Multiple skin cancer risk behaviors in the U.S. population

BACKGROUND: The incidence of all types of skin cancer has increased over the past 3 decades in the United States. Increased skin cancer risk is associated with exposure to ultraviolet radiation. This study examined the age-stratified prevalence and correlates of multiple skin cancer risk behaviors (infrequent use of sun-protective clothing, staying in the sun when outside on a sunny day, infrequent use of sunscreen, indoor tanning, and receiving a sunburn) among U.S. adults. METHODS: 28,235 adults participating in the 2005 National Health Interview Survey (NHIS) answered questions regarding sun-protection behaviors, indoor tanning in the past year, and sunburns in the past year. Examined correlates included geographic location, demographics, healthcare access, BMI, physical activity, smoking, alcohol use, melanoma family history, perceived cancer risk, skin sensitivity to the sun, and receipt of a total skin exam. RESULTS: The most commonly reported skin cancer risk behaviors were infrequent use of sun-protective clothing and infrequent use of sunscreen. The majority of individuals reported multiple skin cancer risk behaviors. Although significant correlates varied according to age, individuals reporting more risk behaviors were more likely younger, residing in the Midwest, male, non-Hispanic white, less-educated, smokers, risky drinkers, and had skin that was less sun-sensitive. CONCLUSIONS: The majority of the U.S. population engage in multiple skin cancer risk behaviors. A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population.     

Environmental exposure to dioxin-like compounds and the mortality risk in the U.S. population

Background

Little is known about the mortality risk associated with chronic dioxin exposure in the general U.S. populations.

Objective

To explore the association between dioxin-like chemicals and mortality risk in a large population-based cohort study.

Methods

The analysis included 2361 subjects aged 40 years or older from the 1999–2004 National Health and Nutrition Examination Survey (NHANES). Exposure to a mixture of dioxin-like chemicals, including dibenzo-p-dioxins, dibenzofurans, and polychlorinated biphenyls was estimated using toxic equivalency values (TEQs) calculated with 2005 World Health Organization toxic equivalency factors. All-cause and cause-specific mortalities were obtained from the NHANES-linked follow-up data through December 31, 2006. Cox proportional-hazards models were applied to assess the associations of interest.

Results

A total of 242 deaths occurred during the follow-up period, including 75 from cardiovascular disease and 72 from cancer. There was an increased mortality risk associated with logarithmically expressed dioxin TEQs for all-cause deaths (hazard ratio = 1.19, 95% confidence interval = 1.02–1.39, p = 0.02). Similar graded dose–response trends were found for cardiovascular and cancer mortality which did not reach statistical significance.

Conclusions

In general, higher dioxin exposure is associated with an increased mortality risk among subjects aged 40 and above. The cause-specific analyses and responsible mechanisms will require further investigation.     

DSM-IV alcohol dependence and drinking in the U.S. population: A risk analysis

PURPOSE: This paper examines the relationship between alcohol dependence according to the criteria found in the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association and drinking in the U.S. general population.

METHODS: The data set under analysis is the 1988 National Health Interview Survey, which interviewed a probability sample of 22,102 adult drinkers in the U.S. household population. The response rate was 86%.

RESULTS: Results indicate that there is a linear relationship between DSM-IV dependence and the mean number of drinks consumed per day, or the number of days drinking five or more glasses of alcohol in the past 12 months. Respondents who reported consuming five or more drinks in a day have about six times more chances of being dependent than respondents who did not report such pattern of drinking. Older drinkers are less at risk than younger drinkers.

CONCLUSIONS: There is a risk of alcohol dependence at relatively low volumes of consumption. The risk increases gradually with the volume of consumption. An added and higher risk exists when drinkers engage in a pattern of consumption involving the ingestion of five or more drinks per day.     

Differences in U.S. hospital service utilization between traditional Medicare and Medicare HMO patients

This study examines the differences between traditional U.S. Medicare and Medicare HMO Florida inpatient hospital utilization during the years 1992-1998, using nine high volume Diagnosis Related Groups. Utilization was measured by the number of ancillary services consumed, as well as the charges for those services. The analyses controlled for differences in utilization due to patient age, race, hospital size, year and market differences in hospital costs. Patient data were severity-adjusted and the analysis focused on the patients at the highest severity level. The study found that Medicare HMO patients with chronic diseases at the highest severity of illness level consumed significantly more services than traditional Medicare patients with the same chronic diseases. It was concluded that these Medicare HMO patients were either sicker (despite the severity adjustment) than the traditional Medicare patients and/or Medicare HMOs used different production processes than traditional Medicare, perhaps in order to minimize length of stay. Medicare HMO patients with acute illnesses at the highest severity level did not, in general, consume significantly more services than traditional Medicare patients at the same level of severity for the same diagnoses. The results imply that Medicare policy with regard to HMO expansion may not result in cost savings, and may, instead, result in higher costs if the proportion of the Medicare population hospitalized with chronic illnesses increases.     

HIV behavioral surveillance among the U.S. general population

HIV behavioral surveillance in the United States is conducted among three groups: infected populations, high-risk populations, and the general population. We describe the general population component of the overall U.S. HIV behavioral surveillance program and identify priority analyses. This component comprises several data systems (ongoing, systematic, population-based surveys) through which data on risk behaviors and HIV testing are collected, analyzed, and disseminated. Multiple data systems are needed to balance differences in scope and purpose, as well as strengths and weaknesses of the sampling frames, mode of administration, and frequency of data collection. In a concentrated epidemic, such as in the United States, general population data play a small but important role in monitoring the potential spread of infection more broadly, particularly given increases in HIV transmission through heterosexual contact.     

Growth of the Medicare population.

The growth rate of Medicare enrollees significantly exceeds the growth rate of the general population. Moreover, the group of enrollees aged 85 years or over is growing proportionately faster than all other groups of the aged. These phenomena and other interesting trends of the Medicare population are explored in this article.     

Medicare risk contracting: analyzing managed care for the aging population in the USA.

This paper focuses on Medicare risk contracting in the USA. The issue of the current method of reimbursement versus Medicare risk contracting is explored. Risk sharing and payment mechanisms are described and analyzed. The strengths and weaknesses (score-card) of Medicare beneficiaries entering HMOs are reviewed. Finally, the issue of selection bias in Medicare HMOs is discussed regarding future implementation strategy.     

Magnesium and calcium dietary intakes of the U.S. population

Dietary intake levels of calcium and magnesium, as well as calcium/magnesium ratios, were assessed for 12 age/sex groups of the U.S. population through use of USDA's 1977-78 Nationwide Food Consumption Survey. Results indicated that a majority of the U.S. population consumed less than recommended amounts (NRC-RDA) of both calcium and magnesium. Approximately 60% of 0 to 5 year olds and 40% of 6 to 11 year olds had average daily calcium intakes of less than 800 mg, while 60 and 85% of the male and female adolescents, respectively, had intakes below the recommended level of 1,200 mg/day. Approximately 80 to 85% of the adult female groups and 50 to 65% of the adult male groups had average intakes below recommended levels. With the exception of children ages 0 to 5 years, the average daily magnesium intakes of all age/sex classes were below the NRC-RDA. Magnesium consumption was particularly low among adolescent females, adult females, and elderly men, with 85, 80-85 and 75%, respectively, of the population groups having average magnesium intakes below their respective NRC-RDA. Furthermore, the majority of the population groups did not consume appropriate proportions of these two minerals to obtain optimal calcium/magnesium ratios. While adolescent females and adult females had more appropriate ratio values than other segments of the population, these ratios principally resulted from their very low intakes of calcium. The most inappropriate calcium/magnesium ratios, observed for children, male adolescents, and young adult males, were, in general, due to their more appropriate calcium intakes and their low magnesium intakes.     

Variability in food consumption patterns of adults in the U.S. population

This study used the 24‐hour dietary recall data of white adult respondents in the NHANES I to demonstrate variability in food consumption patterns among subgroups of this population. Both a quantitative dimension, mean intake levels and the qualitative dimensions of nutrient density and diet diversity were used. Generally males consumed more food energy and nutrients than did females, as did younger, as compared to older subjects. This pattern was less consistent for vitamins A and C than for other nutrients. Sex differences in diet diversity were small. The higher energy and nutrient consumption of males, similarity in the number of “nutritious” foods in the diet and higher nutrient density values found among females, together, support the existence of variability in food consumption.     

Magnesium and calcium dietary intakes of the U.S. population.

Dietary intake levels of calcium and magnesium, as well as calcium/magnesium ratios, were assessed for 12 age/sex groups of the U.S. population through use of USDA's 1977-78 Nationwide Food Consumption Survey. Results indicated that a majority of the U.S. population consumed less than recommended amounts (NRC-RDA) of both calcium and magnesium. Approximately 60% of 0 to 5 year olds and 40% of 6 to 11 year olds had average daily calcium intakes of less than 800 mg, while 60 and 85% of the male and female adolescents, respectively, had intakes below the recommended level of 1,200 mg/day. Approximately 80 to 85% of the adult female groups and 50 to 65% of the adult male groups had average intakes below recommended levels. With the exception of children ages 0 to 5 years, the average daily magnesium intakes of all age/sex classes were below the NRC-RDA. Magnesium consumption was particularly low among adolescent females, adult females, and elderly men, with 85, 80-85 and 75%, respectively, of the population groups having average magnesium intakes below their respective NRC-RDA. Furthermore, the majority of the population groups did not consume appropriate proportions of these two minerals to obtain optimal calcium/magnesium ratios. While adolescent females and adult females had more appropriate ratio values than other segments of the population, these ratios principally resulted from their very low intakes of calcium. The most inappropriate calcium/magnesium ratios, observed for children, male adolescents, and young adult males, were, in general, due to their more appropriate calcium intakes and their low magnesium intakes.     

Dietary intake and arsenic methylation in a U.S. population

Millions of people worldwide are exposed to arsenic-contaminated drinking water, and ingestion of inorganic arsenic (InAs) has been associated with increased risks of cancer. The primary metabolic pathway of ingested InAs is methylation to monomethyl arsenic (MMA) and dimethyl arsenic (DMA). However, people vary greatly in the degree to which they methylate InAs, and recent evidence suggests that those who excrete high proportions of ingested arsenic as MMA are more susceptible than others to arsenic-caused cancer. To date, little is known about the factors that determine interindividual differences in arsenic methylation. In this study, we assessed the effect of diet on arsenic metabolism by measuring dietary intakes and urinary arsenic methylation patterns in 87 subjects from two arsenic-exposed regions in the western United States. Subjects in the lower quartile of protein intake excreted a higher proportion of ingested InAs as MMA (14.6 vs. 11.6%; p = 0.01) and a lower proportion as DMA (72.3 vs. 77.0%; p = 0.01) than did subjects in the upper quartile of protein intake. Subjects in the lower quartile of iron, zinc, and niacin intake also had higher urinary percent MMA and lower percent DMA levels than did subjects with higher intakes of these nutrients. These associations were also seen in multivariate regression analyses adjusted for age, sex, smoking, and total urinary arsenic. Given the previously reported links between high percent MMA and increased cancer risks, these findings are consistent with the theory that people with diets deficient in protein and other nutrients are more susceptible than others to arsenic-caused cancer.