Purpose: The lack of individual socioeconomic status (SES) information in cancer registry data necessitates the use of area-based measures to investigate health disparities. Concerns about ...confidentiality, however, prohibit publishing patients' residential locations at the subcounty level. We developed a census tract-based composite SES index to be released in place of individual census tracts to minimize the risk of disclosure. Methods: Two SES indices based on the measures identified in the literature were constructed using factor analysis. The analyses were repeated using the data from the 2000 decennial census and 2005–2009 American Community Survey to create the indices at two time points, which were linked to 2000–2009 Surveillance, Epidemiology, and End Results registry data to estimate incidence and survival rates. Results: The two indices performed similarly in stratifying census tracts and detecting socioeconomic gradients in cancer incidence and survival. The gradient in the incidence is positive for breast and prostate, and negative for lung cancers, in all races, although the level varies. The positive gradient in survival is more salient for regionalstaged breast, colorectal, and lung cancers. Conclusions: The census tract-based SES index provides a valuable tool for monitoring the disparities in cancer burdens while avoiding potential identity disclosure. This index, divided into tertiles and quintiles, is now available to the researchers on request.
This study compares and analyzes the relationship of design-build (DB) and design-bid-build (DBB) project delivery methods with performance metrics of large highway projects (
>$50 million
). ...Project performance is measured in cost, schedule, and change orders on these two types of highway projects. This study also investigates associations between project characteristics (input variables) and project performance (output variables) of large highway projects. The performance comparison methodology used here is derived from work done on a Texas Department of Transportation study of the State Highway 130 Project. The study results show that the construction speed and project delivery speed per lane mile (or lane kilometer) of DB projects were significantly faster than that of DBB projects for this sample. The study also showed that out of 21 inputs analyzed, 14 inputs have statistically significant associations with one or more outputs of these projects.
National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese.
Cancer ...incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison.
Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese).
These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.
Introduction
Anxiety symptoms are the most common neuropsychiatric manifestation of Parkinson’s disease (PD), contributing to decreased quality of life. Few longitudinal studies in PD samples have ...examined correlates of anxiety symptoms over time. Understanding predictor variables may help to identify novel targets for reducing anxiety in PD. The aim of this study was to identify predictors of anxiety symptoms over 3 years in a clinic-based PD cohort.
Methods
Our cohort included patients with PD at an academic medical center in the Southeastern United States (
n
= 105). Visits included assessment of motor, psychiatric, and cognitive features, including neuropsychological testing. For our multivariate model, we selected 11 predictor variables with the most existing evidence or theoretical support for an association with anxiety symptoms in PD. Multivariate linear mixed model regression was performed to determine which variables were significantly associated with anxiety symptoms over time.
Results
Over half of participants (57%) met the screening threshold for an anxiety disorder at some point during the study. Independent predictors of anxiety symptoms over time included symptoms of REM sleep behavior disorder (RBD) and dysautonomia.
Discussion
In this PD sample, RBD and dysautonomia symptoms were significantly associated with anxiety symptoms over time. Each of these relationships has been reported in one of two prior longitudinal studies. Unlike prior studies, cognitive impairment was not a significant predictor of anxiety symptoms in our sample. Future research should confirm the direction and mechanisms underlying these relationships, including the potential for anxiety symptom reduction through treatment for RBD and dysautonomia.
Purpose
Use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival.
Methods
Health Eating, ...Activity, and Lifestyle (HEAL) Study participants (
n
= 707) were diagnosed with stage I–IIIA breast cancer. Participants completed a 30-month post-diagnosis interview including questions on CAM use (natural products such as dietary and botanical supplements, alternative health practices, and alternative medical systems), weight, physical activity, and comorbidities. Outcomes were breast cancer-specific and total mortality, which were ascertained from the Surveillance Epidemiology and End Results registries in Western Washington, Los Angeles County, and New Mexico. Cox proportional hazards regression models were fit to data to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. Models were adjusted for potential confounding by sociodemographic, health, and cancer-related factors.
Results
Among 707 participants, 70 breast cancer-specific deaths and 149 total deaths were reported. 60.2 % of participants reported CAM use post-diagnosis. The most common CAM were natural products (51 %) including plant-based estrogenic supplements (42 %). Manipulative and body-based practices and alternative medical systems were used by 27 and 13 % of participants, respectively. No associations were observed between CAM use and breast cancer-specific (HR 1.04, 95 % CI 0.61–1.76) or total mortality (HR 0.91, 95 % CI 0.63–1.29).
Conclusion
Complementary and alternative medicine use was not associated with breast cancer-specific mortality or total mortality. Randomized controlled trials may be needed to definitively test whether there is harm or benefit from the types of CAM assessed in HEAL in relation to mortality outcomes in breast cancer survivors.
Abstract
Introduction
The workplace is a major source of exposure to secondhand smoke from combustible tobacco products. Smokefree workplace policies protect nonsmoking workers from secondhand smoke ...and help workers who smoke quit. This study examined changes in self-reported smokefree workplace policy coverage among U.S. workers from 2003 to 2010–2011.
Methods
Data came from the 2003 (n = 74,728) and 2010–2011 (n = 70,749) waves of the Tobacco Use Supplement to the Current Population Survey. Among employed adults working indoors, a smokefree workplace policy was defined as a self-reported policy at the respondent’s workplace that did not allow smoking in work areas and public/common areas. Descriptive statistics were used to assess smokefree workplace policy coverage at two timepoints overall, by occupation, and by state.
Results
The proportion of U.S. workers covered by smokefree workplace policies increased from 77.7% in 2003 to 82.8% in 2010–2011 (p < .00001). The proportion of workers reporting smokefree workplace policy coverage increased in 21 states (p < .001) and decreased in two states (p < .001) over this period. In 2010–2011, by occupation, this proportion ranged from 74.3% for blue collar workers to 84.9% for white collar workers; by state, it ranged from 63.3% in Nevada to 92.6% in Montana.
Conclusions
From 2003 to 2010–2011, self-reported smokefree workplace policy coverage among indoor adult workers increased nationally, and occupational coverage disparities narrowed. However, coverage remained unchanged in half of states, and disparities persisted across occupations and states. Accelerated efforts are warranted to ensure that all workers are protected by smokefree workplace policies.
Implications
This study assessed changes in the proportion of indoor workers reporting being covered by smokefree workplace policies from 2003 to 2010–2011 overall and by occupation and by state, using data from the Tobacco Use Supplement to the Current Population Survey. The findings indicate that smokefree workplace policy coverage among U.S. indoor workers has increased nationally, with occupational coverage disparities narrowing. However, coverage remained unchanged in half of states, and disparities persisted across occupations and states. Accelerated efforts are warranted to ensure that all workers are protected by smokefree workplace policies.
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