An optical method for characterizing carbon content in ceramic pot filters.

Ceramic pot filter (CPF) technology is a relatively common means of household water treatment in developing areas, and performance characteristics of CPFs have been characterized using production CPFs, experimental CPFs fabricated in research laboratories, and ceramic disks intended to be CPF surrogates. There is evidence that CPF manufacturers do not always fire their products according to best practices and the result is incomplete combustion of the pore forming material and the creation of a carbon core in the final CPFs. Researchers seldom acknowledge the existence of potential existence of carbon cores, and at least one CPF producer has postulated that the carbon may be beneficial in terms of final water quality because of the presence of activated carbon in consumer filters marketed in the Western world. An initial step in characterizing the presence and impact of carbon cores is the characterization of those cores. An optical method which may be more viable to producers relative to off-site laboratory analysis of carbon content has been developed and verified. The use of the optical method is demonstrated via preliminary disinfection and flowrate studies, and the results of these studies indicate that the method may be of use in studying production kiln operation.

Neighbourhood composition and depressive symptoms among older Mexican Americans.

STUDY OBJECTIVE: Research suggests that economically disadvantaged neighbourhoods confer an increased risk of depression to their residents. Little research has been reported about the association between ethnic group concentration and depression. This study investigated the association between neighbourhood poverty and neighbourhood percentage Mexican American and depressive symptoms for older Mexican Americans in the south western United States. DESIGN: A population based study of older non-institutionalised Mexican Americans from the baseline assessment (1993/94) of the Hispanic established population for the epidemiologic study of the elderly (H-EPESE) merged with 1990 census data. SETTING: Five south western states in the United States. PARTICIPANTS: 3050 Mexican Americans aged 65 years or older. MAIN RESULTS: There was a strong correlation between the percentage of neighbourhood residents living in poverty and the percentage who were Mexican American (r = 0.62; p<0.001). Percentage neighbourhood poverty and percentage Mexican American had significant and opposite effects on level of depressive symptoms among older Mexican Americans. After adjusting for demographic and other individual level factors, each 10% increase in neighbourhood population in poverty was associated with a 0.763 (95% CI 0.06 to 1.47) increase in CES-D score, while each 10% increase in Mexican American neighbourhood population was associated with a -0.548 (95% CI -0.96 to -0.13) unit decrease in CES-D score among older Mexican Americans residing in their neighbourhoods. CONCLUSIONS: The findings suggest a sociocultural advantage conferred by high density Mexican American neighbourhoods, and suggest the need to include community level factors along with individual level factors in community based epidemiological health studies.

The use of herbal medicine by older Mexican Americans.

BACKGROUND: Little is known about use of herbal medicines by older Mexican Americans. The objective of this study was to determine the characteristics among older Mexican Americans that correlate with use of herbal medicines. METHODS: We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California. RESULTS: The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview. CONCLUSIONS: Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.

Impact of pain on disability among older Mexican Americans.

BACKGROUND: Joint pain is a very common complaint among elderly persons and may lead to functional disability. The purpose of this study is to estimate the prevalence of self-reported pain on weight bearing and its impact on the 2-year incidence of limitation in lower-body activities of daily living (ADL) in initially nondisabled Mexican American elderly subjects. METHODS: We studied a probability sample of 2167 noninstitutionalized Mexican American men and women aged 65 or older residing in five Southwestern states. Subjects were asked about pain on weight bearing, ADL, depressive symptomatology, and the presence of chronic diseases. The body mass index was computed using measured height and weight. Finally, a three-task (tandem balance, 8-foot walk, and repeated chair stands), performance-based, lower-body function test was performed. RESULTS: The overall prevalence of pain on weight bearing in the sample was 31.9%, with 37.7% for women versus 24.0% for men (p <.001). The most prevalent sites of pain were knees (14.7%), followed by ankle/feet (12.1%). In a logistic regression analysis, pain was a significant independent predictor of subsequent disability and of the inability to perform tandem balance, 8-foot walk, and repeated chair stands. CONCLUSIONS: Pain on weight bearing is prevalent among older Mexican Americans and is a major independent risk factor for subsequent disability.

Impact of arthritis on disability among older Mexican Americans.

OBJECTIVE: To estimate the impact of self-reported diagnosis of arthritis at baseline on the two year incidence of limitation in activities of daily living and instrumental activities of daily living in initially non-disabled Mexican-American elderly. DESIGN: Longitudinal study. SETTING Southwestern United States (Texas, New Mexico, Colorado, Arizona and California). SUBJECTS: A probability sample of 2,167 non-institutionalized Mexican-American men and women, aged 65 or older. MEASURES: Having ever been told by a doctor that a subject had arthritis, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), depressive symptomatology, presence of chronic diseases (diabetes mellitus, heart attack, stroke, cancer), and body mass index (BMI). RESULTS: Among non-disabled persons at baseline, 11.2% of subjects with arthritis reported at least one ADL limitation after two years, compared to 6.9% of subjects without arthritis. Similarly, among non-disabled persons at baseline, 34.7% of subjects with arthritis reported at least one IADL limitation after two years, compared to 27.0% of subjects without arthritis. In logistic regression analysis, depression, diabetes, and arthritis were found to be predictive of the development of ADL disability, controlling for sociodemographic variables. Depression was the only condition that significantly predicted IADL disability. CONCLUSIONS: Subjects with arthritis were more likely to develop ADL and IADL disability over a two-year period than those without arthritis.

Obesity and health conditions in elderly Mexican Americans: the Hispanic EPESE. Established Population for Epidemiologic Studies of the Elderly.

The objective of this analysis was to determine the prevalence of obesity and its association with selected medical conditions in a non-institutionalized elderly Mexican-American population. Data employed are from a representative sample of 3050 elderly Mexican Americans from the five Southwestern states: Texas, California, Colorado, New Mexico, and Arizona. Complete Body Mass Index (BMI) data were available for 2769 individuals. The in-home survey obtained socio-demographic data, anthropometric measurements, including height and weight, blood pressure readings, self-reported health conditions and depressive symptomatology. It was found that 23% of men and 35% of women were obese (BMI > or =30 kg/m2). Using a weighted logistic regression model, a BMI of > or =26 kg/m2 was associated with a significantly higher risk of diabetes; a BMI of > or =30 kg/m2 was significantly associated with arthritis and measured hypertension and a BMI<22 kg/m2 was associated with a higher likelihood of self-reported cancer. In addition, the prevalence of obesity was found to be much higher in this elderly Mexican-American population than in the general population.

Prevalence of arthritis in older Mexican Americans.

OBJECTIVE: This study examines the prevalence of self-reported physician-diagnosed arthritis and arthritis symptoms and their relationship to functional limitations in Mexican American elderly. METHODS: We conducted a cross-sectional study using a probability sample of 2,873 non-institutionalized Mexican American men and women aged 65 or older, residing in the southwestern United States. Measures included self-reported physician-diagnosed arthritis, morning pain or stiffness, pain when standing, global health rating, activities of daily living (ADL), instrumental activities of daily living (IADL), depressive symptoms, presence of chronic diseases (diabetes mellitus, hypertension, heart attack, stroke), and body mass index. The Mantel-Haenszel chi-square statistic was used to test differences by arthritis status, and a logistic regression model was used to predict the odds of having arthritis. RESULTS: The overall prevalence of self-reported physician-diagnosed arthritis in the sample was 40.8 percent, 50.0 percent among women and 28.8 percent among men (P < 0.001). Morning pain or stiffness was reported by 37.7 percent of respondents and pain when standing or walking by 31.9 percent. All comorbid conditions, and both IADL and ADL limitations, were more prevalent in those with arthritis than in those without arthritis. Female sex and several medical conditions were independently associated with self-reported arthritis. CONCLUSIONS: Self-reported physician-diagnosed arthritis is common among older Mexican Americans. Functional limitation and disability are more prevalent among subjects with arthritis than among those without arthritis.

Changes in blood pressure and risk factors for cardiovascular disease among older Mexican-Americans from 1982-1984 to 1993-1994.

OBJECTIVE: To determine the 10-year changes in blood pressure and cardiovascular risk factors among older Mexican-Americans. DESIGN: Comparative analyses of the Hispanic Health and Nutrition Examination Survey (HHANES) and the Hispanic EPESE (Established Populations for Epidemiologic Studies of the Elderly). Both of these were population-based studies using a multistage stratified probability sampling design of noninstitutionalized persons. SETTING: Five US states in the southwest: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 216 Mexican-Americans aged 65 to 74 from the 1982-1984 HHANES and 3050 Mexican-Americans aged 65+ from the 1993-1994 Hispanic EPESE. MEASUREMENTS: Mean systolic and diastolic blood pressure; cigarette smoking; high levels of alcohol use; body mass index and obesity; self-reported heart attack, stroke, and diabetes; hypertension. RESULTS: Among 65- to 74-year-old Mexican-Americans, there was a decrease over time in the percent of those who smoked cigarettes from 27.60% to 13.96% and a decrease in mean systolic blood pressure level. The percent of subjects categorized as obese or severely obese increased significantly, as did the prevalence of diagnosed diabetes, increasing from 20.06% in 1982-1984 to 29.82% in 1993-1994. Mean diastolic blood pressure increased from 77.15 mm Hg in 1982-1984 to 81.21 mm Hg in 1993-1994. CONCLUSIONS: Our findings suggest major changes in cardiovascular risk factors between 1982-1984 and 1993-1994 among older Mexican-Americans.

Lower body functioning as a predictor of subsequent disability among older Mexican Americans.

BACKGROUND: Disability measures among elderly non-Hispanic White populations have traditionally been associated with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). More recently, performance-based measures have increasingly been used to predict the onset of disability in initially nondisabled elderly populations. METHODS: We used data from two waves (1993-94 and 1995-96) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (EPESE) to assess the degree with which lower mobility performance measures predict future disability in a representative sample of older Mexican Americans from the Southwestern United States. RESULTS: Performances on an 8-foot walk, repeated chair stands, and standing balance among nondisabled subjects at baseline were significantly associated with the onset of ADL and lower body disability 2 years later, controlling for age, gender, and the presence of medical conditions. The results were significant for each performance measure and for a measure combining all three. CONCLUSION: This study offers further evidence that performance-based measures of lower body function are able to predict future disability in older Mexican Americans, as has been found with other elderly populations. These measures were able to detect changes over a relatively short period of time (2 years). In addition, the study found that the short (8-foot) walk was the most sensitive measure in predicting future disability.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly.

OBJECTIVES: To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans. DESIGN: Cross-sectional survey of a regional probability sample of older Mexican Americans. SETTING: The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: 2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates. OUTCOME MEASURES: Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers. RESULTS: Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage. CONCLUSIONS: These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.

Impact of selected medical conditions on self-reported lower-extremity function in Mexican-American elderly.

OBJECTIVE: To examine the independent impact of common medical conditions on lower-extremity function in Mexican-American elderly. DESIGN: Cross-sectional study using a probability sample of non-institutionalized Mexican Americans aged 65 or older. SETTING: The five Southwestern states, Texas, New Mexico, Arizona, Colorado and California. PARTICIPANTS: All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. MAIN OUTCOME MEASURES: Respondents were asked whether they could perform four activities related to lower-extremity function without help: walking across a small room, getting from a bed to a chair, walking up and down stairs, and walking half a mile. A summary measure of lower body disability created from these four items was regressed on seven common medical conditions plus five control variables using multiple logistic regression. RESULTS: Adjusted Odds Ratios (OR) suggested that impaired lower-extremity function was associated with previous diagnosis of hip fracture (OR = 4.28), stroke (OR = 3.47), lower extremity arthritis (OR = 2.60), heart attack (OR = 2.29), diabetes (OR = 2.03) and obesity (OR = 1.50). Impaired lower-extremity function was significantly associated with older age (75+ years old), gender (female) and marital status (unmarried). In addition, there was a linear increase in the risk of function loss by number of medical conditions. CONCLUSIONS: It appears that Mexican-American elderly diagnosed with medical conditions, especially stroke and hip fracture, have a high risk for lower-extremity dysfunction. These findings have implications for efforts to prevent or reduce lower-extremity dysfunction, as well as for the provision of community-based long-term care services for Mexican-American elderly.

The association between chronic diseases and depressive symptomatology in older Mexican Americans.

BACKGROUND: Among the elderly population, the risk for psychological distress increases with the number of chronic diseases and accompanying functional disability. The prevalence of chronic medical conditions and functional disability varies substantially across ethnocultural groups, however. Using data from the Hispanic EPESE, we previously reported that among older Mexican Americans, the total number of chronic medical conditions and the presence of functional impairment are strong predictors of depressive symptoms. METHODS: Using multiple regression, we examined the association between specific chronic diseases, individual functional disabilities, and depressive symptoms in this group of ethnic elders. RESULTS: Multiple regression models indicated that diabetes (OR = 1.25, 95% CI = 1.03-1.56), arthritis (OR = 1.42, 95% CI = 1.17-1.72), urinary incontinence (OR = 1.94, 95% CI = 1.46-2.59), bowel incontinence (OR = 2.28, 95% CI = 1.15-4.55), kidney disease (OR = 3.11, 95% CI = 1.13-8.58), and ulcers (OR = 2.56, 95% CI = 1.23-5.29) were predictive of high levels of depressive symptoms. Hip fracture, although recognized as having a substantial impact on functional status, was not found to be associated with depressive symptoms. History of stroke was not significantly associated with depressive symptoms in bivariate or multivariate analyses, but history of stroke with residual speech problems was predictive (OR = 2.16, 95% CI = 1.01-4.79). Among specific activities of daily living, only impaired ability to walk across a room (OR = 1.65, 95% CI = 1.04-2.73) or to bathe oneself (OR = 1.87, 95% CI = 1.12-3.12) proved to be predictive in multivariate analyses. CONCLUSIONS: This constellation of chronic medical conditions and functional disabilities is very different from those reported to be associated with depressive symptoms in older non-Hispanic White and African Americans, and appears to comprise those conditions most associated with substantial physical impairment, pain, and discomfort.

Undertreatment of hypertension in older Mexican Americans.

OBJECTIVE: To identify the prevalence of hypertension and factors associated with nontreatment and poor control of hypertension in Mexican Americans aged 65 years and older. DESIGN: A population-based survey of older Mexican Americans conducted in 1993-1994. SETTING: Subjects residing in five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: An area probability sample of 3050 noninstitutionalized Mexican American men and women aged 65 and older took part in a 90-minute in-home interview, which included review of all medications taken and two sitting blood pressure measurements. OUTCOME MEASURES: Measured were previous diagnoses of hypertension, current medication for hypertension, and current blood pressure RESULTS: Sixty-one percent of older Mexican-Americans were hypertensive, and 51% of those with hypertension were taking antihypertensive medications. Only 25% of hypertensive subjects (18% of males and 30% of females) were in good blood pressure control (i.e., systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg). In multivariate analyses, factors associated with increased likelihood of treatment included female gender (OR = 1.9), history of heart disease (OR = 2.4), possessing a regular source of health care (OR = 2.7), and having seen a physician two or more times in the previous year (OR = 3.8). These were also independent predictors of good blood pressure control. CONCLUSION: Nontreatment of hypertension is still a major public health concern in older Mexican Americans. We estimate that adequate blood pressure control in this population would prevent approximately 30,000 adverse cardiovascular events over 10 years, affecting approximately 6% of the entire Mexican American older population.

Lower-extremity functioning in older Mexican Americans and its association with medical problems.

OBJECTIVE: To describe lower-extremity functioning in community-dwelling older Mexican Americans and to examine its relationship with medical problems. DESIGN: Cross-sectional analyses of survey and performance-based data obtained in a population-based study employing area probability sampling. SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older. MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower-extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure. RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower-extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance. CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower-extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance-based tests of lower-extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.

Factors influencing unawareness of hypertension among older Mexican Americans.

BACKGROUND: The objective of the study was to identify factors associated with unawareness of hypertension among Mexican Americans age 65 years and older. METHODS: This was a population-based survey of 3,050 older Mexican Americans conducted in five Southwestern states in 1993-1994. An in-home interview included sociodemographics, review of medications, and blood pressure measurements. RESULTS: Sixty percent of all subjects were hypertensive, and 37% of these were unaware of their diagnosis. Unaware hypertensive had significantly higher mean blood pressures than did aware hypertensives (145.7/ 86.2 mm Hg vs 142.4/83.1 mm Hg). While 77% of aware hypertensives were treated, only 10% of unaware hypertensives were treated. In multivariate analyses, factors associated with unawareness included male gender (OR = 1.8), being married (OR = 1.6), having Medicaid (OR = 1.6), having made fewer than two visits to a doctor in the past year (OR = 2.8), having a history of heart disease (OR = 0.57) or stroke (OR = 0.37), and having poor self-reported health (OR = 0.43). CONCLUSION: Despite 3 decades of hypertension detection and education programs, unawareness of hypertension remains high among older Mexican Americans. There is a continued need for community-based education programs for hypertensives who are unaware of their diagnosis, and also there is need for programs to increase access to primary care physicians.

The effect of medical conditions on the functional limitations of Mexican-American elderly.

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for eating to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican-American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly.

Determinants of cancer stage. A population-based study of elderly New Mexicans.

To assess the role of delay and other factors in determining stage of cancer at diagnosis, the authors interviewed a population-based sample of 800 elderly persons with newly diagnosed cancer at selected sites. Lengthening delay interval was associated with a declining proportion of local stage cases for breast cancer but not other sites. Of the other determinants of stage examined, older age, having a family physician, receiving medical checkups, having greater knowledge of cancer, and having no functional loss were most strongly predictive of local stage. For breast cancer, performance of breast self-examination also predicted local stage.

Survival after cancer surgery of elderly patients in New Mexico, 1969-1982.

To examine the effects of advancing age, sex, and ethnicity on estimated 30-day survival after surgery for cancer, we reviewed population-based data on 16,130 cancer cases collected by the New Mexico Tumor Registry from 1969-1982. For surgery at most sites, mortality increased with increasing age. The highest mortality was observed for sites requiring laparotomy or thoracotomy. Sex and ethnicity (Hispanic versus non-Hispanic white) had little effect on short-term survival. Comparison of short-term survival for two time periods, 1969-1975 and 1976-1982, showed a strong trend of improving survival for many sites.

Changing treatment of breast cancer in New Mexico from 1969 through 1985.

A review of information from the New Mexico Tumor Registry on women diagnosed as having primary breast cancer from 1969 through 1985 revealed temporal changes in the surgical treatment of this disease. After 1980 the percentage of women receiving breast-conserving surgery for local-stage disease increased from 6% to 25%. Most surgeons performing operations for breast cancer had not performed a breast-conserving operation before 1981 but had used this procedure at least once in the period from 1981 through 1985. Women younger than 50 years or older than 80 years were most likely to undergo this procedure. In that period, radiotherapy after breast-conserving surgery could not be documented for 26% of the women 65 years old or younger or for 56% of the women aged 65 years or older. Thus, there has been a marked shift in New Mexico in the surgical approach to local-stage breast cancer in the 1980s. This shift involved most surgeons treating the disease and included women of all age groups. The apparent lack of adjuvant radiotherapy in some women receiving conservative surgeries may prove to be a deleterious consequence of this change in surgical management.

Delay in seeking care for cancer symptoms: a population-based study of elderly New Mexicans.

To characterize the delay by the elderly in seeking care for cancer symptoms, we interviewed 800 New Mexicans, greater than or equal to 65 years of age, with newly diagnosed cancer. Overall, 29.4% of the subjects were asymptomatic when cancer was detected, and 48.0% presented within 2 months of symptom onset. However, 19.2% of the subjects delayed seeking care for at least 12 weeks and 7.4% delayed at least 1 year. Site of cancer was the strongest determinant of delay. Hispanics tended to report longer delay than non-Hispanics, and age was not associated with delay. Of the numerous other factors considered, only having a regular checkup was significantly associated with delay interval.