Is vaginal douching related to cervical carcinoma?

The association between cervical carcinoma and vaginal douching was examined in a population-based case-control study conducted in the low-risk population of Utah between 1984 and 1987. The authors compared 266 cases of in situ and invasive cervical carcinoma with 408 group-matched controls by vaginal douching behavior, controlled for age, lifetime number of sex partners, cigarette smoking history, religious activity, and educational level. Essentially no association was found in women who douched once per week or less, but in those who douched more than once per week, a consistent relation was demonstrated (adjusted odds ratio = 4.7, 95% confidence interval 1.9-11). Few differences were found with type of douching preparation used. The authors hypothesize that frequent douching alters the vaginal chemical environment, making the cervix more susceptible to pathologic change.

Smoking behavior and attitudes of employees of a large HMO before and after a work site ban on cigarette smoking.

Smoking-related data collected during 1976-87 by anonymous cross-sectional surveys of nonphysician employees of a large medical care organization were used to assess how a work site smoking ban affected employees' smoking behavior and attitudes. The smoking ban was implemented at 11 work sites at various times during 1985-86. All work sites had three or more pre-ban surveys and one or two post-ban surveys. The majority of employees reported support for the smoking ban. The ban's effects were assessed by comparing observed post-ban rates with expected rates projected from secular trends in the pre-ban data by the use of logistic regression models that included age, sex, education, and job class as covariates. The work site smoking ban had a substantial effect on the presence of smoke in the work environment, but no short-term effect on smoking prevalence or attempts to quit. The apparent effect of the ban on quantity of cigarettes smoked was assessed by a pre-ban and post-ban analysis of the 1986-87 survey data. A nonequivalent post-ban and post-ban comparison was used to estimate the secular trend. A significant reduction of 1.4 cigarettes per day (P = 0.022) was found in smokers' rate during working hours.

Implications of pregnancy for residents and their training programs.

This study investigated the implications of pregnancy on residents and their training programs and how programs have planned for pregnancy disruptions compared to other employers. We received questionnaires from 236 male and female residents and their families who had experienced at least one pregnancy during their training. Results for female residents were compared with working spouses of male residents. Approximately half of the female residents reported that their programs had formal leave policies compared to 70% of the working spouses. The average amount of leave taken by residents was considerably less than that taken by the spouse group. For both groups, 35% of all pregnancies were unplanned; 19% of these without benefit of birth control. Approximately 30% of both groups said they should have timed their pregnancies differently. Female residents were more likely to perceive their pregnancies as a stressful time. Despite this greater stress, female residents were equally as unlikely as spouses of male residents to miss work for pregnancy-related causes. This study supports the need for better planning for pregnancy during residency training.

Tobacco, alcohol, coffee, and caffeine as risk factors for colon cancer in a low-risk population.

We used data from a population-based case-control study to examine how use of tobacco products and consumption of alcohol, coffee, and caffeine relate to colon cancer in Utah. We hypothesized that low use of these substances is one factor contributing to the low colon cancer incidence in Utah and could help explain the low risk associated for colon cancer with being a member of the Church of Jesus Christ of Latter-day Saints. In females, we observed little or no increase in risk of colon cancer from smoking cigarettes or from consumption of alcohol, caffeine, or coffee. Males who used pipes, however, experienced an increased risk for colon cancer (OR = 4.1, 95% CI = 1.3-12.3). Risk for colon cancer associated with alcohol use was greatly attenuated after adjusting for caffeine and pipe use in males; males who consumed higher levels of caffeine during the two to three years prior to the interview were at higher risk than males who consumed low levels of caffeine (OR = 2.0, 95% CI = 1.0-4.2); similar associations were observed for coffee consumption. Nonuse of these substances could explain the low colon cancer incidence rates observed in members of the Church of Jesus Christ of Latter-day Saints and Utah males.

Dietary intake and colon cancer: sex- and anatomic site-specific associations.

A case-control study was conducted in Utah between July 1979 and June 1983 in which 231 cases of colon cancer identified through the Utah Cancer Registry and 391 controls identified through random digit dialing were interviewed. Odds ratios (OR) were calculated comparing the highest exposure categories with the lowest exposure categories. The highest quintile of body mass index (weight (kg)/height (m)2 for males; weight (kg)/height (m)1.5 for females) was associated with increased risk in both males (OR = 2.1) and females (OR = 2.3). In females, total dietary fat (OR = 1.9) and energy intake (OR = 1.5) were associated with an increased colon cancer risk after adjusting for age, body mass index, and crude fiber. Fiber was protective in females (OR = 0.5) after adjusting for age, body mass index, and energy intake, as was beta-carotene (OR = 0.5) after also adjusting for crude fiber. Adjusted risk estimates in males were 2.0 for total dietary fat, 3.8 for polyunsaturated fat, 2.1 for monounsaturated fat, 2.1 for energy intake, 2.5 for protein, 0.3 for fiber, 0.4 for beta-carotene, and 0.3 for cruciferous vegetables. Risk estimates differed by site of cancer within the colon. In males, protein (OR = 3.8) was a risk factor for cancer of the descending colon, while fats (OR = 2.7-8.8) increased the risk of cancer of the ascending colon. The hypotheses that dietary fat increases colon cancer risk while dietary fiber decreases colon cancer risk and that fat and protein may be independently associated with colon cancer risk are supported.

Nutrient intake and ovarian cancer.

A case-control study was conducted in Utah between 1984 and 1987 to evaluate the effects of nutrient intake on risk of developing ovarian cancer. Detailed dietary intake information was available from 85 first primary ovarian cancer cases and 492 population-based controls. Calories, fat, protein, fiber, and vitamins A and C did not appreciably alter the risk of developing ovarian cancer. However, high intake of beta-carotene appears to confer protection against ovarian cancer (odds ratio = 0.5, 95% confidence interval 0.3-1.0) after adjusting for age, number of pregnancies, and the body mass index of weight/height.

Cigarette smoking and exposure to passive smoke are risk factors for cervical cancer.

Personal cigarette smoking and exposure to passive smoke as risk factors for cervical cancer were examined in a population-based, case-control study conducted in Utah. Personal cigarette smoking was found to increase the risk of cervical cancer, after adjusting for age, educational level, church attendance, and sexual activity. The adjusted risk estimate associated with being a current smoker was 3.42 (95% confidence interval [Cl], 2.10 to 5.57); for having smoked for 5 or more pack-years, it was 2.81 (95% Cl, 1.73 to 4.55); and for having smoked at least 100 lifetime cigarettes, it was 2.21 (95% Cl, 1.44 to 3.39). The adjusted risk estimate (also adjusted for actual cigarettes smoked) associated with passive smoke exposure for 3 or more hours per day was 2.96 (95% Cl, 1.25 to 7.03). Risk from passive smoking was greater in women who were not smokers (odds ratio, 3.43; 95% Cl, 1.23 to 9.54) than in women who smoked (odds ratio, 2.59; 95% Cl, 0.23 to 29.24).

Differences in risk estimations from a hospital and a population-based case-control study.

A hospital-based and population-based case-control study of cervical cancer (in situ and invasive) was conducted in urban Utah to determine if methods of respondent selection affect estimates of risk for variables thought to be associated with the disease. Population cases (N = 409) and cases from two large hospitals (N = 124) were identified through the Utah Cancer Registry. Population-based controls (N = 379) were identified through random-digit dialing; hospital-based controls (N = 150) with gynaecological disorders other than cancers and elective abortions were chosen from the same hospitals as the cases for the hospital study. Both control groups were frequency matched to cases by age. Approximately 79% of the identified cases and 85% of the selected controls completed interviews conducted in their homes. Most risk estimates were lower in the hospital-based study because of the more case-like attributes of this group. Stratified analysis for social class led to adjusted risk estimates which were lower than the unadjusted risk estimates for the population-based study, but not for the hospital-based study. The close social class matching in the hospital-based study seems to have led to concurrent overmatching on other risk factors since many of these are closely related to social class. Findings are discussed in terms of implications for case-control study design.

Neonatal mortality in Utah.

A cohort study of neonatal mortality (N = 106) in white singleton births (N = 14,486) in Utah for January-June 1975 was conducted. Using membership and activity in the Church of Jesus Christ of Latter-day Saints (LDS or Mormon) as a proxy for parental health practices, i.e., tobacco and alcohol abstinence, differential neonatal mortality rates were calculated. The influence of potential confounding factors was evaluated. Low activity LDS members were found to have an excess risk of neonatal death five times greater than high activity LDS, with an upper bound of a two-sided 95% confidence interval of 7.9. The data consistently indicate a lower neonatal mortality rate for active LDS members. Non-LDS were found to have a lower rate than either medium or low activity LDS.