Evelyn P. Davila

Secondhand smoke exposure and depressive symptoms

Objective: To evaluate the association between secondhand smoke (SHS) exposure and depression. Tobacco smoking and depression are strongly associated, but the possible effects of SHS have not been evaluated. Methods: The 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) is a cross-sectional sample of the noninstitutionalized civilian U.S. population. SHS exposure was measured in adults aged ≥20 years by serum cotinine and depressive symptoms by the Patient Health Questionnaire. Zero-inflated Poisson regression analyses were completed with adjustment for survey design and potential confounders. Results: Serum cotinine-documented SHS exposure was positively associated with depressive symptoms in never-smokers, even after adjustment for age, race/ethnicity, gender, education, alcohol consumption, and medical comorbidities. The association between SHS exposure and depressive symptoms did not vary by gender, nor was there any association between SHS smoke exposure and depressive symptoms in former smokers. Conclusions: Findings from the present study suggest that SHS exposure is positively associated with depressive symptoms in never-smokers and highlight the need for further research to establish the mechanisms of association. NHANES = National Health and Nutrition Examination Survey; SHS = secondhand smoke; CDC = Centers for Disease Control and Prevention; OR = odds ratio; GABA = γ-aminobutyric acid.

Sustained Low Influenza Vaccination Rates in US Healthcare Workers

INTRODUCTION A substantial morbidity and mortality burden attributable to the influenza virus is observed annually in the United States. Healthcare workers are an occupational group at increased risk of exposure, demonstrated to transmit influenza to their patient populations, and vital to the care of these patient populations. The prevention of the spread of the flu is a significant public health concern. In the present study, we examined influenza vaccination rates and their 5-year trends within the major occupational healthcare worker groups and compared them to non-Healthcare Workers. METHODS Using data from the nationally representative 2004-2008 National Health Interview Survey (NHIS), US healthcare workers (n=6349) were analyzed. RESULTS Seasonal influenza vaccination coverage estimates remain low among all healthcare workers, highest among the health diagnosing and treating practitioners (52.3%), and lowest among other healthcare support occupations (32.0%). Among all other occupational groups, pooled influenza vaccination rates were highest for white collar workers (24.7%), and lowest for farm workers (11.7%). There were no significant upward or downward trends in influenza vaccination rates for any healthcare or other occupational worker group during the 5-year survey period. CONCLUSION Improving these low vaccination rates among healthcare workers warrants a comprehensive national approach to influenza prevention that includes education and strong encouragement of routine annual vaccination among healthcare workers. Policy enhancements such as free provision of seasonal influenza vaccine, coverage for treatment and workers compensation for vaccine-related complications are needed.

Reported Eye Care Utilization and Health Insurance Status Among US Adults

OBJECTIVES To estimate prevalence and correlates of eye care utilization by means of data from the National Health Interview Survey. METHODS Nearly 290,000 adults 18 years or older participated in the survey from 1997 through 2005. Eye care utilization was based on self-reported contact with an eye care professional in the past year. Participants were classified by level of visual impairment based on response to 2 questions. The survey and logistic regression procedures in SAS statistical software were used to compute 1997 through 2005 pooled eye care utilization rates and to identify correlates of utilization. RESULTS Overall eye care utilization rates were 58.3%, 49.6%, and 33.7%, respectively, for participants with severe, some, and no visual impairment; rates for respondents without health insurance were 35.9%, 23.8%, and 14.3%, respectively. Multivariable logistic regression analyses completed in racial/ethnic and age category subgroups indicated that no reported visual impairment, lack of health insurance, male sex, and low education were associated with low eye care utilization rates. CONCLUSIONS Interventions designed to increase eye care utilization rates in select sociodemographic subgroups are needed. Overall utilization rates may also be enhanced if progress is made toward dramatically increasing the number of Americans with health insurance.

Food label use and awareness of nutritional information and recommendations among persons with chronic disease

BACKGROUND Because of the relation between chronic disease and poor nutritional habits, the use of food labels and adherence to dietary recommendations are important for chronic disease populations. We explored whether persons with chronic disease read nutrient information on food labels and whether they were aware of dietary guidelines. OBJECTIVE This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population. DESIGN A total of 5603 respondents aged > or =17 y from the 2005-2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease. RESULTS Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance. CONCLUSIONS People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.

Reported Skin Cancer Screening of US Adult Workers

BACKGROUND Early detection of skin cancer by skin examination may reduce its associated morbidity and mortality, in particular for workers routinely exposed to sun. OBJECTIVES We sought to describe the proportion of US workers reporting skin cancer screening examination in a representative sample of the US worker population in the National Health Interview Survey. METHODS Report of skin cancer examination in the 2000 and 2005 National Health Interview Survey cancer control supplements were examined by a range of variables. RESULTS Lifetime and 12-month reported clinical skin examination prevalence was 15% and 8%, respectively. Workers with elevated occupational exposure to ultraviolet light were less likely to have ever received a skin examination than the average US worker. Logistic regression analysis identified occupational category and age, sex, race, education level, health insurance, and sun-protective behavior as significant independent correlates of skin cancer examination. LIMITATIONS A limitation is potential healthy worker effect and underestimation of skin cancer screening with self-reported data. CONCLUSIONS Routine examination by primary care physicians frequently does not include a thorough skin examination. Physicians should be even more vigilant with patients at increased risk of excessive occupational sun exposure, as early detection of skin cancer by periodic skin examination decreases morbidity and can improve survival.

Prevalence of the Metabolic Syndrome Among U.S. Workers

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.

Earlier age at menopause, work, and tobacco smoke exposure.

Objective:Earlier age at menopause onset has been associated with increased all-cause, cardiovascular, and cancer mortality risks. The risk of earlier age at menopause associated with primary and secondary tobacco smoke exposure was assessed. Design:This was a cross-sectional study using a nationally representative sample of US women. A total of 7,596 women (representing an estimated 79 million US women) from the National Health and Nutrition Examination Survey III were asked time since last menstrual period, occupation, and tobacco use (including home and workplace second-hand smoke [SHS] exposure). Blood cotinine and follicle-stimulating hormone levels were assessed. Logistic regressions for the odds of earlier age at menopause, stratified on race/ethnicity in women 25 to 50 years of age and adjusted for survey design, were controlled for age, body mass index, education, tobacco smoke exposure, and occupation. Results:Among 5,029 US women older than 25 years with complete data, earlier age at menopause was found among all smokers and among service and manufacturing industry sector workers. Among women age 25 to 50 years, there was an increased risk of earlier age at menopause with both primary smoking and SHS exposure, particularly among black women. Conclusions:Primary tobacco use and SHS exposure were associated with increased odds of earlier age at menopause in a representative sample of US women. Earlier age at menopause was found for some women worker groups with greater potential occupational SHS exposure. Thus, control of SHS exposure in the workplace may decrease the risk of mortality and morbidity associated with earlier age at menopause in US women workers.

Accuracy of self-reported smoking and secondhand smoke exposure in the US workforce: The national health and nutrition examination surveys

Objectives:Occupational health studies often rely on self-reported secondhand smoke (SHS) exposure. This study examines the accuracy of self-reported tobacco use and SHS exposure. Methods:Data on serum cotinine, self-reported tobacco use, and SHS exposure for US workers were extracted from three National Health and Nutrition Examination Surveys (n = 17,011). Serum cotinine levels were used to classify workers into SHS exposure categories. The percent agreement between self-reported tobacco use and SHS exposure with the cotinine categories was calculated. Results:Workers reporting tobacco use were 88% accurate whereas workers reporting work, home, or home+work exposures were 87% to 92% accurate. Workers reporting no SHS exposure were only 28% accurate. Conclusions:Workers accurately reported their smoking status and workplace-home SHS exposures, but substantial numbers reporting “no exposures” had detectable levels of cotinine in their blood, indicating exposure to SHS.

Secondhand smoke exposure and the risk of hearing loss

Hearing loss has been associated with tobacco smoking, but its relationship with secondhand smoke is not known. We sought to investigate the association between secondhand smoke exposure and hearing loss in a nationally representative sample of adults. The National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional dataset, was utilised to investigate the association between secondhand smoke exposure and hearing loss. Data collected from non-smoking participants aged 20-69 years were included in the analysis if they had completed audiometric testing, had a valid serum continue value, and provided complete smoking, medical co-morbidity and noise exposure histories (N=3307). Hearing loss was assessed from averaged pure-tone thresholds over low- or mid-frequencies (500, 1000 and 2000 Hz) and high-frequencies (3000, 4000, 6000 and 8000 Hz), and was defined as mild or greater severity (pure-tone average in excess of 25 dB HL). Second-Hand Smoke (SHS) exposure was significantly associated with increased risk of hearing loss for low-/mid-frequencies (adjusted OR=1.14; 95% CI 1.02-1.28 for never smokers and 1.30; 1.10–1.54 for former smokers) and high-frequencies (1.40; 1.22–1.81 for former smokers), after controlling for potential confounders. Findings from the present analysis indicate that SHS exposure is associated with hearing loss in non-smoking adults.

Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007.

ObjectiveThe public health burden of tobacco-associated diseases in the USA remains high, in part because many peoples attempts to quit are unsuccessful. This study examined factors associated with having lifetime or recent attempts to quit smoking among current smokers, based on a telephone survey of Florida adults.MethodsData from the 2007 telephone-based Florida Behavioral Risk Factor Surveillance System (BRFSS) and its follow-up survey, the Tobacco Callback Survey, were used to assess determinants of having ever attempted to quit smoking and attempted to quit smoking in the past 12 months. All analyses were conducted using SAS.ResultsAmong 3,560 current smokers, 41.5% reported having tried to quit smoking in the past 12 months while 83.4% reported having ever tried to quit. Having a history of a tobacco-related medical condition was significantly associated with both recent (Adjusted Odds Ratio (AOR) 1.41 [Confidence Interval 1.19–1.65]) and lifetime quit attempts (AOR 1.43 [1.15–1.79]). Greater nicotine dependence and being advised by a physician to quit smoking were also positively associated with lifetime quit attempts.Receipt of healthcare provider advice to quit smoking in the past 12 months and a strong belief that quitting following a long history of regular smoking would not result in health benefits and belief that there are health benefits to quitting smoking were associated with lifetime quit attempts.ConclusionTargeted smoking cessation interventions are needed for smokers with selected medical conditions and with high nicotine dependence. The importance of physician advice in encouraging individuals to quit is further highlighted.