer rates by state. Visual representation of data included map series for comparisons across multiple years and graphical chart illustrations embedded in maps to show race/ethnic comparisons by state. All geographical data was analyzed at the state level. Results: Tobacco initiation was delayed among women, and country wide data demonstrated an increase in lung cancer among women and a decrease among men between 2004 and 2006. Despite a decline in incidence among men, the age-adjusted death rate for lung cancer was higher for men (67.0 per 100,000 persons) than for women (40.0 per 100,000 persons). In 2006, Kentucky (a state with a thriving tobacco industry where the only smoking related state laws prohibit smoking in government offices, universities, and the state capitol, except in designated smoking areas) had the highest age-adjusted lung cancer incidence rates in both men (124.8 per 100,000) and women (76.6 per 100,000) while Utah had the lowest age-adjusted cancer incidence rates in both men and women (32.0 per 100,000 and 24.7 per 100,000 respectively). Conclusion: The states with the lowest smoking rates are those that have implemented smoking bans in workplaces, restaurants, and bars. The decrease in smoking rates has not been evenly distributed across all sectors of society; there are notable gender and racial disparities in the number of smokers and in the number of people enrolled in smoking cessation programs. Increasing bans on public smoking, increased cost of cigarettes, and improved access to smoking cessation programs are apparently linked to decreased sales and use of tobacco products as observed at the state level. In the long term this should lead a decrease in the number of lung cancer cases associated with tobacco products. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1883. doi:10.1158/1538-7445.AM2011-1883</jats:p

Abstract 3577: A decade of changed behavior: Trends in screening adherence and incidence 2000-2010

Abstract Background: Cancer is still one of the most prominent diseases of all times claiming more than 569,490 lives in 2010. Over the past decade the United States (U.S.), like many other industrialized and developed nations have seen a significant decrease in the incidence of cancers and have experienced an increase in the number of cancer survivors. The decrease in incidence can be attributed to an increase in the number of persons adhering to recommended cancer screenings. In 2012, there will be an estimated 1 million newly diagnosed Americans, 75% of who would have adhered to recommended cancer screening in the previous year. Methods: We used incidence data from the Surveillance Epidemiology and End Results database (2000 -2008) to assess the trend in incidence rates of some of the most common cancers in the United States. Using SAS version 9.2, we pooled data from the National Health Interview Survey (NHIS) - Cancer Supplements (2000, 2005 and 2010) and analyzed adherence to recommended screening (n= 90,959). The guidelines provided by the American Cancer Society were used to guide analyses. Screening compliance was measured among the appropriate age and sex cohort within the U.S. population. Results: There has been a 17.22% decrease in the incidence of colorectal cancers and a11.06% decrease in lung cancer incidence between 2000 and 2008. While Bladder and Cervical cancer showed no significant time trends, gender specific cancers, namely prostate and breast also showed significant decreases; 16.21% and 6.78% respectively. There was an 18.12% increase in the incidence of Melanoma cases. There was a significant increase in adherence to recommended screening between 2000 and 2010. Adherence to mammography screening guidelines increased two fold between 2000 and 2010 as represented by women interviewed in the NHIS. Similar trends were observed for pap smears and colorectal screenings; 2010 analyses showed 70.48% compliance for mammography, 72.80% for colorectal screening and 68.19% for pap smears. Conclusion: Though screening compliance is below the preferred level, there has been an increase in adherence to recommended screening in the U.S. population over the past decade. This has translated into decreased cancer incidence and an increased prevalence as more persons live beyond the five year survivor mark. Identification of cancers with high incidence rates is needed to direct targeted interventions and public health campaigns. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3577. doi:1538-7445.AM2012-3577</jats:p

Correlates of leisure time physical activity compliance in colorectal cancer survivors

Physical inactivity is a risk factor for cancer morbidity and mortality, but its influence in colorectal cancer (CRC) survivors is understudied. We investigated sociodemographic, physically limiting, and behavioral predictors influencing leisure time physical activity (LTPA) among CRC survivors. Pooled 1997–2010 National Health Interview Survey data (N=2378) were used to evaluate LTPA compliance in CRC survivors according to Healthy People 2010 recommendations. Univariate and multivariable logistic regression analyses were performed to identify predictors of LTPA compliance among CRC survivors. Independent variables included: age, gender, race/ethnicity, education, health insurance, body mass index (BMI), ≥2 chronic conditions limiting physical activity, time since cancer diagnosis, and poverty, marital, smoking and alcohol status. Multivariable regression models reveal that Hispanics, non-Hispanic Blacks, those with ≥2 physically limiting chronic conditions, and current smokers were less likely to comply with LTPA recommendations. CRC survivors who were of “other” race, more than one race, those with some college degree or college degree, and current drinkers were more likely to comply. Hispanics, non-Hispanic Blacks, those with >2 physically limiting chronic conditions and current smokers warrant additional efforts to encourage physical activity and to determine the impact of regular physical activity on CRC survivorship. •Minority and currently smoking CRCS are less likely to achieve adequate LTPA.•CRCS with >2 limiting chronic conditions are less likely to achieve adequate LTPA.•High education and current drinking are associated with achieving adequate LTPA.•Age, gender, obesity, and health insurance did not predict LTPA in CRCS.•Educational interventions targeting LTPA awareness for CRCS are recommended