Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls, and fracture in functionally independent older adults.

PURPOSE: This study had three goals: (1) to assess knowledge of osteoporosis risk factors, (2) to determine the prevalence of risk factors for osteoporosis, falls, and fractures, and (3) to ascertain the relationship between knowledge and prevalence of osteoporosis risk factors in affluent independent community-dwelling aging adults. METHODS: Forty-nine individuals over the age of 50 years completed a series of questionnaires and clinical testing procedures to identify osteoporosis knowledge, fall and fracture risk factors. RESULTS: Positive correlations were found between greater knowledge of osteoporosis risk factors and confidence in performing activities of daily living (r=0.32, p=0.05), better static and dynamic balance (r=0.42, p=0.01) and greater lower extremity strength (r=0.33, p=0.05). Despite these correlations 64% of participants had less than 50% correct responses related to osteoporosis knowledge. The average number of risk factors was 5.5 with many participants having modifiable risk factors including inadequate calcium and vitamin D intake and limitations in agility, balance, strength and flexibility. CONCLUSIONS: Participants with increased knowledge of risk factors presented with increased confidence performing activities of daily living, greater lower extremity strength and lower fall risk. Knowledge of disease processes, risk factors and strategies for prevention and management may improve patient compliance for behavioral changes necessary in successful participatory management.

Cancer survival in California Hispanic farmworkers, 1988-2001.

CONTEXT: Although epidemiologic studies have identified elevated cancer risk in farmworkers for some cancer types, little is known about cancer survival in this population. PURPOSE: To determine if cancer survival differs between a Hispanic farmworker population and the general Hispanic population in California. METHODS: Hispanic United Farm Workers of America union members and California Hispanics diagnosed from 1988 to 2001 with a first primary cancer were identified from the California Cancer Registry. Kaplan-Meier observed 5-year cause-specific survival rates were calculated, and log-rank tests assessed population differences. Cox proportional hazards models for the most common cancers provided age-, stage-, and year of diagnosis-adjusted hazard ratios. FINDINGS: Observed 5-year cancer-specific survival rates were lower for Hispanic United Farm Workers of America men compared to California Hispanic men for all cancer sites combined (53.7% vs 57.7%, respectively) and colorectal cancer (48.1% vs 60.6%, respectively) and higher for non-Hodgkin's lymphoma (86.7% vs 57.6%, respectively). Only non-Hodgkin's lymphoma survival differences remained significant (P = .021) after adjusting for age and stage at diagnosis. No statistically significant survival differences were detected between United Farm Workers of America and California Hispanic women. CONCLUSIONS: Although survival was generally similar between United Farm Workers of America members and California Hispanics, lower crude survival among United Farm Workers of America men for all sites combined and colorectal cancer warrants public health measures to address barriers to cancer screening in California's Hispanic farm-working populations. Histology-specific analyses with larger sample sizes are required before reaching conclusions on non-Hodgkin's lymphoma survival differences.

Triazine herbicides and epithelial ovarian cancer risk in central California.

OBJECTIVE: We sought to determine whether women with ovarian cancer have increased occupational exposure to triazine herbicides. METHODS: A population-based case-control study of incident cases (n=256) and random digit-dialed control subjects (n=1122) was conducted. Participants were administered telephone interviews to obtain agricultural work history. These histories were used with the statewide pesticide usage database to calculate cumulative exposure estimates. The data were analyzed by stratified analysis and unconditional logistic regression techniques. RESULTS: The analysis of ever versus never occupational exposure to triazines demonstrated that cases were slightly but not significantly more likely to be exposed than control subjects (adjusted odds=1.34; 95% confidence interval=0.77-2.33). There was no evidence of a dose-response relationship between triazines and ovarian cancer (P=0.22). CONCLUSIONS: Considered with previous studies and animal laboratory data, the current evidence is not persuasive as to the presence or absence of an association between ovarian cancer and triazine exposure.

Cancer incidence in the Hmong in California, 1988-2000.

The Hmong represent a unique new Southeast Asian immigrant group to the U.S. Approximately 169,000 Hmong reside in the U.S., primarily in California, Minnesota, and Wisconsin. Previous studies of cancer in this population have indicated that Hmong experience an elevated risk of gastric, hepatic, cervical, and nasopharyngeal cancers and experience a reduced risk of breast, prostate, lung, and colorectal cancers. Approximately 65,000 Hmong live in California, where there has been a population-based cancer registry since 1988, and the authors used these data to calculate age-adjusted cancer incidence rates and to examine disease stage and tumor grade at diagnosis. Changes in rates during the period studied also were evaluated. These rates and proportions were compared with rates among the non-Hispanic white (NHW) and Asian/Pacific Islander (API) populations of California. Between 1988 and 2000, a total of 749 Hmong in California were diagnosed with invasive cancer, and the age-adjusted rate of cancer for the Hmong was 284 per 100,000 population, compared with 362.6 and 478 per 100,000 in the API and NHW populations, respectively. The age-adjusted incidence rates of cancer in the Hmong were elevated for hepatic, gastric, cervical, and nasopharyngeal cancers and for leukemia and non-Hodgkin lymphoma (NHL). Rates were lower in the Hmong for colorectal, lung, breast, and prostate cancers. For gastric cancer and lung cancer, age-adjusted rates increased between 1988 and 2000 in the Hmong, although breast cancer incidence declined. Cervical cancer incidence increased, rates of NHL were declining, and rates for colorectal cancer remained steady between 1988 and 2000. The Hmong experienced later disease stage at diagnosis than other API and generally poorer grade of disease at diagnosis. Hmong experienced lower overall invasive cancer incidence rates than API or NHW populations in California. However, they experienced higher rates of hepatic, gastric, cervical, and nasopharyngeal cancers; and, for most types of cancer, they were diagnosed in a later disease stage.

Lymphohematopoietic cancers in the United Farm Workers of America (UFW), 1988-2001.

OBJECTIVE: Agricultural risk factors for lymphohematopoietic cancers (LHC) in Hispanic farm workers in California were examined in a nested case-control study embedded in a cohort of 139,000 ever members of a farm worker labor union in California. METHODS: Crop and pesticide exposures were estimated by linking county/month and crop specific job history information from union records with California Department of Pesticide Regulation pesticide use reports during the 20-year period prior to cancer diagnosis. RESULTS: A total of 131 LHC diagnosed in California between 1988 and 2001 were included in the analysis. Analyses were conducted by gender and subtype of non-Hodgkins lymphoma (nodal, extra nodal) and by leukemia histology (lymphocytic, granulocytic). Odds ratios were calculated by stratification and by unconditional logistic regression. Risk for all LHC was elevated in workers cultivating vegetables (OR = 1.67, 95% CI = 1.12-2.48). Risk of leukemia was associated with exposure to the pesticides mancozeb (OR = 2.35, 95% CI = 1.12-4.95) and toxaphene (OR = 2.20, 95% CI = 1.04-4.65) while NHL risk was increased in association with 2,4-D (OR = 3.80, 95% CI=1.85-7.81). Risk of leukemia was particularly elevated among female workers and for granulocytic versus lymphocytic leukemia for several chemicals. No associations were noted for multiple myeloma. CONCLUSIONS: California farm workers employed where mancozeb and toxaphene were used had an increased risk of leukemia compared to farm workers employed elsewhere. Employment in farms using 2,4-D was associated with an increased risk of NHL.

Gastric adenocarcinoma among Hmong in California, USA, 1988-2000.

BACKGROUND: This study examined gastric adenocarcinoma incidence, mortality, and tumor characteristics in the Hmong population of California, 1988-2000. Many Hmong relocated to the United States at the conclusion of the Vietnam War. Resettlement difficulties encountered by Hmong have included socioeconomic and healthcare issues. Hmong are wary of Western medicine and would resort to it as the last option, which may delay the diagnosis and treatment of diseases such as cancer. METHODS: Data from the California Cancer Registry were used to calculate incidence and mortality rates for Hmong, and were compared to these in Asian Pacific Islanders (API) and non-Hispanic whites (NHW). The population at risk was estimated through linear interpolation, using data from the 1990 and 2000 decennial censuses. RESULTS: Hmong experienced incidence and mortality rates of gastric adenocarcinoma several times higher than those of API and NHW. More than 97% of Hmong patients chose no treatment, compared to only 25.6% of API and 30.3% of NHW patients. Hmong were more likely to be diagnosed with cancer at later stages but at better histologic grades than API and NHW. CONCLUSIONS: Further investigations into Helicobacter pylori, Epstein-Barr virus, acid reflux, and dietary practices of Hmong living in the United States are needed before any firm conclusion can be made, as these risk factors may impact gastric cancer development. Hmong should also be encouraged to use traditional and Western medicines simultaneously, provided that traditional healthcare practices do not interfere with biomedicines.

Hormone replacement therapy and invasive and borderline epithelial ovarian cancer risk.

Risk of epithelial ovarian cancer (EOC) attendant to use of hormone replacement therapy (HRT) was evaluated in a population-based case-control study of newly diagnosed EOC cases (n=256) and randomly selected population controls (n=1122). Telephone interviews were conducted to obtain information on history of HRT and several other covariates. Multivariate adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of HRT was 1.39 (95% CI: 1.01-1.93) compared to never use. Long-term use (>10 years) increased risk (OR: 1.62, CI: 1.05-2.50) although the trend p-value for duration of use was of only borderline significance (p=0.08). The relationship was stronger in women without hysterectomy (OR: 1.66, 95% CI: 1.14-2.41) or tubal ligation (OR: 1.56, 95% CI: 1.08-2.26). In this study, use of HRT is associated with an increased risk of EOC.

Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California.

Perineal talc use has been suggested as a possible risk factor for ovarian cancer based on its structural similarity to asbestos, a known human carcinogen. A population-based epidemiologic case-control study of epithelial ovarian cancer (EOC) was conducted in 22 counties of Central California that comprise the reporting area for 2 regional cancer registries. Telephone interviews were conducted with 256 cases diagnosed in the years 2000-2001 and 1,122 controls frequency-matched on age and ethnicity. The interview obtained information on demographic factors, menstrual and reproductive experience, exogenous hormone use, surgical history and family history of cancer. Questions on perineal talc use included frequency of use, duration of use and specific years when talc was used. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of talc was 1.37 (CI = 1.02-1.85) compared to never users. However, no dose response association was found. Tubal ligation (TL) modified the effect of talc on EOC such that women with TL had an OR of 0.88 (CI = 0.46-1.68) associated with perineal talc use, whereas women with no TL had an OR of 1.54 (CI = 1.10-2.16). Talc use and EOC risk was highest in women with serous invasive tumors (OR = 1.77; CI = 1.12-2.81). This study provides some support for the hypothesis that perineal talc use is associated with an increased risk of EOC.

Epithelial ovarian cancer risk by invasiveness and cell type in the Central Valley of California.

OBJECTIVE: To evaluate epithelial ovarian cancer (EOC) risk factors by level of invasiveness and histology. METHODS: A population-based epidemiologic case-control study of EOC was conducted over a 2-year period (January 2000 to December 2001) in 22 counties of Central California that comprise the reporting area for two regional cancer registries. Telephone interviews were conducted with 256 cases and 1122 control frequencies matched on age and ethnicity. The interview obtained information on demographic factors as well as information pertinent to the respondent's menstrual and reproductive experience, use of exogenous hormones, surgical history, and family history of cancer. Adjusted odds ratios were calculated using stratification as well as Logistic regression methods. Analyses were completed by level of invasiveness and cell type. RESULTS: Strong protective associations were observed for use of oral contraceptives and parity. Risk increased with a family history of ovarian, but not breast cancer and age at first birth was positively associated with increased risk. Hormone replacement therapy was associated with increased risk only in long-term users. Many of the relationships were observed only in specific histologic subtypes of EOC. CONCLUSION: Risk of EOC is associated with several lifestyle and environmental exposures but the impact of these effects appears to be dependent upon level of invasiveness and histologic subtypes of EOC. However, the sample size available for analysis limits our statistical power and our ability to analyze data by histologic subtype, thus limiting interpretation of our results.

Cervical cancer among Hmong women in California, 1988 to 2000.

BACKGROUND: The Hmong immigrated to the United States from Laos after the Vietnam conflict ended. Hmong encounter numerous readjustment issues, including health care. Traditional Hmong health beliefs and practices encompass more spiritual than biological etiologies. Hmong usually seek the first course of treatment from traditional healers, as they had in Laos. This practice delays early diagnosis and treatment of disease because biomedicine is used only as a last resort. This study examined cervical cancer incidence, mortality, and other tumor characteristics in the Hmong female population of California between 1988 and 2000. METHODS: Data from the California Cancer Registry were used to calculate annual average incidence, mortality, and age-specific rates for Hmong women diagnosed with cervical cancer. The population at risk was estimated with linear interpolation using data from the 1990 and 2000 censuses. RESULTS: Hmong women experienced incidence and mortality rates three and four times higher than Asian/Pacific Islander and non-Hispanic white women, respectively. Fifty-one percent of Hmong women chose no treatment, compared to 5.8% for Asian/Pacific Islander women and 4.8% for non-Hispanic white women. Hmong women aged >/= 40 years carried an unequal burden of cervical cancer. They were more likely to be diagnosed with cervical cancer at later stages and poorer histologic grades, and had a lower survival rate than younger Hmong females. CONCLUSIONS: Cervical cancer is clearly a public health issue that threatens the health and well-being of Hmong women. Culturally sensitive screening and prevention programs need to be developed to target older Hmong women using bilingual and bicultural Hmong women health educators using verbal communication.