James R. Davis

Gender and Histologic Type Variations in Smoking-related Risk of Lung Cancer

We conducted a registry-based case-control study to examine the relation between smoking and lung cancer by gender and histologic type. Our analyses were based on 14,596 cases and 36,438 age-matched controls. Relative risk associated with ever-smoking, and level of smoking was consistently higher in females than males for all lung cancers combined (ever-smoking odds ratios: 12.7 for females and 9.1 for males) and for each histologic type except adenocarcinoma. Female-male differences in relative risk were larger in younger age groups. The largest estimates of the attributable fraction due to smoking were observed for small cell carcinoma (97% in females and 91% in males); conversely, the smallest value was noted for adenocarcinoma (86% in females). Although our study was unable to measure absolute risk, our findings, other recent studies, and contemporary female smoking patterns raise concerns that female smokers may assume a proportionally greater burden of lung cancer morbidity and mortality in the future.

Physical activity on the job and cancer in Missouri.

We conducted a series of case-control studies to investigate the risks of 16 cancer types in relation to occupational physical activity. These studies were based on Missouri Cancer Registry data for 17,147 White male cancer patients registered between 1984 and 1989. Colon cancer risk was increased for both the moderate (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 1.0, 1.3) and low (OR = 1.2; 95% CI = 1.0, 1.5) activity levels. Similar elevations were observed for prostate cancer at the moderate (OR = 1.1; 95% CI = 1.0, 1.3) and low (OR = 1.5; 95% CI = 1.2, 1.8) levels of activity, and for cancer of the testis at the low activity level (OR = 2.2; 95% CI = 1.3, 3.7). An opposite trend (p less than 0.01) was noted for lung cancer, which showed decreased risk at the moderate (OR = 0.9; 95% CI = 0.8, 1.0) and low (OR = 0.8; 95% CI = 0.6, 0.9) activity levels. These associations suggest that further study of the relationship between physical activity and site-specific cancer risk is warranted.

Demographic and socioeconomic differences in beliefs about the health effects of smoking.

To assess sociodemographic differences in beliefs about the health effects of cigarette smoking and passive smoke exposure, we recently surveyed 2092 adults in St. Louis and Kansas City, Mo. The percentages of respondents who knew that smoking causes lung cancer, emphysema, and heart disease were 76.7, 74.1, and 67.2, respectively. After multivariate adjustment, knowledge about smokings health effects was generally lower among women, older respondents, those of lower education level, and current smokers. Blacks were generally less likely to appreciate the health effects of active smoking, but were more likely to acknowledge the health effects of passive smoking.

Family pesticide use and childhood brain cancer

The relationship between family pesticide use and childhood brain cancer was examined in a case-control study. Telephone interviews were conducted from June 1989 through March 1990 with the natural mothers of 45 childhood brain cancer cases, 85 friend controls, and 108 cancer controls. In comparisons to friend controls, significant positive associations were observed for use of pesticides to control nuisance pests in the home, no-pest-strips in the home, pesticides to control termites, Kwell® shampoo, flea collars on pets, diazinon in the garden or orchard, and herbicides to control weeds in the yard. In comparisons to cancer controls, significant positive associations were observed for use of pesticide bombs in the home, pesticides to control termites, flea collars on pets, insecticides in the garden or orchard, carbaryl in the garden or orchard, and herbicides to control weeds in the yard. In general, positive associations in comparisons to one control group were supported by elevated odds ratios in comparisons to the other control group. Several potentially important associations were identified in this study. However, small sample sizes, potential recall bias, multiple comparisons, and lack of detailed exposure verification require further research to confirm these findings.

An analysis of occupational risks for brain cancer.

We evaluated the risks of brain cancer in relation to employment history in a case-control study of 312 cases and 1,248 cancer controls. Subjects were identified through the Missouri Cancer Registry for the period 1984 through 1988. Job classification was based on data routinely abstracted from hospital records. Elevated risks were identified for certain white collar occupations: for men employed in engineering, the odds ratio (OR) = 2.1; 95% confidence interval (CI) = 0.4, 10.3; for social science professionals, the OR = 6.1; 95% CI = 1.5, 26.1. Among occupations with potential exposure to occupational carcinogens, increased risks were observed for men employed in agricultural crop production (OR = 1.5; 95% CI = 1.0, 2.4), printing and publishing (OR = 2.8; 95% CI = 1.0, 8.3), and brickmasons and tilesetters (OR = 2.5; 95% CI = 0.5, 11.5). Most of elevated brain cancer risks were due to astrocytic cancers, but the excess among agricultural workers occurred in other cell types. No increase in risk was noted for current cigarette smokers (OR = 0.9; 95% CI = 0.7, 1.5) or ex-smokers (OR = 1.0; 95% CI = 0.7, 1.5). This exploratory study indicates a need for further studies of occupational risks of brain cancer.

Family pesticide use in the home, garden, orchard, and yard.

This study examined family use of pesticides in the home, garden, orchard, and yard. Data were collected from 238 families in Missouri during telephone interviews from June 1989 to March 1990.Nearly all families (97.8%) used pesticides at least one time per year and two thirds used pesticides more than five times per year. More than 80% used pesticides during pregnancy and 70% used pesticides during the first 6 months of a childs life.The most common setting for family pesticide use was in the home, where 80% of families used pesticides at least once per year. This was followed by herbicide use to control yard weeds (57% of families) and insecticide use to control fleas and ticks on pets (50% of families). A substantial number of families also used pesticides in the garden or orchard (33%).Flea collars were the most popular pest control product (50% of families). Carbaryl or Sevin® was also popular, with 28.2% of families reporting use. No-pest-strips (dichlorvos) and Kwell® shampoo (lindane) were used by almost 10% of participating families.Examination of study data revealed that families limited exposure to pesticides for the mother during pregnancy and for children during the first 6 months of life. Families failed to recognize and reduce pervasive exposures associated with no-pest-strips and flea collars.

Occupation, smoking, and alcohol in the epidemiology of bladder cancer

We conducted a case-control study to evaluate the effects of occupation, smoking, and alcohol consumption on bladder cancer risk. A total of 823 male cases and 2,469 age-matched controls were identified through the Missouri Cancer Registry. Relative risk estimates of 2.0 or greater were observed for janitors and cleaners, mechanics, miners, and printers. Current cigarette smoking was associated with a two-fold excess risk of bladder cancer, whereas alcohol consumption showed no association with bladder cancer risk.

Cancer risks among Missouri farmers

A series of case–control studies was conducted to investigate cancer risks among farmers. These studies were based on Missouri Cancer Registry data for 15,000 white male patients, including 1720 subjects classified as farmers, registered between 1984 and 1988. For each cancer site, all other cancer registrations formed the control group. The largest risks among farmers were found for lip cancer (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.99 to 4.73) and cancer of the bone (OR, 2.02; 95% CI, 0.66 to 5.81). Elevated risks were observed for several other sites, including the nasal cavity and sinuses (OR, 1.66; 95% CI, 0.54 to 4.70), prostate (OR, 1.33; 95% CI, 1.18 to 1.51), non‐Hodgkins lymphoma (OR, 1.40; 95% CI, 1.04 to 1.85), and multiple myeloma (OR, 1.40; 95% CI, 0.87 to 2.24). Other smaller elevations in risk were noticed for cancer of the rectum (OR, 1.21; 95% CI, 0.95 to 1.53), liver (OR, 1.19; 95% CI, 0.58 to 2.37), malignant melanoma (OR, 1.26; 95% CI, 0.63 to 2.45), kidney (OR, 1.21; 95% CI, 0.89 to 1.65), and leukemia (OR, 1.12; 95% CI, 0.81 to 1.55); however, some of these estimates were imprecise due to small numbers. The overall OR for lymphatic and hematopoietic cancers was 1.28 (95% CI, 1.06 to 1.56). Consistent with previous studies, a decreased risk of lung cancer was observed among farmers (OR, 0.67; 95% CI, 0.60 to 0.76). The current findings are presented in the context of other recent studies, including discussions of possible causes of farming‐associated excess cancer risk and possible sources of bias.

Cancer control knowledge and priorities among primary care physicians

Primary care physicians can play a key role in prevention and early detection of cancer. To assess cancer control knowledge and priorities among primary care physicians in Missouri, we conducted a random survey of 207 physicians. Although reported knowledge of the role tobacco plays in cancer causation was high, activity in tobacco cessation counselling and referral was low. Respondents considered diet to be a relatively unimportant factor in cancer causation, whereas they viewed sun exposure, genetics/family history, and radiation exposure as large contributors to the cancer burden. Among cancer early detection tests, high activity was shown for the Pap test and breast examination. Conversely, low activity was reported for colon sigmoidoscopy. Inverse correlations were shown between age group of the physician and several cancer prevention and early detection practices. For each cancer prevention and screening practice, reported activity was higher for medical doctors than for doctors of osteopathic medicine. Possible barriers or controversies in cancer control included disagreement with the current recommendation for Pap testing, the cost of mammography, and patient fear of sigmoidoscopy. These findings suggest that primary care physicians are not achieving their full potential in cancer control and indicate areas where increased emphasis is warranted.

O5-S1.04 Social media and chlamydia testing by university students: a pilot study

Background Facebook is the worlds largest social media site, and university students comprise one of the largest user groups. Sexually transmitted infections are also highly prevalent among university students in the USA. We evaluated a targeted Facebook advertisement for easy, inexpensive chlamydia testing at The Ohio State University (OSU), a public university with 55 000 students. Methods Over 2 weeks in May 2010, our advertisement for