Patti Herring

Are strict vegetarians protected against prostate cancer

BACKGROUND According to the American Cancer Society, prostate cancer accounts for ∼27% of all incident cancer cases among men and is the second most common (noncutaneous) cancer among men. The relation between diet and prostate cancer is still unclear. Because people do not consume individual foods but rather foods in combination, the assessment of dietary patterns may offer valuable information when determining associations between diet and prostate cancer risk. OBJECTIVE This study aimed to examine the association between dietary patterns (nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, vegan, and semi-vegetarian) and prostate cancer incidence among 26,346 male participants of the Adventist Health Study-2. DESIGN In this prospective cohort study, cancer cases were identified by matching to cancer registries. Cox proportional hazards regression analysis was performed to estimate HRs by using age as the time variable. RESULTS In total, 1079 incident prostate cancer cases were identified. Around 8% of the study population reported adherence to the vegan diet. Vegan diets showed a statistically significant protective association with prostate cancer risk (HR: 0.65; 95% CI: 0.49, 0.85). After stratifying by race, the statistically significant association with a vegan diet remained only for the whites (HR: 0.63; 95% CI: 0.46, 0.86), but the multivariate HR for black vegans showed a similar but nonsignificant point estimate (HR: 0.69; 95% CI: 0.41, 1.18). CONCLUSION Vegan diets may confer a lower risk of prostate cancer. This lower estimated risk is seen in both white and black vegan subjects, although in the latter, the CI is wider and includes the null.

Social Determinants of Physical Activity Among Adult Asian-Americans: Results from a Population-Based Survey in California

The objective of this study was to evaluate the key social determinants of physical activity among six Asian-American subgroups using public access 2007 California Health Interview Survey data. Physical activity was defined as meeting the American College of Sports Medicine recommendation of 450 metabolic equivalent-minutes per week. Factors positively associated with meeting physical activity recommendations included being bilingual among Chinese and Vietnamese, and increasing age for Chinese only. On the other hand, being middle aged, currently married, and low neighborhood safety were significantly associated with lower odds of meeting physical activity recommendations, as were being female for Japanese and Koreans, and living above the poverty level for Vietnamese. Such results highlight the heterogeneity among Asian-Americans and need for health messages targeted at specific subgroups. Additionally, the role of built environment, particularly in areas with high Filipino residents, should be a public health priority for increasing physical activity outcomes.

Obesity and Life Expectancy Among Long-Lived Black Adults

BACKGROUND In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults. METHODS The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort-half of whom attained an age of 58-108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women). RESULTS Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8-10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1- 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5-24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously. CONCLUSIONS Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks.

Association between Acculturation and Binge Drinking among Asian-Americans: Results from the California Health Interview Survey

Objective. Evaluate the association between acculturation and binge drinking among six Asian-American subgroups. Methods. A cross-sectional analysis of public access adult portion of 2007, 2009, and 2011/2012 California Health Interview Survey data was conducted. Univariate and multivariable logistic regression analyses were utilized with any binge drinking in the past year as the outcome variable and language spoken at home and time in USA as proxy measures of acculturation. Results. A total of 1,631 Asian-Americans (N = 665,195) were identified as binge drinkers. Binge drinking was positively associated with being first generation South Asian (OR = 3.05, 95% CI = 1.55, 5.98) and monolingual (English only) Vietnamese (OR = 3.00; 95% CI = 1.58, 5.70), especially among females. Other factors associated with increased binge drinking were being female (Chinese only), not being current married (South Asian only), and being an ever smoker (all subgroups except South Asians). Conclusion. First generation South Asians and linguistically acculturated Vietnamese, especially females, are at an increased risk of binge drinking. Future studies and preventive measures should address the cultural basis of such health risk behaviors among Asian-American adults.

Vegetarian dietary patterns and the risk of breast cancer in a low-risk population.

Among cancers in American women, breast cancer (BC) has the second highest incidence and mortality. The association of BC with diet has been inconsistent. Studies that evaluate associations with dietary patterns are less common and reflect an individuals whole diet. We associated dietary patterns with the risk of BC in American women of the Adventist Health Study-2 (AHS-2), a prospective cohort of 96 001 subjects recruited between 2002 and 2007. Answers to a previously validated FFQ were used to classify subjects to vegan, lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian dietary patterns. Incident BC were identified by matching AHS-2 subjects to data from forty-eight state cancer registries. Statistical analyses used proportional hazard regression analyses with covariates that were chosen a priori. From 50 404 female participants (26 193 vegetarians), we identified 892 incident BC cases, with 478 cases among vegetarians. As compared with non-vegetarians, all vegetarians combined did not have a significantly lower risk (hazard ratio (HR) 0·97; CI 0·84, 1·11; P=0·64). However, vegans showed consistently lower (but non-significant) point estimates when compared with non-vegetarians (all cases: HR 0·78; CI 0·58, 1·05; P=0·09). In summary, participants in this cohort who follow a vegetarian dietary pattern did not experience a lower risk of BC as compared with non-vegetarians, although lower risk in vegans is possible. These findings add to the very limited literature associating vegetarian diets with BC risk and can assist nutritionists when evaluating the impact of these diets. The findings will also motivate further evaluation of vegan diets and their special characteristics.

Generational differences in fast food intake among South-Asian Americans: results from a population-based survey.

The goal of this study was to evaluate the association between generational status and fast food consumption among South-Asian Americans. We conducted a secondary analysis of data from the California Health Interview Survey for 2007, 2009, and 2011. After adjusting for control variables, South-Asian Americans of the third generation or more had a fast food intake rate per week 2.22 times greater than first generation South-Asian Americans. Public health practitioners must focus on ways to improve dietary outcomes among this fast-growing ethnic population in the United States.

Integrating academia with community-based health practices: the San Bernardino County Community-Based Pediatric Vision Outreach System.

In humans, sight is the most powerful of the five senses. Recent research has demonstrated that preschoolers and school-age children are most at risk for developing visual problems.1,2 Regular school screenings, comprehensive eye examinations, and appropriate surgical interventions are all necessary to safeguard the integrity of the visual system. However, a child’s access to eye care services is largely dependent on the health insurance status of the family. The Census Bureau has calculated that 38.7 million people living in the United States lack health insurance.3 In California, 18.7% of the population was without health insurance in 2000, the seventh highest uninsured rate in the nation.4 Poor uninsured children in California are in far worse overall health than poor children on Medicaid or low-income children covered by health insurance.5 In California, many individual counties are faced with the growing problem of providing health care services for large uninsured populations. For instance, San Bernardino County is the largest county in the contiguous United States and home to approximately 185,000 children ages 0–5 years.6 It has been estimated that as many as 19% of children ages 0–18 years living in the county are uninsured.7 For poor families, accessing low-cost health care and preventive services can dramatically influence positive health outcomes, especially in children. However in San Bernardino County, geographic isolation, poverty, high exposure to violence, and impoverished residential environments have limited many residents’ access to preventive care services and have generated huge health disparities.8,9 Periodic physical examinations, routine dental care, vaccinations, and dilated eye examinations are among the preventive health services that are necessary for the health of our children.10 Yet in the area of comprehensive vision care, there are very few options for financial aid available to children without health insurance if they live in San Bernardino County. In the fall of 1999, four community activists living in the city of San Bernardino (including present author EH) became involved in creating a system whereby low-cost or no-cost vision services could be provided for needy children. An innovative approach to the problem clearly was necessary. A course for MPH students offered by the Department of Health Promotion and Education (DHPE), School of Public Health, Loma Linda University, gave the initial program planners a systematic method for gathering the necessary needs assessment data, planning a system of care, and implementing and evaluating the program in the target communities. The San Bernardino County CommunityBased Pediatric Vision Outreach System (PVOS) evolved out of these circumstances.

Recruiting and motivating black subjects to complete a lengthy survey in a large cohort study: an exploration of different strategies

BackgroundThe effectiveness of multiple innovative recruitment strategies for enrolling Black/African American participants to the Adventist Health Study-2 (AHS-2) is described. The study’s focus is diet and breast, prostate and colon cancer.MethodsPromotions centered on trust, relationship building and incentives for increasing enrollment and questionnaire return rate. Of the sub-studies described, one had a randomized control group, and the others, informal controls. The subjects are from all states of the U.S. and some provinces of Canada. The offer of a Black art piece, follow-up calls, a competitive tournament as well as other strategies accounted for nearly 3,000 additional returns even though they were often used in small subsets.ResultsFlexibility and multiple strategies proved advantageous in gaining the cooperation of Blacks, who are usually reluctant to participate in research studies.ConclusionsLessons learned during initial enrollment should help us retain our final Black cohort of 26,000, and obtain new information when required.

Two Physical Activity Measures: Paffenbarger Physical Activity Questionnaire Versus Aerobics Center Longitudinal Study as Predictors of Adult-Onset Type 2 Diabetes in a Follow-Up Study:

Purpose: To compare 2 self-report methods of measuring weekly minutes of physical activity based on the Aerobics Center Longitudinal Study (ACLS) questionnaire and question 6 of the Paffenbarger Physical Activity Questionnaire (PPAQ) to determine the better predictor of adult-onset type 2 diabetes mellitus (T2DM). Design: An observational, prospective study. Setting: Survey data from the Adventist Health Study-2 (AHS-2) collected between 2002 and 2006 (baseline) and the Psychosocial Manifestations of Religion Sub-Study (PsyMRS), an AHS-2 subset collected 1 to 4 years later. Patients: Nine thousand eight hundred seventy-three male and female participants aged 23 to 106 years (mean, 63 years). Three hundred eighty participants reported adult-onset T2DM at follow-up. Measures: Question 6 from the PPAQ and a question adopted from the ACLS were assessed at baseline. Incident diabetes was defined as participants who reported receiving treatment for adult-onset T2DM in the last 12 months in the PsyMRS and not at baseline. Analysis: Multivariate logistic regression analyses controlled for age, gender, ethnicity, education, body mass index (BMI), diet, and sedentary activity. Each exposure variable was compared to nonexercisers. Results: The PPAQ (odds ratio [OR]: 0.998; 95% confidence interval [CI]: 0.997-1.000) and the ACLS (OR: 0.999; 95% CI: 0.998-1.001) exhibited similar likelihood of predicting incident adult-onset T2DM in a healthy, mixed-gender population when controlling for several confounders. Conclusions: The demonstrative nomenclature of the PPAQ may be more effectual in capturing physically active individuals than the ACLS notwithstanding generalizability and response bias limitations.