Jacqueline W. Miller

Binge drinking and associated health risk behaviors among high school students.

OBJECTIVES. Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming ≥5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors. METHODS. We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors. RESULTS. Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors. CONCLUSIONS. Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.

Understanding the burden of human papillomavirus‐associated anal cancers in the US

Anal cancer is an uncommon malignancy in the US; up to 93% of anal cancers are associated with human papillomavirus.

Cancer incidence among children and adolescents in the United States, 2001-2003.

OBJECTIVE. Our goal was to describe current childhood cancer incidence in the United States and identify demographic and geographic variation among children and adolescents with cancer. METHODS. We examined data from 39 National Program of Cancer Registries and 5 Surveillance, Epidemiology, and End Results statewide registries (representing >90% of the US population) to identify cancers diagnosed among persons aged 0 to 19 from 2001–2003. Diagnosed cancers were grouped by the third version of the International Childhood Cancer Classification. Analyses were stratified according to gender, age, race, ethnicity, and US census region. A multivariable negative binomial regression model was used to evaluate demographic and geographic differences in incidence for all cancers combined. RESULTS. We identified 36446 cases of childhood cancer with an age-adjusted incidence rate of 165.92 per million. Stratified analyses showed that, for all cancers combined, boys had a significantly higher rate than girls; children (aged 0–14 years) had a significantly lower rate than adolescents (aged 15–19 years); and white children had the highest incidence rate among all races. Young people living in the Northeast had the highest incidence rate among all US census regions, which may be partially attributed to significantly higher incidence rates for central nervous system neoplasms and lymphomas in this region compared with other US census regions. Negative binomial regression analysis demonstrated that the childhood cancer-incidence rate varied significantly according to gender, age, race, ethnicity, and geography. CONCLUSIONS. This study is the first to demonstrate substantial regional differences in the incidence of childhood cancer. It also shows that incidence varies according to gender, age, race, and ethnicity. Our research findings are useful for prioritizing future childhood cancer research needs.

Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006

BACKGROUND Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have limited in-depth analyses for all racial and ethnic groups. OBJECTIVE We sought to describe racial and ethnic variations in melanoma incidence and survival. METHODS Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. RESULTS Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. LIMITATIONS Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). CONCLUSIONS Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States.

Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians†‡

Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking.

The Changing Incidence of In situ and Invasive Ductal and Lobular Breast Carcinomas: United States, 1999-2004

Background: National incidence rates for lobular and ductal breast cancers have not been available previously. Evidence suggests that the increased risk of breast cancer associated with combined hormone replacement therapy use is higher for invasive lobular cancers (ILC) than for invasive ductal cancers (IDC). This study provides U.S. incidence rates for these histologic types for both in situ and invasive cancers and assesses changes in the incidence of these cancers over time. Methods: Data for this study included incident ductal and lobular breast cancer cases diagnosed from 1999 through 2004 in central cancer registries in 44 states and the District of Columbia from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program. We estimated incidence per 100,000 women by 10-year age groups, race, and ethnicity. We also assessed the percent change in invasive and in situ cancer incidence over time. Results: We observed distinct differences in the change of incidence over time between in situ and invasive lobular and ductal breast cancers. The age-adjusted rates of ILC and IDC declined an average of 4.6% and 3.3% per year, respectively. Overall, ILC decreased 20.5% from 1999 to 2004. The patterns of ductal and lobular in situ cancer incidence were not consistent over time, and the total change was negligible. Conclusion: The declines in ILC observed in our study are consistent with a decrease in cancer incidence related to a reduced use of combined hormone replacement therapy. However, other factors could also be responsible for these changes. (Cancer Epidemiol Biomarkers Prev 2009;18(6):1763–9)

Recent trends in U.S. mammography use from 2000-2006 : A population-based analysis

OBJECTIVE We previously reported a decrease in regular mammogram use from 2000 through 2005. To determine whether a downward trend continued in 2006 we re-examined mammography utilization reported in Behavioral Risk Factor Surveillance System data from 2000 through 2006. METHODS Age-adjusted percentages of women who reported having had a mammogram in the past 2 years were estimated by demographic and socioeconomic characteristics. Logistic regression was used to assess the linear time trends. RESULTS The total age-adjusted proportion of all women aged > or =40 years who reported having had a mammogram within the 2 preceding years did not change when comparing data from 2000 (76.5% [95% CI: 75.9-77.0]) to 2006 (76.1% [75.7-76.6]). However, among those with health care coverage, a statistically significant decline in utilization occurred among women age 40 through 59 years, and non-Hispanic white women. CONCLUSIONS A substantial proportion of women are not being screened by mammography as recommended. Recent data suggest that patterns of utilization have leveled off or declined among certain subgroups of women. These data underscore the need to more effectively address current barriers to the utilization of mammography.

Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality.

BACKGROUND The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening to medically underserved, low-income women aged 40-64 years. No study has evaluated NBCCEDPs effect on breast cancer mortality. PURPOSE This study estimates life-years saved by NBCCEDP breast cancer screening compared with screening in the absence of NBCCEDP and with no screening. METHODS A breast cancer simulation model based on existing Cancer Intervention and Surveillance Modeling Network models was constructed. The screening module from these models was modified to reflect screening frequency for NBCCEDP participants. Screening data for uninsured women represented what would have happened without the program. Separate simulations were performed for women who received NBCCEDP (Program) screening, women who potentially received screening without the program (No Program), and women who received no screening (No Screening). The impact of NBCCEDP was estimated as the difference in life-years between the Program and No Program, and the Program and No Screening scenarios. The analysis was performed in 2008-2009. RESULTS Among 1.8 million women who were screened between 1991 and 2006, the Program saved 100,800 life-years compared with No Program and 369,000 life-years compared with No Screening. Per woman screened, the Program saved 0.056 life-years (95% CI=0.031, 0.081) compared with No Program and 0.206 life-years (95% CI=0.177, 0.234) compared with No Screening. Per woman with invasive breast cancer and screen-detected invasive cancer, the Program saved 0.41 and 0.71 life-years, respectively, compared with No Program. CONCLUSIONS These estimates suggest that NBCCEDP breast cancer screening has reduced mortality among medically uninsured and underinsured low-income women.

Myocarditis, Pericarditis, and Dilated Cardiomyopathy after Smallpox Vaccination among Civilians in the United States, January-October 2003

Myocarditis was reported after smallpox vaccination in Europe and Australia, but no association had been reported with the US vaccine. We conducted surveillance to describe and determine the frequency of myocarditis and/or pericarditis (myo/pericarditis) among civilians vaccinated during the US smallpox vaccination program between January and October 2003. We developed surveillance case definitions for myocarditis, pericarditis, and dilated cardiomyopathy after smallpox vaccination. We identified 21 myo/pericarditis cases among 37,901 vaccinees (5.5 per 10,000); 18 (86%) were revacinees, 14 (67%) were women, and the median age was 48 years (range, 25-70 years). The median time from vaccination to onset of symptoms was 11 days (range, 2-42 days). Myo/pericarditis severity was mild, with no fatalities, although 9 patients (43%) were hospitalized. Three additional vaccinees were found to have dilated cardiomyopathy, recognized within 3 months after vaccination. We describe an association between smallpox vaccination, using the US vaccinia strain, and myo/pericarditis among civilians.

RELIGIOUS AFFILIATION AND ALCOHOL CONSUMPTION IN THE UNITED STATES

Levels of alcohol consumption are a major public health issue. This study aims to gain a better understanding of how geographical patterns of religious affiliation in the United States relate to geographical patterns of alcohol consumption. We explored state‐level correlations between alcohol consumption and religious adherence. Although we found no statistically significant correlation between overall religious adherence rates and current or binge drinking rates, states with higher adherence rates were significantly more likely to have high proportions of binge drinking among current drinkers. Yet, regionally, we found a strong inverse correlation in the Southeast and a strong positive correlation in the Midwest and Northeast between adherence rates and current and binge drinking rates. These geographical differences were largely explained after stratifying by major religious denominational groupings. States with high Catholic adherence rates tended to have higher drinking rates, whereas states with high Evangelical Protestant adherence rates tended to have lower drinking rates. These findings suggest that the relationship between religion and alcohol may be denomination‐specific and challenge the lay perception that religious adherence per se is associated with less alcohol consumption and less excessive drinking among those who drink.