Steven D. Stellman

Artificial sweetener use and one-year weight change among women

Weight change over a 1-year period was examined in a highly homogeneous group of 78,694 women ages 50-69 enrolled in a prospective mortality study. Artificial sweetener usage increased with relative weight and decreased with age. Users were significantly more likely than nonusers to gain weight, regardless of initial weight. Average weight gains or losses by artificial sweetener users differed by less than 2 pounds from gains or losses among nonusers. These results were not explicable by differences in food consumption patterns. The data do not support the hypothesis that long-term artificial sweetener use either helps weight loss or prevents weight gain.

Alcohol and breast cancer: A cohort study

The relation between alcohol consumption and several causes of death, including breast cancer, was examined in a population of 581, 321 women enrolled in a prospective study in 1959 and followed for 12 years. Women who drank occasionally had about the same breast cancer mortality rate as nondrinkers; those who drank one to four drinks per day had SMRs 7-26% higher; five drinks per day, 1.89; and six or more drinks per day, 1.65. The two highest-consumption groups risks were significantly higher than those of nondrinkers after multivariate adjustment for several breast cancer risk factors. Distinctive dose-response relationships were observed for two known alcohol-related conditions: cirrhosis of the liver and cancer of the aero-digestive tract, suggesting that results for other causes are not seriously biased by misclassification of drinking habits. Death rates from all causes combined were elevated for drinkers of three or more drinks per day. Whether or not the association of elevated breast cancer death rates ultimately turns out to be causal, there is ample reason to continue to warn the public against excessive drinking.

Health and Reproductive Outcomes among American Legionnaires in Relation to Combat and Herbicide Exposure in Vietnam

History of diagnosed illnesses, medical symptoms, and reproductive outcomes and their relation to combat intensity and herbicide exposure were studied, via a mailed questionnaire, among 6810 American Legionnaires who served during the Vietnam War (42% in Southeast Asia, 58% elsewhere). Heart disease, venereal disease, and benign fatty tumors were reported significantly more often by Vietnam veterans than by controls. Combat intensity was significantly dosage-related to history of high blood pressure, ulcers, arthritis and rheumatism, genito-urinary problems, nervous system disease, major injury, hepatitis, and benign fatty tumors. Agent Orange exposure was significantly dosage-related to history of benign fatty tumors, adult acne, skin rash with blisters, and increased sensitivity of eyes to light. Rates of the latter two conditions and of change in skin color were especially elevated in men whose military occupations involved direct handling of herbicides. Five symptom complex scales were constructed via factor analysis to measure degrees of feeling faint, fatigue or physical depression, body aches, colds, and skin irritation. Means of all five scales were significantly higher in Vietnam veterans compared to controls, and in herbicide handlers compared to nonhandlers. Both combat and Agent Orange exposure were significant, independent predictors of each of the five scales. Neither combat nor Agent Orange exposure was associated with difficulty in conception, time to conception of first child, or to birthweight or sex ratio of offspring, but maternal smoking was strongly related to reduced birthweight. The percentage of spouses pregnancies which resulted in miscarriages was significantly higher for Vietnam veterans than controls (7.6% vs 5.5%, P less than 0.001). Logistic regression analysis showed that Agent Orange exposure and maternal smoking were both independently and significantly associated with miscarriage rates in a dose-related manner.

Mortality by relative weight and exercise

Mortality in relation to relative weight and exercise was analyzed from data collected in the first 2 years of the American Cancer Societys Cancer Prevention Study II. It included data on 868,620 persons who had no history of cancer, heart disease, or stroke and who were not sick at the start of the study. Standardized mortality ratios (SMR) were 187 for men who were 20% or more underweight and 187 for men who were 40% or more overweight. Comparable SMR in women were 186 and 178. Current smokers had considerably higher SMR than nonsmokers for all causes of death and cancer deaths at each relative weight category. Degree of exercise reported by subjects was inversely related to mortality, independent of smoking habits. Subjects who exercised heavily and died of cancer of the lung, colonrectum, and pancreas had 20% to 37% higher SMR than men and women who reported moderate exercise.

Lung cancer risk is proportional to cigarette tar yield: Evidence from a prospective study

The age-adjusted risk for lung cancer among over 120,000 male current cigarette smokers in the American Cancer Societys 1959-1972 prospective study was analyzed according to tar yield and quantity smoked per day. At each quantity level, the risk increased with increasing tar yield, and at each tar level, the risk increased with numbers of cigarettes smoked daily. The risks in smokers of cigarettes with the lowest yields, however, far exceeded those of former smokers and nonsmokers. The excess lung cancer risk for current smokers was directly proportional to the estimated total milligrams of tar consumed daily: SMR = 100 + 1.731 x milligrams tar per day. Tar yields today are much lower than they were at the time of this study and presage an eventual reduction (but not elimination) of lung cancer risk for those who continue to smoke cigarettes, especially among lifetime smokers of low-tar cigarettes.

Social and behavioral consequences of the Vietnam experience among American legionnaires

One aspect of a cross-sectional questionnaire study of a sample of Vietnam veterans belonging to The American Legion was devoted to analysis of social and behavioral consequences of service in Southeast Asia. Members of the study population were stratified by whether they served in Southeast Asia and, within the Southeast Asia group, by varying degrees of exposure to combat and to herbicides. Using validated scales for behavioral affect and for the exposure measures for combat and herbicides, a wide range of adverse effects was observed. Men who faced high levels of combat intensity were found to be at greater risk for divorce and for generally being less happy and satisfied with their lives, their marriages, their role as fathers, and as sexual human beings. Although in this population they have reached comparatively high levels of education, they earn significantly less money than peers of their same age and educational attainment. Vietnam veterans returning from combat were found to exhibit higher levels of behavioral disturbances, with mean scores for depression, anxiety, irritation, feelings of helplessness, and physical signs of depression significantly worse than noncombat peers. The lifestyle of combat veterans also continues to place them at greater risk for poor health. They smoke, drink, and use prescription drugs at rates significantly greater than the other veterans in this study. Combat veterans have had a significantly poorer rate of reduction and cessation of smoking and drinking than others in this population. Evidence is also presented which shows that for some of the behavioral outcomes measured, a negative interactive effect of concurrent exposure to herbicides is present.

Patterns of Artificial Sweetener Use and Weight. Change in an American Cancer Society Prospective Study

Extreme obesity and leanness are risk factors for many types of cancer. An earlier American Cancer Society study (1959-1972) found a nearly twofold increased risk for death from all causes in men and women who weighed 40% or more above average for their age and height, and found elevated cancer rates as well. A new (1982), ongoing ACS prospective study of 1.2 million men and women continues to find increased death rates from all causes and from cancer in the very heavy and the very lean. Artificial sweetener (AS) use is an important correlate of relative weight in this population. The relationship between weight change during the year preceding enrollment and AS usage was studied in a highly homogeneous subgroup of 78694 women ages 50-69 years. The percentage of users increased with body mass index (BMI) and was inversely related to age. Users were significantly more likely than non-users to gain weight, regardless of initial BMI. Among those who gained weight, the average number of lbs gained by AS users was higher (by 0.5-1.5 lb) than the amount gained by non-users. Within the entire cohort, AS users of both sexes ate chicken, fish and vegetables significantly more often than did non-users and consumed beef, butter, white bread, potatoes, ice cream and chocolate significantly less often, suggesting that our weight change results are not explicable by differences in food consumption patterns.

Combat and herbicide exposures in Vietnam among a sample of American legionnaires

A cross-sectional survey of 6810 randomly selected members of The American Legion in six states who served in the U.S. Armed Forces during the Vietnam Era was conducted by a mailed questionnaire. Combat stress was evaluated by a previously validated eight-item scale. Exposure to Agent Orange and other herbicides was estimated via exposure probability index previously developed by the authors which uses an algorithm based on the combined Air Force and Joint Services HERBS files of spray data. Two-fifths of the men had served in Southeast Asia, generally at the same time during which the major proportion of herbicides were used; the remaining subjects served elsewhere. Both combat and Agent Orange exposure exhibited distinct, meaningful distributions among Vietnam veterans with service in Southeast Asia and were also correlated with each other (r = 0.24). Our analysis demonstrates conclusively that mere presence in Vietnam cannot be used as a proxy for exposure to Agent Orange. Categorization of Vietnam veterans according to herbicide exposure can be successfully accomplished, based on an existing detailed herbicide application data base. This analysis, together with the consistent dose-related results obtained in this series of papers on health and behavioral effects, demonstrates the utility of questionnaire-derived herbicide and combat exposure measures for epidemiologic study of Vietnam veterans.

Utilization, Attitudes, and Experiences of Vietnam Era Veterans with Veterans Administration Health Facilities: The American Legion Experience

A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above

Tobacco usage in France: An epidemiological study

30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans physical and mental health.