Ralph V. Katz

The Tuskegee Legacy Project: Willingness of Minorities to Participate in Biomedical Research

The broad goal of the Tuskegee Legacy Project (TLP) study was to address, and understand, a range of issues related to the recruitment and retention of Blacks and other minorities in biomedical research studies. The specific aim of this analysis was to compare the self-reported willingness of Blacks, Hispanics, and Whites to participate as research subjects in biomedical studies, as measured by the Likelihood of Participation (LOP) Scale and the Guinea Pig Fear Factor (GPFF) Scale. The Tuskegee Legacy Project Questionnaire, a 60 item instrument, was administered to 1,133 adult Blacks, Hispanics, and non-Hispanic Whites in 4 U.S. cities. The findings revealed no difference in self-reported willingness to participate in biomedical research, as measured by the LOP Scale, between Blacks, Hispanics, and Whites, despite Blacks being 1.8 times as likely as Whites to have a higher fear of participation in biomedical research on the GPFF Scale.

Prevalence and Intraoral Distribution of Root Caries in an Adult Population

A descriptive epidemiologic survey of root caries in 473 20- to 64-year-olds revealed an age- and sex-adjusted overall root caries index (RCI) rate of 11.4% indicating that approximately one in nine surfaces with recession exhibited root caries. Although age-adjusted RCI rates for males and females were similar, the sex-adjusted RCI rates for each decade of life between 20 and 60 increased from 1.1% to 4.7% to 13.0% to 22.0%. Intraoral distribution patterns for root caries revealed that the most frequently attacked tooth types were mandibular molars (RCI = 40%), mandibular premolars (RCI = 25%) and maxillary canines (RCI = 23%). The least frequently attacked tooth types were the mandibular incisors (RCI = 2%). The interproximal surfaces exhibited the highest RCI rates in the maxillary arch while the buccal surfaces showed the highest RCI rates in the mandibular arch.

Malnutrition and Dental Caries: A Review of the Literature

Protein-energy malnutrition occurs when there are deficiencies in protein, energy foods or both, relative to a body’s needs. This paper reviews the association of early childhood malnutrition with: (1) dental caries, (2) en amel hypoplasia, (3) salivary gland hypofunction, and (4) delayed eruption. Studies suggest that caries of the primary dentition is associated with early childhood malnutrition, though the effect on caries of the permanent dentition has essentially not been studied. Enamel hypoplasia, salivary glandular hypofunction and saliva compositional changes may be mechanisms through which malnutrition is associated with caries, while altered eruption timing may create a challenge in the analysis of age-specific caries rates.

Intraoral squamous cell carcinoma: Epidemiologic patterns in connecticut from 1935 to 1985

There were 6181 cases of invasive intraoral squamous cell carcinoma accessioned by the Connecticut State Tumor Registry from 1935 to 1985. Cases were analyzed for age, sex, lesion site, and histologic differentiation. Crude, age‐specific, and age‐ adjusted incidence rates plus birth cohort analyses were also calculated. It was found that incidence rates for both men and women increased over the 51‐year period of study. For men, age‐adjusted incidence rates (1970 United States standard) increased from 4.9/100,000 in 1935 to 1939 to 8.5/100,000 in 1980 to 1985; for women, rates increased from 0.5/100,000 to 3.3/100,000 for the same period. The male‐to‐female ratio for intraoral squamous cell carcinoma declined dramatically from 9.8 to 2.6 during the 51‐year study period primarily because of the steep rate of increased incidence in women relative to that seen in men. The peak age of intraoral squamous cell carcinoma was the seventh decade. Age‐specific analysis showed that the older the age group, the higher the incidence for both sexes. During recent years, there was evidence of slightly increased incidence in men younger than 40. The tongue was the most common site for intraoral squamous cell carcinoma, followed closely by the floor of the mouth. Moderately differentiated tumors were most common (54.3% of the total), followed by both well‐differentiated cases (29.1%) and those that were poorly differentiated (16.6%).

Professional attitudes toward denture adhesives: A Delphi Technique survey of academic prosthodontists

STATEMENT OF PROBLEM The use of denture adhesives and their role in prosthodontics has been an intriguing and conflicted topic, both in clinical practice and dental education. PURPOSE This study generated discussion, and if possible, obtained a consensus on a series of issues related to denture adhesives among a group of leading academic prosthodontists. MATERIAL AND METHODS The Delphi Technique survey method was used. It consists of a series of survey questionnaire rounds to a panel of experts to either develop a consensus (>70% agreement) or to clarify the reasons for multiple schools of thought on a topic. A 24-item Delphi questionnaire was sent to an expert panel that consisted of a 33% regionally stratified random sample of program directors of undergraduate complete denture courses in US dental schools. The 5 major topic areas on denture adhesives addressed by the questionnaire items were (1) general perceptions, (2) specific clinical uses/misuses, (3) patient education, (4) inclusion in dental curricula, and (5) overall opinions of utility. RESULTS Of the 18 randomly selected panelists, 94% (n = 17) agreed to participate, with either 16 or 17 fully participating in each of the 3 survey rounds. The panel achieved consensus and clearly concluded that denture adhesives: (1) are a useful adjunct in denture prosthesis services, having specific roles in both the fabrication and postinsertion phases; (2) had the potential for misuse, both by dentists and by patients; and (3) should be an integral part of patient education for all denture patients and of the undergraduate dental curriculum. However, the panel was unable to achieve consensus on whether denture adhesives should be used at the postinsertion phase for immediate denture patients and whether, on the whole, they were a beneficial adjunct in denture patient management (59% agreed they were). The panelists also clearly expressed their concerns that neither dentists nor patients should use denture adhesives as a substitute for either good clinical practices or proper denture maintenance routines. CONCLUSIONS This panel of leading academic prosthodontists concluded that denture adhesives are a useful adjunct in denture prosthesis services, with specific roles in both fabrication and postinsertion phases. They also indicated that only through education, for dentists and patients, would the dual goals of maximizing the beneficial aspects of denture adhesive use while minimizing the misuse of denture adhesives be achieved.

Dental Caries, Periodontal Disease, and Cardiac Arrhythmias in Community‐Dwelling Older Persons Aged 80 and Older: Is There a Link?

Objectives: To examine whether caries or periodontitis is associated with cardiac arrhythmias in community‐dwelling people aged 80 and older.

Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City

Abstract Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S. A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% are current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer. Between the two communities, there were significant differences in paan and gutka usage, migration effects, and oral cancer risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products.

Unwillingness to Participate in Colorectal Cancer Screening: Examining Fears, Attitudes, and Medical Mistrust in an Ethnically Diverse Sample of Adults 50 Years and Older:

Purpose. Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening. Design. Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households. Setting. New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico. Subjects. Ethnically diverse sample of 454 adults ≥50 years of age. Measures. Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening. Analysis. Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening. Results. Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15–53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48–30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03–11.35), and older age (OR = 1.10; 95% CI, 1.04–1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03–.57) and medical mistrust (OR = .19; 95% CI, .06–.60) were negatively associated with unwillingness to screen. Conclusions. Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.

Changing trends in oral cancer in the United States, 1935 to 1985: A Connecticut study

An extensive epidemiologic study was undertaken in an attempt to analyze patterns of oral cancer distribution and demography in Connecticut between 1935 and 1985. Sources of data for the investigation included both the Connecticut Tumor Registry (CTR) and the University of Connecticut Oral Pathology Biopsy Service. During the 51-year study period, 9,708 cases of primary oral cancer were reported to the CTR. Male age-adjusted incidence rates for overall oral cancer remained stable between 1935 and 1964 (14.5 to 14.8 per 100,000), with a gradual decline to 10.9 per 100,000 in the early 1980s. In contrast, age-adjusted rates for females advanced approximately threefold, from 1.4 per 100,000 in the 1930s to 4.1 per 100,000 in the early 1980s. There was a decrease in age-specific rates of oral cancer in males aged 70 and older; in contrast, age-specific incidence rates in females increased steadily over the same period. It was also found that female birth cohorts born in 1900 and later exhibited higher oral cancer incidence rates than those of previous cohorts. Between the 1960s and the present, male patients 30 to 39 years of age exhibited a nearly fourfold increase in oral cancer incidence; this was not observed among similarly aged females. Connecticut counties with highest oral cancer incidence rates in both sexes were the more densely populated Hartford and New Haven counties. In general, the picture of oral cancer, as revealed through analysis of cases accessioned by the University biopsy service between 1975 and 1986, exhibited similar trends to those disclosed by analysis of CTR data.(ABSTRACT TRUNCATED AT 250 WORDS)

The Legacy of the Tuskegee Syphilis Study: Assessing its Impact on Willingness to Participate in Biomedical Studies

The phrase, legacy of the Tuskegee Syphilis Study, is sometimes used to denote the belief that Blacks are more reluctant than Whites to participate in biomedical research studies because of the infamous study of syphilis in men run by the U.S. Public Health Service from 1932–72. This paper is the first to attempt to assess directly the accuracy of this belief within a multi-city, multi-racial, large-scale, detailed random survey. We administered the Tuskegee Legacy Project (TLP) Questionnaire to 826 Blacks and non-Hispanic White adults in three U.S. cities. While Blacks had higher levels of general awareness of the Tuskegee Syphilis Study, there was no association between either awareness or detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, either for Blacks or Whites observed in our survey. While this study refutes the notion that there is a direct connection between detailed knowledge of the Tuskegee Syphilis Study and willingness to participate in biomedical research, it does not assess the broader question of whether and how historical events influence people’s willingness to participate in research. Future studies should explore this.