It has been suggested that aspects of lactose consumption and metabolism favoring a relatively high tissue level of galactose-1-phosphate may predispose women to ovarian cancer. The authors sought to examine this hypothesis in a study of... more
It has been suggested that aspects of lactose consumption and metabolism favoring a relatively high tissue level of galactose-1-phosphate may predispose women to ovarian cancer. The authors sought to examine this hypothesis in a study of 108 18- to 74-year-old Caucasian residents of a three-county area of western Washington who were diagnosed with stage I ovarian cancer during 1989-1991, and 108 age- and race-matched controls. Lactose and galactose intake, measured using a food frequency questionnaire, had been hypothesized to increase risk, but were somewhat lower among the cases than among the controls (75th percentile of lactose intake vs. 25th: odds ratio (OR) = 0.80, 95% confidence interval (Cl) 0.52-1.2; of galactose intake: OR = 0.71, 95% Cl 0.48-1.1). Intestinal lactase activity, also hypothesized to have a positive relation with ovarian cancer occurrence, was measured with an oral lactose challenge followed by determination of urinary galactose; no evidence that it was related to the disease was found (75th percentile of excreted galactose vs. 25th: OR = 0.87, 95% Cl 0.62-1.2). Galactose-1-phosphate uridyltransferase (transferase), the enzyme responsible for the metabolism of galactose-1-phosphate, was measured in erythrocytes; no deficit in cases was observed (75th percentile of transferase activity vs. 25th: OR = 1.3, 95% Cl 0.80-2.1). There was also no excess of cases carrying low-activity genetic variants of the transferase enzyme (lower-activity variants vs. higher-activity variants: OR = 0.61, 95% Cl 0.21-1.7). These results do not support the hypothesis that aspects of lactose and galactose intake and metabolism have a bearing on the etiology of ovarian cancer.
Research Interests: Endocrinology, Medicine, Humans, Internal Medicine, Lactose intolerance, and 15 moreMathematical Sciences, Female, American, Aged, Intestines, Middle Aged, Carcinoma, Adult, Odds ratio, Dietary Carbohydrates, Lactose, Erythrocytes, Case Control Studies, Medical and Health Sciences, and Ovarian Neoplasms
Research Interests: Epidemiology, Contraception, Cancer, Medicine, Endometrial Cancer, and 15 moreHumans, Female, Middle Aged, Gynecology, Adult, Odds ratio, Prognosis, Risk Factors, IntraUterine Devices, Confidence Interval, Case Control Studies, Cohort Studies, confounding, Medical and Health Sciences, and Endometrial neoplasms
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Research Interests: Epidemiology, Globalization, Gerontology, Cognition, Global Health, and 15 moreAging, Energy Metabolism, Activities of Daily Living, Gait, Humans, Chronic Disease, Exercise, Health Status, Aged, Ethnic Group, Intervention study, Cross Sectional Studies, Disabled Persons, Clinical Trials as Topic, and Frail elderly
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Objective:Perceptions of social-contextual food environments and associated factors that influence food purchases are understudied in American Indian (AI) communities. The purpose of the present study was to: (i) understand the perceived... more
Objective:Perceptions of social-contextual food environments and associated factors that influence food purchases are understudied in American Indian (AI) communities. The purpose of the present study was to: (i) understand the perceived local food environment; (ii) investigate social-contextual factors that influence family food-purchasing choices; and (iii) identify diet intervention strategies.Design:This qualitative study consisted of focus groups with primary household shoppers and key-informant interviews with food retailers, local government food assistance programme directors and a dietitian. An inductive, constant comparison approach was used to identify major themes.Setting:A large AI reservation community in the north-central USA.Participants:Four focus groups (n 31) and seven key-informant interviews were conducted in February and May 2016.Results:Perceptions of both the higher cost of healthy foods and limited access to these foods influenced the types of foods participants purchased. Dependence on government assistance programmes and the timing of benefits also contributed to the types of foods purchased. Participants described purchasing foods based on the dietary needs and preferences of their children. Suggestions for improving the purchase and consumption of healthy foods included: culturally relevant and family-centred cooking classes and workshops focused on monthly food budgeting. Participants also emphasized the importance of involving the entire community in healthy eating initiatives.Conclusions:Cost and access were the major perceived barriers to healthy eating in this large rural AI community. Recommended interventions included: (i) family-friendly and culturally relevant cooking classes; (ii) healthy food-budgeting skills training; and (iii) approaches that engage the entire community.
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Research Interests: Fracture, Breast Cancer, Menopause, Medicine, Postmenopausal Women, and 15 moreHumans, Bone, Fractures, Female, Risk factors, Aged, Longitudinal Studies, Time Factors, Risk Factors, Proportional Hazards Models, Breast Neoplasms, Medical and Health Sciences, postmenopause, postmenopausal, and Fractures Bone
Intractable public health problems are influenced by interacting multi-level factors. Dynamic research approaches in which teams of scientists collaborate beyond traditional disciplinary, institutional, and geographic boundaries have... more
Intractable public health problems are influenced by interacting multi-level factors. Dynamic research approaches in which teams of scientists collaborate beyond traditional disciplinary, institutional, and geographic boundaries have emerged as promising strategies to address pressing public health priorities. However, little prior work has identified, defined, and characterized the outcomes of transdisciplinary (TD) research undertaken to address public health problems. Through a mixed methods approach, we identify, define, and characterize TD outcomes and their relevance to improving population health using the Transdisciplinary Research on Energetics and Cancer (TREC) II initiative as a case example. In Phase I, TREC II leadership (n = 10) identified nine initial TD outcomes. In Phase II (web-based survey; n = 23) and Phase III (interviews; n = 26; and focus groups, n = 23) TREC members defined and characterized each outcome. The resulting nine outcomes are described. The nine complementary TD outcomes can be used as a framework to evaluate progress toward impact on complex public health problems. Strategic investment in infrastructure that supports team development and collaboration, such as a coordination center, cross-center working groups, annual funded developmental projects, and face-to-face meetings, may foster achievement of these outcomes. This exploratory work provides a basis for the future investigation and development of quantitative measurement tools to assess the achievement of TD outcomes that are relevant to solving multifactorial public health problems.
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Meta-analytic methods were used to calculate the relative risk of plasma homocysteine elevations for various types of arteriosclerotic vascular disease reported from 27 publications. The relative risks for coronary artery disease ranged... more
Meta-analytic methods were used to calculate the relative risk of plasma homocysteine elevations for various types of arteriosclerotic vascular disease reported from 27 publications. The relative risks for coronary artery disease ranged between 1.6-1.8, regardless of whether odds ratios were calculated from a homocysteine concentration defined as abnormal by the original authors, or were derived from 5 μmol/L increments. The proportion of cases of coronary artery disease attributable to homocysteine was 10%.
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Background: Organophosphate pesticides (OPs) are the primary form of insect control in American agriculture. For non-occupationally exposed individuals, the primary source of OP exposure is thought...
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Research Interests: Gastroenterology, Vitamin D, Medicine, Lung Cancer, Humans, and 15 moreInternal Medicine, Female, Risk factors, Aged, Middle Aged, Public health systems and services research, Odds ratio, Risk Factors, Logistic Models, Confidence Interval, Adenocarcinoma, Case Control Studies, Quartile, postmenopause, and lung neoplasms
Concerns about reverse causality and selection bias complicate the interpretation of studies of body mass index (BMI, calculated as weight (kg)/height (m)2) and mortality in older adults. The objective of this study was to investigate... more
Concerns about reverse causality and selection bias complicate the interpretation of studies of body mass index (BMI, calculated as weight (kg)/height (m)2) and mortality in older adults. The objective of this study was to investigate methodological explanations for the apparent attenuation of obesity-related risks in older adults. We used data from 68,132 participants in the Women’s Health Initiative (WHI) clinical trial for this analysis. All of the participants were postmenopausal women aged 50–79 years at baseline (1993–1998). To examine reverse causality and selective attrition, we compared rate ratios from inverse probability of treatment– and censoring–weighted Poisson marginal structural models with results from an unweighted adjusted Poisson regression model. The estimated mortality rate ratios and 95% confidence intervals for BMIs of 30.0–34.9, 35.0–39.9 and ≥40.0 were 0.86 (95% confidence interval (CI): 0.77, 0.96), 0.85 (95% CI: 0.72, 0.99), and 0.88 (95% CI: 0.72, 1.07), respectively, in the unweighted model. The corresponding mortality rate ratios were 0.96 (95% CI: 0.86, 1.07), 1.12 (95% CI: 0.97, 1.29), and 1.31 95% CI: (1.08, 1.57), respectively, in the marginal structural model. Results from the inverse probability of treatment– and censoring–weighted marginal structural model were attenuated in low BMI categories and increased in high BMI categories. The results demonstrate the importance of accounting for reverse causality and selective attrition in studies of older adults.
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Research Interests: Bioengineering, Geriatrics, Pharmacoepidemiology, Rehabilitation, Fracture, and 15 moreAging, Medicine, Prevention, Pharmaceuticals, Humans, Clinical research, Female, Bone Density, Aged, Osteoporotic fractures, Proportional hazards model, Hip fracture, Confidence Interval, Medical and Health Sciences, and hazard ratio
Research Interests: Demography, Medicine, Social Class, Humans, United States, and 14 moreFemale, Mammography, Socioeconomic Status, Washington, Aged, Middle Aged, Adult, Ethnic Group, Ethnic/Racial Health Disparities, Community Health Centers, Breast Neoplasms, Early detection of cancer, healthcare disparities, and Residence Characteristics
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Research Interests: Depression, Mild Cognitive Impairment, Preventive medicine, Medicine, Overweight, and 15 moreHumans, Health related Quality of Life, Female, Patient Compliance, Body Mass Index, Health Status, Aged, Middle Aged, Nutrition Policy, Calorie, Cognition disorders, Lethargy, postmenopausal, Intention to treat analysis, and dietary intervention
Research Interests: Nutrition, Environmental Health, Treatment Outcome, Folic acid, Medicine, and 14 moreSafety, Pregnancy, Population, Humans, United States, Female, Fortification, Nutritional Status, Homocysteine, Biological markers, Neural Tube Defects, Nutritional Requirements of Freshwater Fish, folic acid deficiency, and Medical and Health Sciences
This study reports the validity, reliability, and responsiveness of a 33-item fat- and fiber-related behavior questionnaire (FFB) and describes how this instrument provides insight into the process of adopting healthy diets. Data are from... more
This study reports the validity, reliability, and responsiveness of a 33-item fat- and fiber-related behavior questionnaire (FFB) and describes how this instrument provides insight into the process of adopting healthy diets. Data are from the Eating Patterns Study, a randomized clinical trial of a physician-delivered, self-help intervention to reduce fat and increase fiber intake. Intervention (n = 850) and control participants (n = 945) completed both a food frequency questionnaire and the FFB at baseline and at 3 and 12 months postintervention. Validity, as assessed by correlation of the FFB with the food frequency questionnaire at baseline, was 0.53 for fat (fat scale with percentage energy from fat) and 0.50 for fiber (fiber scale with fiber g/1000 kcal; both P < 0.001). Reliability, as assessed by the intraclass correlation in controls across all three time points, was 0.77 for the fat scale and 0.74 for the fiber scale (both P < 0.001). The largest changes in fat-related behavior were in avoiding fat as a flavoring and in using specially manufactured low-fat foods, and the largest changes in fiber-related behavior were in substituting high-fiber versions of common foods. Overall, the FFB was a reasonably valid and reliable measure of dietary intake, which provided insight into the behavioral effects of the dietary intervention.
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One of the national objectives in "Healthy People 2000" is for members of the public to increase their consumption of fruits and vegetables to five or more servings daily. The National Cancer Institute (NCI) began a nationwide campaign to... more
One of the national objectives in "Healthy People 2000" is for members of the public to increase their consumption of fruits and vegetables to five or more servings daily. The National Cancer Institute (NCI) began a nationwide campaign to achieve this objective in 1991. As part of this campaign, the NCI funded nine research studies in 1993. These projects are implementing and evaluating community-based programs designed to increase fruit and vegetable consumption among different segments of the population in Alabama, Arizona, Georgia, Louisiana, Maryland, Massachusetts, Minnesota, North Carolina, and Washington. The settings for these projects include the Special Supplement Food Program for Women, Infants, and Children (WIC Programs), churches, worksites, and schools. The projects are led by multidisciplinary teams and entail extensive collaboration among academic, governmental, private sector, and voluntary agencies within each State. The projects represent a model public health paradigm for conducting this type of research.
Research Interests: Nursing, Health Promotion, Environmental Health, Health Education, Diet, and 15 morePublic Health, Medicine, Humans, United States, Pubmed, Fruit, Vegetables, Food Services, Public Administration and Policy, Public health systems and services research, Occupational therapy services in mental health services, Public health policy and administration, Nutritional Requirements of Freshwater Fish, guidelines as topic, and consumption sociology
Research Interests: Engineering, Research Design, Diet, Medicine, Humans, and 13 moreFemale, Food Frequency Questionnaire, Aged, Middle Aged, Questionnaires, Randomized Controlled Trial, Reproducibility of Results, Guidance and Counseling Intervention Programs, Dietary fats, Randomized Controlled Trials as Topic, Breast Neoplasms, Nutrition assessment, and Medical and Health Sciences
Research Interests: Incidence Geometry, Dialysis, Medicine, Humans, Kidney, and 15 moreEnd Stage Renal Disease, Female, Male, Incidence, Hip Fractures, Clinical Sciences, Aged, Bone fracture, Hip fracture, Bone Loss, European Continental Ancestry Group, General Population, Age Groups, Cohort Studies, and Age distribution
Research Interests: Clinical Trial, Breast Cancer, Life Sciences, Community Health, Cardiovascular disease, and 15 moreColorectal cancer, Endometrial Cancer, Humans, Chronic Disease, Female, Health Science, Aged, Coronary heart disease, Hip fracture, Health risk, Indexation, JAMA, Confidence Interval, Breast neoplasm, and hazard ratio
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Introduction: Obesity, a risk factor for certain cancers, can also be related to reduced health-related quality of life and productivity. We examined eating physical activity behaviors, and body mass index (BMI), as predictors of... more
Introduction: Obesity, a risk factor for certain cancers, can also be related to reduced health-related quality of life and productivity. We examined eating physical activity behaviors, and body mass index (BMI), as predictors of health-related quality of life and productivity. Methods: MOVE ‘M is a worksite-randomized trial targeting diet and physical activity to reduce weight gain. Secondary outcomes include Obesity and Weight Loss Quality of Life (OWLQOL) and productivity. Baseline data collection occurred from 2006–2008, and data were analyzed in 2009. Results: Baseline data were analyzed for individual-level associations using linear mixed models. Since gender was found to be an effect modifier, data were analyzed separately for men (n=288) and women (n=281). BMI was negatively associated with OWLQOL in both women (p&lt;0.001) and men (p&lt;0.001). The linear effect estimate for OWLQOL score associated with one category increase in BMI was 32% (95% CI: 27%, 37%) for women and 12% (95% CI: 8%, 17%) for men. Physical activity was associated (p=0.007) with OWLQOL only in women. Eating while doing another activity was negatively associated with OWLQOL scores only in men (p=0.0003) and with productivity only in women (p=0.004). Conclusion: Our results suggest obese persons, particularly women, experience diminished OWLQOL. If longitudinal analyses confirm these findings, there may be additional work-related and general health benefits from reducing weight and increasing physical activity. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B6.
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Introduction: The traditional lifestyle of Yup’ik Alaska Native people, including a diet high in marine-based foods and daily physical activity, may be cardio-protective. However iq’mik, a traditional form of smokeless tobacco used by... more
Introduction: The traditional lifestyle of Yup’ik Alaska Native people, including a diet high in marine-based foods and daily physical activity, may be cardio-protective. However iq’mik, a traditional form of smokeless tobacco used by >50% of Yup’ik adults, could increase cardio-metabolic (CM) risk. Objective: Our objective was to characterize the associations between iq’mik use and CM risk factors (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], blood glucose [BG], systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR] and body mass index [BMI]). Methods: We analyzed a cross-sectional sample of Yup’ik adults (n=874). Current iq’mik use, demographic and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG and BG. SBP, DBP, HR and BMI were obtained by physical exam. We characterized the association between current iq’mik use and continuous CM risk factor measures both unadjusted for lifestyle and adjusted for lifestyle using two approaches, adjustment for: A) measures of Yup’ik lifestyle and B) a propensity score representing the conditional probability of using iq’mik. Findings: Current iq’mik use was significantly associated with increased HDL-C levels and inversely associated with TG, BG, HR, and BMI (Table). However, after adjusting for lifestyle by either method, associations were attenuated, only BG remaining inversely associated with current iq’mik use (Table). Conclusions: Iq’mik use was associated with cardio-protective measures when not adjusted for Yup’ik lifestyle factors. After adjusting for aspects of Yup’ik lifestyle, the inverse association between iq’mik use and BG remained, raising additional research questions about physiologic mechanisms.
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Introduction: Hispanics are the fastest growing population in the United States (US). They present a mixed picture of cancer incidence and mortality. For breast cancer, Latinas have a lower incidence (83.5 per 100,000) than non-Hispanic... more
Introduction: Hispanics are the fastest growing population in the United States (US). They present a mixed picture of cancer incidence and mortality. For breast cancer, Latinas have a lower incidence (83.5 per 100,000) than non-Hispanic White (NHW) women (147.3 per 100,000); however, with longer time in the US, breast cancer incidence increases in Latinas. Further, they are more likely to be diagnosed in late stage and therefore have lower five year survival rates than NHW women. Finally, Latinas are more likely to suffer from triple negative cancers that are more aggressive than estrogen-receptive cancer. One reason for the late-stage diagnosis may be that Latinas, especially Mexican-American women, are less likely to present for mammography screening than NHW women. In a recent study by Miranda et al., evidence shows that for Mexican-American women overall, less than 60 percent have had a mammogram. Furthermore, the lack of a medical home means that many Latinas do not routinely receive messages about the importance of mammography nor are they likely to receive referrals for mammography. In our P-50 funded by the National Cancer Institute's Center for Population Health and Health Disparities (CPHHD), we have a multi-level mammography promotion project. Called Fortaleza Latina, the overall goal of the project is to develop and test a culturally-appropriate multi-level intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington State. Of corollary interest is the way Latinas perceive their risk of getting breast cancer and their response to perceived risk. For this study, we are especially interested in perceptions of risk and decisions Latinas report they would make based on their perceptions. Methods: In a two-armed study (control vs. intervention), Latinas who are out of compliance with mammography are identified by a federally qualified health clinic system. After a baseline survey is conducted, women are randomized to receive the intervention vs. usual care. The baseline survey contains a number of questions that are related to breast cancer risk perception by Latinas. Three questions that assess perceived risk refer to one's own risk of developing breast cancer, one's risk compared to other women, and one's worry about developing breast cancer. Variables that were examined as correlates of risk include the presence of a medical home, the presence of health insurance, the financial ability to pay, attitudes about recommendations for mammography, and demographic variables. Results: Of 358 women who were out of compliance with mammography and who responded to the baseline questionnaire to date, 94 percent were of Hispanic origin. Of these, 91 percent speak Spanish most of the time and 97 percent were born outside of the US with over 80 percent born in Mexico. In terms of perceived risk of developing breast cancer, 41 percent perceived their risk as low, 41 percent as moderate, and 18 percent as high. Perceived risk compared to others was more likely (10%), about the same (57%), and less likely (33%). In terms of worry, 31 percent said rarely, 51 percent said sometimes, and 17 percent said frequently. There were no relationships between medical home and perceived risk or health insurance and perceived risk, although over 53 percent of respondents said cost would be an issue. Discussion: Perceived risk of breast cancer in this population is relatively low, with 1 in 5 women perceiving their risk as high. Many variables that were thought to correlate with risk did not do so, suggesting that commonly thought variables of association were not supported. Although this was a multi-level study looking at neighborhood, clinic, and individual, variation in the population was small with 49 percent of respondents having a household income of $15,000, 44 percent having $15,000 to $40,000, and only 6.7 percent having a total household income of more than $40,000. Conversely, it may be that the questions we asked about perceived risk and correlates of risk were not applicable to this group whose worries might be focused on more basic needs than risk of breast cancer. More study is needed to explore possible relationships in breast cancer risk among Latinas. Citation Format: Beti Thompson, Shirley AA Beresford, Gloria D. Coronado, Antoinette Argula, Sonia Bishop, Catherine C. Duggan. Multilevel breast cancer intervention in Latinas. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr SS01-05.
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Background: Prior research suggests that vitamin D protects against lung cancer with evidence only among subgroups including women and non-smokers. We investigated whether vitamin D intake was associated with lung cancer and explored... more
Background: Prior research suggests that vitamin D protects against lung cancer with evidence only among subgroups including women and non-smokers. We investigated whether vitamin D intake was associated with lung cancer and explored whether vitamin A intake modified the association. Methods: Data from 128,779 postmenopausal women including 1,771 incident lung cancers in the Women's Health Initiative, 1993-2010, were analyzed. Twelve percent of women received active intervention (1 g calcium+400 IU vitamin D3 daily) in the Calcium/Vitamin D Trial. Baseline total intake was assessed by a food frequency questionnaire and supplement bottle labels. Hazard ratios (HR) were estimated by Cox proportional hazard models. Results: No association was observed overall. Among never smokers, vitamin D intake was inversely associated with total lung cancer (HR=0.37, 95% confidence interval [CI]=0.18-0.77, ≥800 vs. &lt;100 IU/d; P-trend=0.01). The Calcium/Vitamin D Trial active intervention was not associated with a lower lung cancer risk among women with vitamin A intake ≥1,000 μg/d Retinol Activity Equivalent (RAE), but among those with vitamin A intake &lt;1,000 μg/d RAE (HR=0.69, 95% CI=0.50-0.96; P-interaction=0.09). Among current smokers with excess vitamin A intake (≥3,000 μg/d RAE), the intervention was associated with a higher lung cancer risk (HR=2.26, 95% CI=1.02-5.01), as no association was observed among current smokers with vitamin A intake &lt;3,000 μg/d RAE (P-interaction=0.01). Conclusion: Vitamin D intake was associated with a lower lung cancer risk in never-smoking, postmenopausal women. Lower vitamin A intake may be important for a beneficial association of 1 g calcium+400 IU vitamin D3 supplementation with lung cancer. Citation Format: Ting-Yuan David Cheng, Andrea Z. LaCroix, Shirley A.A. Beresford, Gary E. Goodman, Mark D. Thornquist, Yingye Zheng, Rowan T. Chlebowski, Gloria Y.F. Ho, Marian L. Neuhouser. Vitamin D intake and lung cancer risk in the Women's Health Initiative (WHI). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2572. doi:10.1158/1538-7445.AM2013-2572
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Objective: Navajo children are at increased risk for obesity, in part due to limited access to healthy foods. School garden interventions increase access to fresh fruit and vegetables and consumption of healthy foods. Our study describes... more
Objective: Navajo children are at increased risk for obesity, in part due to limited access to healthy foods. School garden interventions increase access to fresh fruit and vegetables and consumption of healthy foods. Our study describes the development and pilot testing of a school garden intervention for Navajo elementary school children. Methods: We reviewed existing school garden interventions and conducted formative research with students, caregivers, and school staff to inform the intervention. The intervention consisted of a garden built at the school and a yearlong curriculum on gardening and healthy eating. We pilot-tested the intervention in an elementary school on the Navajo Nation. Results: Formative research revealed the importance of incorporating Diné culture, including traditional growing practices and the preparation of traditional foods into the curriculum. School staff also stressed the value of tying the curriculum to state and Diné educational standards. Students enjoyed opportunities for hands-on activities and snack preparation. Conclusions: Schools have a meaningful role to play in addressing childhood obesity disparities among Navajo children. School-based interventions that draw on cultural strengths and include healthy traditional practices can be a promising strategy for increasing fruit and vegetable consumption.
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Research Interests: Life Style, Diet, Medicine, Linear models, Multivariate Analysis, and 15 moreHumans, Female, Male, Food Frequency Questionnaire, Feeding Behavior, Aged, Middle Aged, Adult, Age Factors, Cardiovascular Diseases, Cross Sectional Studies, Alaska, Quartile, Metabolic Syndrome X, and Medical and Health Sciences
Research Interests: Incidence Geometry, Ovarian Cancer, Medicine, Endometrial Cancer, Humans, and 15 moreFemale, Population based study, Aged, Middle Aged, Gynecology, Adult, Odds ratio, Risk Factors, Case Control Study, Logistic Models, Oral Contraceptive, Case Control Studies, Medical and Health Sciences, Ovarian Neoplasms, and Endometrial neoplasms
Research Interests: Health Behavior, Incidence Geometry, Life Style, Adolescent, Medicine, and 15 moreHumans, Internal Medicine, Diabetes mellitus, Female, Male, Patient Compliance, Incidence, Aged, Middle Aged, Adult, Odds ratio, Cardiovascular Diseases, American Heart Association, Diabetes Care, and Medical and Health Sciences
To determine whether a low dosage (0.3 mg/day) of unopposed conjugated estrogens can be used without incurring an elevated risk of endometrial cancer. In this case-control study, cases (n = 484) consisted of women diagnosed with... more
To determine whether a low dosage (0.3 mg/day) of unopposed conjugated estrogens can be used without incurring an elevated risk of endometrial cancer. In this case-control study, cases (n = 484) consisted of women diagnosed with endometrial cancer between 1985 and 1991 in three counties in Western Washington. Controls (n = 780) were identified using random digit dialing within the same three counties. Subjects were interviewed in person to obtain basic demographic and medical history information, as well as specific information about hormone use. Eighteen cases and eight controls had taken 0.3 mg/day of unopposed conjugated estrogens and no other dose or preparation of estrogens (risk relative to that of women who had not taken postmenopausal hormones = 5.4, 95% confidence interval [CI] 2.3, 13.0). The risk was particularly high in women whose use of this dose was both current and of more than 8 years&#39; duration (odds ratio = 9.2, 95% CI 2.9, 29.0). The elevation in risk in users of 0.3 mg/day was similar in size to that associated with the daily unopposed use of 0.625 mg of conjugated estrogens. The results suggest that a dosage of 0.3 mg per day of unopposed conjugated estrogens is associated with an increased risk of endometrial cancer.
Research Interests: Obstetrics, Medicine, Birth Weight, Endometrial Cancer, Humans, and 15 moreFemale, Obstetrics Gynecology, Confidence intervals, Risk factors, Aged, Middle Aged, Odds ratio, Risk Factors, Gestation, Miscarriage, Confidence Interval, Case Control Studies, Paediatrics and reproductive medicine, crown rump length, and Endometrial neoplasms
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American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process... more
American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process of adapting the evidence-based Cooking Matters® program for use by AI adults with type 2 diabetes in a rural and resource-limited setting in the North-Central United States. We conducted three focus groups with AI adults with diabetes to (i) identify Cooking Matters® adaptations and (ii) gather feedback on appropriateness of the adapted intervention using Barrera and Castro’s cultural adaptation framework. Transcripts were coded using an inductive, constant comparison approach. Queries of codes were reviewed to identify themes. Contextual considerations included limited access to grocery stores and transportation barriers, reliance on government food assistance and the intergenerational burden of diabetes. Adaptations to content and delivery included incorporating traditional and locally available foods; appealing to children or others in multigenerational households and prioritizing visual over written content. Our use of Barrera and Castro’s framework adds rigor and structure to the cultural adaptation process and increases the likelihood of future intervention success. Other researchers may benefit from using this framework to guide the adaptation of evidence-based interventions in AI communities.