Individual and neighborhood-level socioeconomic characteristics in relation to smoking prevalence among black and white adults in the Southeastern United States: a cross-sectional study

Human papillomavirus-associated anal squamous cell carcinoma: sociodemographic, geographic, and county-level economic trends in incidence rates-United States, 2001-2019

BACKGROUND

Incidence of anal squamous cell carcinoma is increasing, but vaccination against human papillomavirus (HPV) and removal of precancerous anal lesions could prevent new cases. The overall HPV-associated cancer incidence is reported to be higher in rural populations and in counties with lower economic status. We assessed these differences specifically for HPV-associated anal squamous cell carcinoma and described the geographic, county-level economic, and sociodemographic variations in incidence rates and trends.

METHODS

We analyzed data from the US Cancer Statistics to assess age-standardized incidence rates of HPV-associated squamous cell carcinomas among adults aged 18 years and older from 2001 to 2019. We calculated rate ratios and 95% confidence intervals to examine differences in incidence rates. We also quantified changes in incidence rates over time using joinpoint regression.

RESULTS

From 2001 to 2019, 72 421 new cases of HPV-associated anal squamous cell carcinoma were diagnosed among women (2.8 per 100 000) and 37 147 among men (1.7 per 100 000). Age-standardized incidence rates were higher in the South compared with other census regions and in counties ranked in the bottom 25% and 25%-75% economically than in the top 25%. The overall incidence rate increased in women but remained stable in men during 2009-2019. Incidence rates increased in adults aged 50 years and older but decreased among those aged 40-44 years from 2001 to 2019 in women and from 2007 to 2019 in men.

CONCLUSIONS

There were inequities in HPV-associated anal squamous cell carcinoma incidence by geographic and county-level economic characteristics. Failure to improve vaccine and treatment equity may widen existing disparities.

Traffic-Related Air Pollution and Risk of Lung, Breast, and Urinary Tract Cancer in Halifax, Nova Scotia

OBJECTIVES

We assessed the association of traffic-related air pollution (TRAP) with the incidence of lung, breast, and urinary tract cancer in Halifax, Nova Scotia.

METHODS

Our case-control study included 2315 cancers and 8501 age-sex-matched controls. Land-use regression was used to estimate TRAP concentrations. Logistic regression was used to assess cancer risk in relation to TRAP, adjusting for community social and material deprivation.

RESULTS

There was no association between the risk of lung, breast, or urinary tract cancer in relation to TRAP. Lung cancer risk was significantly increased in the most deprived communities, whereas breast cancer risk was highest in the least deprived communities.

CONCLUSIONS

In a city characterized by low levels of ambient air pollution, there was no evidence of a linear increased lung, breast, or urinary tract cancer risk in relation to TRAP.

The Nova Scotia Community Cancer Matrix: A geospatial tool to support cancer prevention

Globally, cancer is a leading cause of death and morbidity and its burden is increasing worldwide. It is established that medical approaches alone will not solve this cancer crisis. Moreover, while cancer treatment can be effective, it is costly and access to treatment and health care is vastly inequitable. However, almost 50% of cancers are caused by potentially avoidable risk factors and are thus preventable. Cancer prevention represents the most cost-effective, feasible and sustainable pathway towards global cancer control. While much is known about cancer risk factors, prevention programs often lack consideration of how place impacts cancer risk over time. Maximizing cancer prevention investment requires an understanding of the geographic context for why some people develop cancer while others do not. Data on how community and individual level risk factors interact is therefore required. The Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. In this analysis we used Bayesian inference to identify communities with high and low risk for lung and bladder cancer: two highly preventable cancers with rates in NS exceeding the Canadian average, and for which key risk factors are high. We report significant spatial heterogeneity in lung and bladder cancer risk. The identification of spatial disparities relating to a community's socioeconomic profile and other spatially varying factors, such as environmental exposures, can inform prevention. Adopting Bayesian spatial analysis methods and utilizing high quality cancer registry data provides a model to support geographically-focused cancer prevention efforts, tailored to local community needs.

Genome-wide association study (GWAS) of circulating vitamin D outcomes among individuals of African ancestry

BACKGROUND

Vitamin D deficiency is more common among African-ancestry individuals and may be associated with adverse health outcomes. Vitamin D binding protein (VDBP) regulates concentrations of biologically active vitamin D.

OBJECTIVE

We conducted genome-wide association study (GWAS) of VDBP and 25-hydroxyvitamin D among African-ancestry individuals.

METHODS

Data were collected from 2,602 African American adults from the Southern Community Cohort Study (SCCS) and 6,934 African- or Caribbean-ancestry adults from the UK Biobank. Serum VDBP concentrations were available only in the SCCS and were measured by using the Polyclonal Human VDBP ELISA kit. Serum 25-hydroxyvitamin D concentrations for both study samples were measured by using Diasorin Liason, a chemiluminescent immunoassay. Participants were genotyped for single nucleotide polymorphisms (SNPs) with genome-wide coverage by using Illumina or Affymetrix platforms. Fine-mapping analysis was performed by using forward stepwise linear regression models including all variants with P value < 5 × 10-8 and within 250 kbps of a lead SNP.

RESULTS

We identified 4 loci notably associated with VDBP concentrations in the SCCS population: rs7041 (per allele β = 0.61 μg/mL, SE = 0.05, P = 1.4 × 10-48) and rs842998 (per allele β = 0.39 μg/mL, SE = 0.03, P = 4.0 × 10-31) in GC, rs8427873 (per allele β = 0.31 μg/mL, SE = 0.04, P = 3.0 × 10-14) near GC and rs11731496 (per allele β = 0.21 μg/mL, SE = 0.03, P = 3.6 × 10-11) in between GC and NPFFR2. In conditional analyses, which included the above-mentioned SNPs, only rs7041 remained notable (P = 4.1 × 10-21). SNP rs4588 in GC was the only GWAS-identified SNP associated with 25-hydroxyvitamin D concentration. Among UK Biobank participants: per allele β = -0.11 μg/mL, SE = 0.01, P = 1.5 × 10-13; in the SCCS: per allele β = -0.12 μg/mL, SE = 0.06, P = 2.8 × 10-02). rs7041 and rs4588 are functional SNPs that influence the binding affinity of VDBP to 25-hydroxyvitamin D.

CONCLUSIONS

Our results were in line with previous studies conducted in European-ancestry populations, showing that GC, the gene that directly encodes for VDBP, would be important for VDBP and 25-hydroxyvitamin D concentrations. The current study extends our knowledge of the genetics of vitamin D in diverse populations.

Do cigarette prices near secondary schools vary by area-level socioeconomic status? Findings from a field study in Ontario and Québec, Canada

OBJECTIVES

To examine, in the context of youth smoking, whether cigarette prices near secondary schools varied by area-level socioeconomic status in Southwestern and Central Ontario, and the greater Montréal region.

METHODS

We collected cigarette prices four times between 2016 and 2019 from stores near secondary schools and used mixed-effects and ordinary least squares regressions.

RESULTS

We found consistent evidence that cigarette prices near secondary schools were lower in neighbourhoods with lower area-level household income, and that differences were large enough to be meaningful. In Ontario and Québec, our results indicate a Can$0.26 [0.04, 0.47] to Can$0.51 [0.33, 0.69] and Can$0.10 [-0.04, 0.24] to Can$0.37 [0.22, 0.52] difference in prices for a pack of 25 cigarettes between neighbourhoods with a median household income standard deviation below/above the provincial median, respectively.

CONCLUSION

Policy changes that limit area-level cigarette price differences without lowering cigarette prices may reduce inequities in youth smoking.

Genetic Risk for Smoking: Disentangling Interplay Between Genes and Socioeconomic Status

This study aims to disentangle the contribution of genetic liability, educational attainment (EA), and their overlap and interaction in lifetime smoking. We conducted genome-wide association studies (GWASs) in UK Biobank (N = 394,718) to (i) capture variants for lifetime smoking, (ii) variants for EA, and (iii) variants that contribute to lifetime smoking independently from EA ('smoking-without-EA'). Based on the GWASs, three polygenic scores (PGSs) were created for individuals from the Netherlands Twin Register (NTR, N = 17,805) and the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 3090). We tested gene-environment (G × E) interactions between each PGS, neighborhood socioeconomic status (SES) and EA on lifetime smoking. To assess if the PGS effects were specific to smoking or had broader implications, we repeated the analyses with measures of mental health. After subtracting EA effects from the smoking GWAS, the SNP-based heritability decreased from 9.2 to 7.2%. The genetic correlation between smoking and SES characteristics was reduced, whereas overlap with smoking traits was less affected by subtracting EA. The PGSs for smoking, EA, and smoking-without-EA all predicted smoking. For mental health, only the PGS for EA was a reliable predictor. There were suggestions for G × E for some relationships, but there were no clear patterns per PGS type. This study showed that the genetic architecture of smoking has an EA component in addition to other, possibly more direct components. PGSs based on EA and smoking-without-EA had distinct predictive profiles. This study shows how disentangling different models of genetic liability and interplay can contribute to our understanding of the etiology of smoking.

A Comparative Analysis of Smoking Rates by Sex and Socioeconomic Status Among Ultra-Orthodox City Residents and Non-Ultra-Orthodox City Residents in Israel

The aim of this cross-sectional study is to examine the differences in smoking rates between ultra-Orthodox Jews and non-ultra-Orthodox Jews and to understand the role of sex and socioeconomic status (SES) in predicting smoking among the two populations. The study population included all Maccabi Healthcare Services members aged 50 or older (N = 30,170) who lived in two cities in the center of Israel: Bnei Brak-a city with a high concentration of ultra-Orthodox, and Ramat Gan-a non-ultra-Orthodox city. After adjusting for age, sex, and SES, the prevalence of smoking in the ultra-Orthodox city was significantly lower than that in the non-ultra-Orthodox city. A significant interaction was found between sex and degree of religiosity in predicting smoking. The smoking differences between men and women in the ultra-Orthodox city were high compared with those in the non-ultra-Orthodox city. Similarly, a significant interaction was found between SES and degree of religiosity in predicting smoking. These results in the effects of sex and SES in predicting smoking between ultra-Orthodox Jews and non-ultra-Orthodox Jews require further research to better understand these differences and plan intervention programs tailored to different populations accordingly.

Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans

Objectives: This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Methods: Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Results: Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Discussion: Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.

Race/ethnicity, neighborhood socioeconomic status and cardio-metabolic risk

Objective

To determine the association between neighborhood socioeconomic status (NSES) and cardio-metabolic risk and whether this relationship differs by race/ethnicity.

Methods

Participants in the Multi-Ethnic Study of Atherosclerosis (n = 5750), ages 45–84 years, from 6 US counties, including 5 examinations from 2000 to 2012. We calculated a modified allostatic load (AL) index, indicating cardio-metabolic risk. NSES score included census-derived measures at census tract of residence. Mixed effects growth curve models were used to assess linear and non-linear associations between NSES and AL at baseline and over time.

Results

Higher NSES was associated with lower AL across race/ethnic groups; considering NSES quintiles, significant associations were found only for the highest NSES quintiles (difference of -0.86 and -1.15 for white and Hispanic participants) vs. the lowest. We found no significant association between NSES and change in AL over time.

Discussion

Our findings suggest that the relationship between NSES and AL reflects the health benefits of living in the most advantaged neighborhoods.

Public health implications

Understanding the impact of higher NSES on health effects may help identify interventions to effectively target high risk neighborhoods.

•

These findings confirm the association between high NSES and low AL; pattern is similar across race/ethnic groups.

•

The relationship between NSES and AL reflects the health benefits of living in the most advantaged neighborhoods.

•

Identifying neighborhood factors that impact health is crucial to effectively target high risk neighborhoods.

Association of Neighborhood Disadvantage in Childhood With DNA Methylation in Young Adulthood

IMPORTANCE

DNA methylation has been proposed as an epigenetic mechanism by which the childhood neighborhood environment may have implications for the genome that compromise adult health.

OBJECTIVE

To ascertain whether childhood neighborhood socioeconomic disadvantage is associated with differences in DNA methylation by age 18 years.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study analyzed data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of children born between 1994 and 1995 in England and Wales and followed up from age 5 to 18 years. Data analysis was performed from March 15, 2019, to June 30, 2019.

EXPOSURES

High-resolution neighborhood data (indexing deprivation, dilapidation, disconnection, and dangerousness) collected across childhood.

MAIN OUTCOMES AND MEASURES

DNA methylation in whole blood was drawn at age 18 years. Associations between neighborhood socioeconomic disadvantage and methylation were tested using 3 prespecified approaches: (1) testing probes annotated to candidate genes involved in biological responses to growing up in socioeconomically disadvantaged neighborhoods and investigated in previous epigenetic research (stress reactivity-related and inflammation-related genes), (2) polyepigenetic scores indexing differential methylation in phenotypes associated with growing up in disadvantaged neighborhoods (obesity, inflammation, and smoking), and (3) a theory-free epigenome-wide association study.

RESULTS

A total of 1619 participants (806 female individuals [50%]) had complete neighborhood and DNA methylation data. Children raised in socioeconomically disadvantaged neighborhoods exhibited differential DNA methylation in genes involved in inflammation (β = 0.12; 95% CI, 0.06-0.19; P < .001) and smoking (β = 0.18; 95% CI, 0.11-0.25; P < .001) but not obesity (β = 0.05; 95% CI, -0.01 to 0.11; P = .12). An epigenome-wide association study identified multiple CpG sites at an arraywide significance level of P < 1.16 × 10-7 in genes involved in the metabolism of hydrocarbons. Associations between neighborhood disadvantage and methylation were small but robust to family-level socioeconomic factors and to individual-level tobacco smoking.

CONCLUSIONS AND RELEVANCE

Children raised in more socioeconomically disadvantaged neighborhoods appeared to enter young adulthood epigenetically distinct from their less disadvantaged peers. This finding suggests that epigenetic regulation may be a mechanism by which the childhood neighborhood environment alters adult health.

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]

Objetivo

Conocer la evolución del consumo de tabaco en Canarias durante 2000-2015 según clase social.

Emplazamiento

Comunidad Autónoma de Canarias.

Participantes

Cohorte CDC-Canarias con cortes en 2000 (n = 6.729), 2008 (n = 6.171) y 2015 (n = 4.705).

Mediciones principales

Tabaquismo, sexo, edad y clase social.

Resultados

El consumo disminuyó un 6% (5-7%, p < 0,001) en general, siendo más acentuado en el periodo 2000-2008 (5%). La disminución fue mayor en hombres, aunque siguieron fumando más que las mujeres, con una prevalencia del 25% (24-26%) frente al 18% (17-19%, p < 0,001). Solo hubo una disminución del consumo en los grupos jóvenes (6% [3-5%]; p = 0,011) y de edades intermedias (7% [6-8%]; p < 0,001). En todas las clases sociales se observó una disminución similar, con mayor prevalencia de tabaquismo en la clase alta: 24% (23-25%) en 2015 (p < 0,001). Al valorar conjuntamente sexo, edad y clase social, los hombres más jóvenes y de edad intermedia presentaron los mayores descensos de consumo: 8% (7-9%) clase baja y alta, 10% (9-11%) clase media. En la clase social baja, las mujeres más jóvenes continúan fumando más (27%) aunque abandonaron más el consumo (14%), fenómeno que en las de clase media se produjo en edades intermedias.

Conclusiones

La evolución del consumo de tabaco en Canarias sigue un patrón similar al conjunto de España. El abandono del consumo de tabaco se ha frenado en el periodo 2008-2015, especialmente en hombres y en clases sociales medias y altas.

Profiles of Psychosocial Risk and Protective Factors and their Associations with Alcohol Use and Regular Smoking in Black Adults

INTRODUCTION

This study aimed to identify the clustering of substance use-related psychosocial risk and protective factors (subgroups) and the differential associations of those subgroups with current alcohol use and regular smoking among Black adults.

METHODS

Data were drawn from 4462 participants (29% Afro Caribbean, 71% African American; median age = 38; 63% female) in a nationally representative study of social, economic, and structural conditions and health in Black Americans. Latent classes, i.e., subgroups, were derived via latent profile analysis with 10 indicators representing social support and religious involvement (support); demands from family and religious community (demands); and socioeconomic and neighborhood factors and racial discrimination (adversity). Frequency of alcohol use and prevalence of regular smoking were compared across classes using regression analyses.

RESULTS

Four classes emerged: (1) high support, low demands and adversity; (2) high support and demands, low-moderate adversity; (3) low support and demands, low-moderate adversity; and (4) low support, high demands and adversity. Relative to Class 1, frequency of alcohol use and regular smoking prevalence were significantly higher only in Class 4.

CONCLUSIONS

Results indicate substantive variations in the clustering of substance use-related psychosocial risk and protective factors in Black adults. Furthermore, they suggest that neither the presence of high demands nor the absence of support alone differentiates likelihood of engaging in frequent alcohol use or regular smoking, but adverse experiences such as racial discrimination may be especially impactful.

Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System: A Retrospective Study

BACKGROUND

Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.

METHODS

A cohort of ever-smokers aged ≥ 55 years was assembled from 19 years of electronic health record data from our academic community health-care system. Patient demographic characteristics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox proportional hazards model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided.

RESULTS

The study included 19,867 male subjects and 21,748 female subjects. Fifty-three percent of the patients were white, 38% were black, and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer compared with those in the least disadvantaged areas (hazard ratio, 1.29; 95% CI 1.07-1.55).

CONCLUSIONS

Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further research investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.

Association between area-level education and the co-occurrence of behavior-related risk factors: a multilevel analysis

INTRODUCTION

This study aimed to investigate the association of four different risk factors for chronic diseases and accumulation of these health behaviors with area-level education, regardless of individual-level characteristics in Brazil.

METHODS

A population-based cross-sectional study was carried out in Southern Brazil including 1,720 adults in 2009/2010. The simultaneous occurrence of tobacco smoking, abusive drinking, unhealthy eating habits, and physical inactivity was investigated. Using multilevel models, we tested whether area-level education was associated with each risk factor and with the co-occurrence of them after controlling sociodemographic individual-level variables.

RESULTS

We observed a between-group variance of 7.79, 7.11, 6.84 and 1.08% for physical inactivity, problematic use of alcohol, unhealthy eating habits, and smoking, respectively. The between-group variance for the combination of four behaviors was 14.2%. Area-level education explained a significant proportion of the variance observed in physical inactivity and unhealthy eating habits. Residents of low educational level neighborhoods showed a 2.40 (95%CI 1.58 - 3.66) times higher chance of unhealthy eating and 1.78 (95%CI 1.19 - 2.67) times higher chance of physical inactivity. The likelihood of individuals with two or three/four risk factors was simultaneously higher among residents of low educational level neighborhoods.

CONCLUSION

Public policies should consider the area-level characteristics, including education to control risk factors for chronic diseases.

Geographic surveillance of community associated MRSA infections in children using electronic health record data

BACKGROUND

Community- associated methicillin resistant Staphylococcus aureus (CA-MRSA) cause serious infections and rates continue to rise worldwide. Use of geocoded electronic health record (EHR) data to prevent spread of disease is limited in health service research. We demonstrate how geocoded EHR and spatial analyses can be used to identify risks for CA-MRSA in children, which are tied to place-based determinants and would not be uncovered using traditional EHR data analyses.

METHODS

An epidemiology study was conducted on children from January 1, 2002 through December 31, 2010 who were treated for Staphylococcus aureus infections. A generalized estimated equations (GEE) model was developed and crude and adjusted odds ratios were based on S. aureus risks. We measured the risk of S. aureus as standardized incidence ratios (SIR) calculated within aggregated US 2010 Census tracts called spatially adaptive filters, and then created maps that differentiate the geographic patterns of antibiotic resistant and non-resistant forms of S. aureus.

RESULTS

CA-MRSA rates increased at higher rates compared to non-resistant forms, p = 0.01. Children with no or public health insurance had higher odds of CA-MRSA infection. Black children were almost 1.5 times as likely as white children to have CA-MRSA infections (aOR 95% CI 1.44,1.75, p < 0.0001); this finding persisted at the block group level (p < 0.001) along with household crowding (p < 0.001). The youngest category of age (< 4 years) also had increased risk for CA-MRSA (aOR 1.65, 95%CI 1.48, 1.83, p < 0.0001). CA-MRSA encompasses larger areas with higher SIRs compared to non-resistant forms and were found in block groups with higher proportion of blacks (r = 0.517, p < 0.001), younger age (r = 0.137, p < 0.001), and crowding (r = 0.320, p < 0.001).

CONCLUSIONS

In the Atlanta MSA, the risk for CA-MRSA is associated with neighborhood-level measures of racial composition, household crowding, and age of children. Neighborhoods which have higher proportion of blacks, household crowding, and children < 4 years of age are at greatest risk. Understanding spatial relationship at a community level and how it relates to risks for antibiotic resistant infections is important to combat the growing numbers and spread of such infections like CA-MRSA.

Neighbourhood deprivation and lung cancer risk: a nested case-control study in the USA

OBJECTIVES

To examine the association between neighbourhood deprivation and lung cancer risk.

DESIGN

Nested case-control study.

SETTING

Southern Community Cohort Study of persons residing in 12 states in the southeastern USA.

PARTICIPANTS

1334 cases of lung cancer and 5315 controls.

PRIMARY OUTCOME MEASURE

Risk of lung cancer.

RESULTS

After adjustment for smoking status and other confounders, and additional adjustment for individual-level measures of socioeconomic status (SES), there was no monotonic increase in risk with worsening deprivation score overall or within sex and race groups. There was an increase among current and shorter term former smokers (p=0.04) but not among never and longer term former smokers. There was evidence of statistically significant interaction by sex among whites, but not blacks, in which the effect of worsening deprivation on lung cancer existed in males but not in females.

CONCLUSIONS

Area-level measures of SES were associated with lung cancer risk in current and shorter term former smokers only in this population.

Adolescent Summaries of Narrative and Expository Discourse: Differences and Predictors

Purpose

Summarizing expository passages is a critical academic skill that is understudied in language research. The purpose of this study was to compare the quality of verbal summaries produced by adolescents for 3 different discourse types and to determine whether a composite measure of cognitive skill or a test of expressive syntax predicted their performance.

Method

Fifty adolescents listened to, and then verbally summarized, 1 narrative and 2 expository lectures (compare–contrast and cause–effect). They also participated in testing that targeted expressive syntax and 5 cognitive subdomains.

Results

Summary quality scores were significantly different across discourse types, with a medium effect size. Analyses revealed significantly higher summary quality scores for cause–effect than compare–contrast summaries. Although the composite cognitive measure contributed significantly to the prediction of quality scores for both types of expository summaries, the expressive syntax score only contributed significantly to the quality scores for narrative summaries.

Conclusions

These results support previous research indicating that type of expository discourse may impact student performance. These results also show, for the first time, that cognition may play a predictive role in determining summary quality for expository but not narrative passages in this population. In addition, despite the more complex syntax commonly associated with exposition versus narratives, an expressive syntax score was only predictive of performance on narrative summaries. These findings provide new information, questions, and directions for future research for those who study academic discourse and for professionals who must identify and manage the problems of students struggling with different types of academic discourse.

Supplemental Material

https://doi.org/10.23641/asha.6167879

Estimating the risk of bladder and kidney cancer from exposure to low-levels of arsenic in drinking water, Nova Scotia, Canada

Arsenic in drinking water impacts health. Highest levels of arsenic have been historically observed in Taiwan and Bangladesh but the contaminant has been affecting the health of people globally. Strong associations have been confirmed between exposure to high-levels of arsenic in drinking water and a wide range of diseases, including cancer. However, at lower levels of exposure, especially near the current World Health Organization regulatory limit (10μg/L), this association is inconsistent as the effects are mostly extrapolated from high exposure studies. This ecological study used Bayesian inference to model the relative risk of bladder and kidney cancer at these lower concentrations-0-2μg/L; 2-5μg/L and; ≥5μg/L of arsenic-in 864 bladder and 525 kidney cancers diagnosed in the study area, Nova Scotia, Canada between 1998 and 2010. The model included proxy measures of lifestyle (e.g. smoking) and accounted for spatial dependencies. Overall, bladder cancer risk was 16% (2-5μg/L) and 18% (≥5μg/L) greater than that of the referent group (<2μg/L), with posterior probabilities of 88% and 93% for these risks being above 1. Effect sizes for kidney cancer were 5% (2-5μg/L) and 14% (≥5μg/L) above that of the referent group (<2μg/L), with probabilities of 61% and 84%. High-risk areas were common in southwestern areas, where higher arsenic-levels are associated with the local geology. The study suggests an increased bladder cancer, and potentially kidney cancer, risk from exposure to drinking water arsenic-levels within the current the World Health Organization maximum acceptable concentration.

Associations between neighborhood socioeconomic environment and physical activity in Cuban immigrants

Physical inactivity is a major public health concern because it is a determinant of obesity and obesity-related chronic diseases. Few longitudinal studies have examined the association between neighborhood socioeconomic (SES) environment and change in physical activity behaviors. Additionally, few studies have examined this association in immigrant groups or Hispanic subgroups such as Cubans. This research aimed to determine if neighborhood SES is associated with longitudinal change in moderate-to-vigorous physical activity (MVPA) among Cuban immigrants who participate in the Cuban Health Study in Miami, Florida. Data on 280 participants [mean age: 37.4 (±4.6), 48.9% women, mean body mass index: 25.0 (±2.5)] collected at baseline, 12 months and 24 months were analyzed. Minutes of MVPA were objectively measured during each data collection period using accelerometers. A neighborhood SES score was calculated for each participant’s residential census tract from American Community Survey data on median household income, median housing value, educational attainment and occupation. The neighborhood SES score was grouped into tertiles, reflecting low, moderate and high neighborhood SES environment. Multilevel linear models were used to examine the relationship between neighborhood SES and change in MVPA over 24 months. At baseline, 94 (33.6%), 108 (38.6%) and 78 (27.9%) participants resided in low, moderate, and high SES neighborhoods, respectively. After adjusting for age, sex, and body mass index, no difference in average change in MVPA over time was observed between participants residing in low and moderate SES neighborhoods (p=0.48) or low and high SES neighborhoods (p=0.62). In Cuban immigrants, longitudinal change in MVPA may not vary by neighborhood socioeconomic environment.

•

Objectively measured time spent in MVPA was calculated among new Cuban immigrant adults.

•

Longitudinal associations between neighborhood SES and MVPA were assessed.

•

Study participants, on average, increased their physical activity over two years.

•

Multilevel modeling indicated that neighborhood SES and change in MVPA were not associated.

Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study

BACKGROUND

Few studies have focused on the impact of neighborhood social environment on changes in smoking and alcohol use over time among African Americans.

METHOD

Jackson Heart Study participants were recruited from the Jackson, MS metropolitan area from 2000 to 2004. Neighborhood social environment was characterized using census-based neighborhood socio-economic status (NSES) and survey-derived perceptions of neighborhood social cohesion, disorder, and violence. Multinomial logistic regression was used to estimate the associations of neighborhood social environment with prevalence of smoking and alcohol use and with changes in these behaviors over time adjusted for individual sociodemographic characteristics.

RESULTS

Participants (N=3166) resided in 108 census tracts. All neighborhood social environment variables were consistently associated with prevalence of current smoking at baseline (11%) and with persistence of smoking over a median of 8-years follow-up (8%). The odds of being a consistent smoker relative to never smoking was about 30% higher per 1SD higher neighborhood violence (aOR: 1.30, 95% CI: 1.16-1.46) and disorder (aOR: 1.26, 95% CI: 1.08 - 1.47) and at least 16% lower per 1SD higher in neighborhood social cohesion (aOR: 0.84, 95% CI: 0.74-0.95) and NSES (aOR: 0.79, 95% CI: 0.67-0.95). Heavy alcohol use at baseline (17%) and consistent heavy use over the study period (8%) were negatively associated with higher NSES (aOR: 0.85, 95% CI: 0.73-0.99 per 1SD increase in NSES).

CONCLUSION

Favorable neighborhood social environments may reduce unhealthy behaviors among African Americans.

Cigarette smoking and the association with serous ovarian cancer in African American women: African American Cancer Epidemiology Study (AACES)

BACKGROUND

Smoking is a risk factor for mucinous ovarian cancer (OvCa) in Caucasians. Whether a similar association exists in African Americans (AA) is unknown.

METHODS

We conducted a population-based case-control study of incident OvCa in AA women across 11 geographic locations in the US. A structured telephone interview asked about smoking, demographic, health, and lifestyle factors. Odds ratios and 95% confidence intervals (OR, 95% CI) were estimated from 613 cases and 752 controls using unconditional logistic regression in multivariable adjusted models.

RESULTS

Associations were greater in magnitude for serous OvCa than for all OvCa combined. Compared to never smokers, increased risk for serous OvCa was observed for lifetime ever smokers (1.46, 1.11-1.92), former smokers who quit within 0-2 years of diagnosis (5.48, 3.04-9.86), and for total pack-years smoked among lifetime ever smokers (0-5 pack-years: 1.79, 1.23-2.59; >5-20 pack-years: 1.52, 1.05-2.18; >20 pack-years: 0.98, 0.61-1.56); however, we observed no dose-response relationship with increasing duration or consumption and no significant associations among current smokers. Smoking was not significantly associated with mucinous OvCa. Associations for all OvCa combined were consistently elevated among former smokers. The proportion of ever smokers who quit within 0-2 years was greater among cases (23%) than controls (7%).

CONCLUSIONS

Cigarette smoking may be associated with serous OvCa among AA, which differs from associations reported among Caucasians. Exposure misclassification or reverse causality may partially explain the absence of increased risk among current smokers and lack of dose-response associations. Better characterization of smoking patterns is needed in this understudied population.

Statistical Assessment of Neighborhood Socioeconomic Deprivation Environment in Spatial Epidemiologic Studies

Neighborhood socioeconomic deprivation has been associated with health behaviors and outcomes. However, neighborhood socioeconomic status has been measured inconsistently across studies. It remains unclear whether appropriate socioeconomic indicators vary over geographic areas and geographic levels. The aim of this study is to compare the composite socioeconomic index to six socioeconomic indicators reflecting different aspects of socioeconomic environment by both geographic areas and levels. Using 2000 U.S. Census data, we performed a multivariate common factor analysis to identify significant socioeconomic resources and constructed 12 composite indexes at the county, the census tract, and the block group levels across the nation and for three states, respectively. We assessed the agreement between composite indexes and single socioeconomic variables. The component of the composite index varied across geographic areas. At a specific geographic region, the component of the composite index was similar at the levels of census tracts and block groups but different from that at the county level. The percentage of population below federal poverty line was a significant contributor to the composite index, regardless of geographic areas and levels. Compared with non-component socioeconomic indicators, component variables were more agreeable to the composite index. Based on these findings, we conclude that a composite index is better as a measure of neighborhood socioeconomic deprivation than a single indicator, and it should be constructed on an area- and unit-specific basis to accurately identify and quantify small-area socioeconomic inequalities over a specific study region.

Small-area spatio-temporal analyses of bladder and kidney cancer risk in Nova Scotia, Canada

BACKGROUND

Bladder and kidney cancers are the ninth and twelfth most common type of cancer worldwide, respectively. Internationally, rates vary ten-fold, with several countries showing rising incidence. This study describes the spatial and spatio-temporal variations in the incidence risk of these diseases for Nova Scotia, a province located in Atlantic Canada, where rates for bladder and kidney cancer exceed those of the national average by about 25% and 35%, respectively.

METHODS

Cancer incidence in the 311 Communities of Nova-Scotia was analyzed with a spatial autoregressive model for the case counts of bladder and kidney cancers (3,232 and 2,143 total cases, respectively), accounting for each Community's population and including variables known to influence risk. A spatially-continuous analysis, using a geostatistical Local Expectation-Maximization smoothing algorithm, modeled finer-scale spatial variation in risk for south-western Nova Scotia (1,810 bladder and 957 kidney cases) and Cape Breton (1,101 bladder, 703 kidney).

RESULTS

Evidence of spatial variations in the risk of bladder and kidney cancer was demonstrated using both aggregated Community-level mapping and continuous-grid based localized mapping; and these were generally stable over time. The Community-level analysis suggested that much of this heterogeneity was not accounted for by known explanatory variables. There appears to be a north-east to south-west increasing gradient with a number of south-western Communities have risk of bladder or kidney cancer more than 10% above the provincial average. Kidney cancer risk was also elevated in various northeastern communities. Over a 12 year period this exceedance translated in an excess of 200 cases. Patterns of variations in risk obtained from the spatially continuous smoothing analysis generally mirrored those from the Community-level autoregressive model, although these more localized risk estimates resulted in a larger spatial extent for which risk is likely to be elevated.

CONCLUSIONS

Modelling the spatio-temporal distribution of disease risk enabled the quantification of risk relative to expected background levels and the identification of high risk areas. It also permitted the determination of the relative stability of the observed patterns over time and in this study, pointed to excess risk potentially driven by exposure to risk factors that act in a sustained manner over time.

Social and Environmental Factors Related to Smoking Cessation among Mothers: Findings from the Geographic Research on Wellbeing (GROW) Study

OBJECTIVES

The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California.

METHODS

Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment.

RESULTS

In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status.

CONCLUSIONS

Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women.

Racial/ethnic differences in associations between neighborhood socioeconomic status, distress, and smoking among U.S. adults

Neighborhood disadvantage may increase smoking by increasing distress, while neighborhood affluence may reduce smoking by increasing positive affect. We examined whether relationships between neighborhood socioeconomic status (SES) and daily smoking operated through distress and positive affect. Simultaneous multivariate path models used pooled cross-sectional data from the 2000 and 2005 National Alcohol Surveys (15,963 respondents; weighted N = 10,753) and the 2000 Decennial Census. Multiple groups analysis assessed differences by gender and race/ethnicity. Covariates included neighborhood immigrant concentration and individual-level demographics. In the full sample, neighborhood disadvantage significantly increased smoking and neighborhood affluence significantly decreased smoking, with no indirect paths through either distress or positive affect. Unique among Hispanics, affluence resulted in decreased smoking indirectly through reduced distress. Relationships between affect and smoking also varied by race/ethnicity, with no significant differences by gender. Interventions targeting neighborhood socioeconomic status and distress may help reduce smoking, particularly for racial/ethnic minorities.

Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services

Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs' availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients' high smoking rates.

The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods

The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.

Neighborhood contextual factors for smoking among middle-aged Japanese: a multilevel analysis

The purpose of this study is to explore neighborhood contextual factors in terms of smoking behaviors among middle-aged Japanese, by using a multilevel analysis. Subjects were Japanese men and women, between 40 and 59 years of age (40,961 for the cross-sectional analysis, and 9,177 for the longitudinal analysis), nested in 39 neighborhoods (Kyuson). The results showed that women in a less residentially stable neighborhood were more likely to be smokers. No associations were seen between current smoking and neighborhood deprivation; however, women in the most deprived neighborhood were more likely to quit smoking. This study is the first to demonstrate the associations between neighborhood environment and current smoking or smoking cessation, in a Japanese setting. The findings imply that policy makers should consider targeting neighborhood conditions in order to help reduce smoking prevalence, especially among women.

Neighbourhood deprivation and smoking and quit behaviour among smokers in Mexico: findings from the ITC Mexico Survey

BACKGROUND

In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated with higher levels of smoking. Few studies in low-income and middle-income countries (LMICs) have investigated the role of the neighbourhood environment on smoking behaviour.

OBJECTIVE

To determine whether neighbourhood socioeconomic deprivation is related to smoking intensity, quit attempts, quit success and smoking relapse among a cohort of smokers in Mexico from 2010 to 2012.

METHODS

Data were analysed from adult smokers and recent ex-smokers who participated in waves 4-6 of the International Tobacco Control (ITC) Mexico Survey. Data were linked to the Mexican government's composite index of neighbourhood socioeconomic deprivation, which is based on 2010 Mexican Census data. We used generalised estimating equations to determine associations between neighbourhood deprivation and individual smoking behaviours.

FINDINGS

Contrary to past findings in HICs, higher neighbourhood socioeconomic deprivation was associated with lower smoking intensity. Quit attempts showed a U-shaped pattern whereby smokers living in high/very high deprivation neighbourhoods and smokers living in very low deprivation neighbourhoods were more likely to make a quit attempt than smokers living in other neighbourhoods. We did not find significant differences in neighbourhood deprivation on relapse or successful quitting, with the possible exception of people living in medium-deprivation neighbourhoods having a higher likelihood of successful quitting than people living in very low deprivation neighbourhoods (p=0.06).

CONCLUSIONS

Neighbourhood socioeconomic environments in Mexico appear to operate in an opposing manner to those in HICs. Further research should investigate whether rapid implementation of strong tobacco control policies in LMICs, as occurred in Mexico during the follow-up period, avoids the concentration of tobacco-related disparities among socioeconomically disadvantaged groups.

Smoking initiation, continuation and prevalence in deprived urban areas compared to non-deprived urban areas in The Netherlands

Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived areas.

Intention to quit smoking and concerns about household environmental risks: findings from the Health in Common Study in low-income housing

PURPOSE

To assess the association between intention to quit smoking and perceptions of household environmental risks among racially/ethnically diverse residents of low-income housing.

METHODS

Baseline data were collected from 2007 to 2009 for the Health in Common Study, which assessed social and physical determinants of cancer risk-related behaviors among residents of 20 low-income housing developments in the Greater Boston metropolitan area. Participants were surveyed about their tobacco use and concerns about household exposures. Household environmental inspections were also conducted to identify conditions associated with increased risk of exposure to indoor environmental agents, including pesticides, mold, and cleaning products.

RESULTS

Intention to quit smoking was associated with a greater degree of concern about exposures in the home, yet not with the actual presence of household hazards, as identified by home inspections and survey findings.

CONCLUSIONS

An ecological approach targeting multiple levels of influence may help to highlight the importance of both quitting tobacco and reducing potential household environmental exposures as part of comprehensive efforts to promote individual and household health.