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Slavik CE, Yiannakoulias N. Investigating reports of cancer clusters in Canada: a qualitative study of public health communication practices and investigation procedures. Health Promot Chronic Dis Prev Can 2022; 42:490-502. [PMID: 36383159 PMCID: PMC9903850 DOI: 10.24095/hpcdp.42.11/12.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION: Public health officials provide an important public service responding to community concerns around cancer and often receive requests to investigate patterns of cancer incidence and communicate findings with citizens. In this study, we identified procedures Canadian public health officials followed when investigating reports of cancer clusters, and explored the challenges officials faced conducting risk communication with communities. METHODS: Thirteen interviews were administered by telephone with 15 officials across Canadian jurisdictions and analyzed using thematic analysis. A content analysis of procedural documents received from five provinces was also undertaken. RESULTS: A third of provinces/territories in this study did not use any consistent guidelines to investigate reports of cancer clusters, a third used their own guidelines and a third used guidelines from other countries. Each Canadian jurisdiction identified a different agency or individual responsible for investigating cluster inquiries. Officials in most interviews considered public education to be the primary objective of risk communication during an investigation. Officials in only 4 of 13 interviews cited an overall positive response from the public after investigating reports of a cancer cluster. CONCLUSION: Differences in practices used to investigate suspected cancer clusters by public health officials were revealed in this work. Establishing pan-Canadian cancer cluster guidelines could improve procedural consistency across jurisdictions and offer enhanced opportunities to compare cluster responses for evaluation. A reporting system to track reported clusters may improve information sharing between federal, provincial/territorial and local investigators. During formal investigations, face-to-face participatory communication approaches should be explored to improve citizen engagement and manage community concerns.
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Affiliation(s)
- Catherine E Slavik
- School of Earth, Environment & Society, McMaster University, Hamilton, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Niko Yiannakoulias
- School of Earth, Environment & Society, McMaster University, Hamilton, Ontario, Canada
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Lim H, Lee YH, Bae S, Koh DH, Yoon M, Lee BE, Kim JS, Kwon HJ. Cancer cluster among small village residents near the fertilizer plant in Korea. PLoS One 2021; 16:e0247661. [PMID: 33630917 PMCID: PMC7906407 DOI: 10.1371/journal.pone.0247661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In Jang-jeom, a small village in Hamra-myeon, Iksan-si, Jeollabuk-do, South Korea, residents raised concerns about a suspected cancer cluster that they attributed to a fertilizer plant near the village. We aimed to investigate whether the cancer incidence in the village was higher than that in the general Korean population when the factory was in operation (2001-2017) and whether living in the village was associated with a higher risk of cancer. METHODS Using national population data and cancer registration data of South Korea, we estimated the standardized incidence ratios (SIRs) in the village to investigate whether more cancer cases occurred in the village compared to other regions. The SIRs were standardized by age groups of 5 years and sex. In order to investigate whether residence in the village increased the risk of cancer, a retrospective cohort was constructed using National Health Insurance Service (NHIS) databases. We estimated the cancer hazard ratios (HRs) using the Cox proportional hazard model, and defined the exposed area as the village of Jang-jeom, and the unexposed or control area as the village neighborhood in Hamra-myeon. We considered potential confounding variables such as age, sex, and income index in the models. Additionally, we measured polycyclic aromatic hydrocarbons (PAHs) and tobacco-specific nitrosamines (TSNAs), suspected carcinogens that may have caused the cancer cluster, in samples collected from the plant and the village. RESULTS Twenty-three cancer cases occurred in Jang-jeom from 2001 to 2017. Between 2010 and 2016, the incidence rates of all cancers (SIR: 2.05, except thyroid cancer: 2.22), non-melanoma skin cancer (SIR: 21.14, female: 25.41), and gallbladder (GB) and biliary tract cancer in men (SIR: 16.01) in the village were higher than those in the national population in a way that was statistically significant. In our cohort analysis that included only Hamra-myeon residents who have lived there for more than 7 years, we found a statistically significant increase in the risk of all cancers (HR: 1.99, except thyroid cancer: 2.20), non-melanoma skin cancer (HR: 11.60), GB and biliary tract cancer (HR: 15.24), liver cancer (HR: 6.63), and gastric cancer (HR: 3.29) for Jang-jeom residents compared to other Hamra area residents. We identified PAHs and TSNAs in samples of deposited dust and residual fertilizer from the plant and TSNAs in dust samples from village houses. CONCLUSIONS The results of the SIR calculation and cancer risk analyses of Jang-jeom village residents from the retrospective cohort design showed consistency in the effect size and direction, suggesting that there was a cancer cluster in Jang-jeom. This study would be a good precedent for cancer cluster investigation.
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Affiliation(s)
- Hyungryul Lim
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Yong-Han Lee
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Sanghyuk Bae
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Do-Hyun Koh
- Citizen Science Institute, Goyang, Gyeonggi-do, Republic of Korea
| | - Mira Yoon
- Environmental Research Department, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Bo-Eun Lee
- Environmental Research Department, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Jeong-Soo Kim
- Institute for Environmental Safety and Health, Seoul, Republic of Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, College of Medicine, Dankook University, Cheonan, Chungcheongnam-do, Republic of Korea
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Taheri E, Mollabahrami F, Farokhzad M, Ghasemi F, Assari MJ. Risk assessment in academic laboratories in the west of Iran: compare the CHRA and the RSLs methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:198-211. [PMID: 30879332 DOI: 10.1080/09603123.2019.1588232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
In the laboratories staffs, there is potential for adverse health effects in exposure to chemicals. Therefore, risk assessment is one of the main issues to prevent these effects. The purpose of this study was to assess the health risk of laboratory staffs and compare the two methods, including 'Chemical Health Risk Assessment' (CHRA) and 'Regional Screening Levels' (RSLs), that developed by the Department of Occupational Safety and Health of Malaysia and the Environmental Protection Agency respectively. Using these two methods, the places with the highest risk were identified. Comparisons showed that RSLs is a precise method without personal judgment. The CHRA is a simple method for wider chemicals that categorize risk. But CHRA includes fewer parameters compared to RSLs, as well as personal judgment. The results of the present study showed that two methods did not compatible. According to the characteristics of these two methods, it is recommended to use them as a compliment each other to obtain accurate results.
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Affiliation(s)
- Elnaz Taheri
- Occupational Health, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Mollabahrami
- Occupational Health, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farokhzad
- Occupational Health, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fakhradin Ghasemi
- Department of Ergonomics, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Javad Assari
- Center of Excellence for Occupational Health, Occupational Health and Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Menozzi A, Menotta S, Fedrizzi G, Lenti A, Cantoni AM, Di Lecce R, Gnudi G, Pérez-López M, Bertini S. Lead and copper in hunted wild boars and radiographic evaluation of bullet fragmentation between ammunitions. FOOD ADDITIVES & CONTAMINANTS PART B-SURVEILLANCE 2019; 12:182-190. [PMID: 30919748 DOI: 10.1080/19393210.2019.1588389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of the present study was to evaluate the content of lead in carcasses of wild boars shot with lead bullets, in comparison with that of copper caused by lead-free ammunitions. Radiographic images of hunted boars were obtained in order to assess the degree of bullet fragmentation in the carcasses. Samples of meat were collected from different body areas at increasing distance from bullet trajectory, to be analysed by ICP-MS for lead and copper levels. In wild boars shot with lead ammunitions, a massive dispersion of bullet fragments and very high lead levels were detected. By contrast, in wild boars killed with copper ammunitions no radiographic signs of bullet fragmentation were observed. Copper ammunitions seem therefore a safer alternative to standard lead-core ones, due to their minimal fragmentation and the relatively low toxicity of this metal.
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Affiliation(s)
| | - Simonetta Menotta
- Chemical Department, Istituto Zooprofilattico Sperimentale Lombardia e Emilia Romagna , Bologna , Italy
| | - Giorgio Fedrizzi
- Chemical Department, Istituto Zooprofilattico Sperimentale Lombardia e Emilia Romagna , Bologna , Italy
| | - Antonio Lenti
- Department of Veterinary Science, University of Parma , Parma , Italy
| | | | - Rosanna Di Lecce
- Department of Veterinary Science, University of Parma , Parma , Italy
| | - Giacomo Gnudi
- Department of Veterinary Science, University of Parma , Parma , Italy
| | - Marcos Pérez-López
- Toxicology Area, Faculty of Veterinary Medicine (UEX), Avenida de la Universidad , Caceres , Spain
| | - Simone Bertini
- Department of Veterinary Science, University of Parma , Parma , Italy
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Cheng Y, Nathanail CP. A study of "cancer villages" in Jiangsu Province of China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:1932-1946. [PMID: 30460653 DOI: 10.1007/s11356-018-3758-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
China's economic boom has created many environmental and health challenges, including so-called cancer villages. This study, the first to use the lens of "cancer villages" at provincial level, examines the correlation between changes in Jiangsu cancer villages and economic and environmental quality indicators identified as being relevant, and hence to highlight environmental issues that should be mitigated to protect public health. Since 2001, 25 cancer villages have been reported in Jiangsu. The distribution pattern of these villages is of a cluster whose mean centre had moved from Suzhou city in 2001 to Taizhou in 2006 and 2011. By applying the buffer analysis tool of ArcGIS10.2.2 using 3-km and 5-km radius buffer, to examine the relationship between these cancer villages and the surrounding rivers, it was revealed that 76% of the villages fall within the 3-km buffer zone, and 88% are within the 5-km buffer zone. A fairly strong correlation between the cancer villages and annual GDP, as well as pollutant discharge, was found, with correlation coefficients of 0.94 for Jiangsu, 0.89 for Northern Jiangsu, 0.93 for Central Jiangsu, 0.83 for Southern Jiangsu and 0.64 for city level. The change of newly added cancer villages is significantly influenced by the discharge of sewage water (raising COD) and SO2, and the peak of newly added cancer villages, as well as discharge of COD and SO2 all occurred in 2005. For four cities, the total sewage water discharge and SO2 emissions are consistent with the order of the distribution density of the villages. The phenomenon of cancer villages in China will gradually be resolved as the government takes effective measures to tackle environmental issues coupled with people's increasing environmental and health awareness.
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Affiliation(s)
- Yuanyuan Cheng
- School of Environmental Science & Engineering, Suzhou University of Science & Technology, No.1 Kerui Road, Suzhou, China.
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Apau J, Acheampong A, Adua E. Exposure to bisphenol A, bisphenol F, and bisphenol S can result in obesity in human body. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23312009.2018.1506601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joseph Apau
- Department of Chemistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Akwasi Acheampong
- Department of Chemistry, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Eric Adua
- Medical and Health Sciences, Edith Cowan University (ECU), Perth, Australia
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Press DJ, McKinley M, Deapen D, Clarke CA, Gomez SL. Residential cancer cluster investigation nearby a Superfund Study Area with trichloroethylene contamination. Cancer Causes Control 2016; 27:607-13. [PMID: 26983615 PMCID: PMC5759954 DOI: 10.1007/s10552-016-0734-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE Trichloroethylene (TCE) is an industrial solvent associated with liver cancer, kidney cancer, and non-Hodgkin's lymphoma (NHL). It is unclear whether an excess of TCE-associated cancers have occurred surrounding the Middlefield-Ellis-Whisman Superfund site in Mountain View, California. We conducted a population-based cancer cluster investigation comparing the incidence of NHL, liver, and kidney cancers in the neighborhood of interest to the incidence among residents in the surrounding four-county region. METHODS Case counts and address information were obtained using routinely collected data from the Greater Bay Area Cancer Registry, part of the Surveillance, Epidemiology, and End Results program. Population denominators were obtained from the 1990, 2000, and 2010 US censuses. Standardized incidence ratios (SIRs) with two-sided 99 % confidence intervals (CIs) were calculated for time intervals surrounding the US Censuses. RESULTS There were no statistically significant differences between the neighborhood of interest and the larger region for cancers of the liver or kidney. A statistically significant elevation was observed for NHL during one of the three time periods evaluated (1996-2005: SIR = 1.8, 99 % CI 1.1-2.8). No statistically significant NHL elevation existed in the earlier 1988-1995 (SIR = 1.3, 99 % CI 0.5-2.6) or later 2006-2011 (SIR = 1.3, 99 % CI 0.6-2.4) periods. CONCLUSION There is no evidence of an increased incidence of liver or kidney cancer, and there is a lack of evidence of a consistent, sustained, or more recent elevation in NHL occurrence in this neighborhood. This evaluation included existing cancer registry data, which cannot speak to specific exposures incurred by past or current residents of this neighborhood.
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Affiliation(s)
- David J Press
- Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
- University of Southern California, 2001 N Soto St, Suite 305, Los Angeles, CA, 90032, USA.
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, Rm. R-214, MC2000, Chicago, IL, 60637, USA.
| | - Meg McKinley
- Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
| | - Dennis Deapen
- University of Southern California, 2001 N Soto St, Suite 305, Los Angeles, CA, 90032, USA
| | - Christina A Clarke
- Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305-5405, USA
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305-5405, USA
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Tabatabaeian M, Moazam E, Tavazohi H, Heidari K, Baharloo R. Geographic distribution of cancer cases in isfahan province/2006-2010. Int J Prev Med 2015; 6:29. [PMID: 25949779 PMCID: PMC4410443 DOI: 10.4103/2008-7802.154383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/02/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To facilitate analysis, interpreting and sharing cancer data and investigation spatial and geographical aspect of cancers in Isfahan province, cancer cases distribution was displayed using geographic information systems (GIS). METHODS About 118,000 cancer data, which were confirmed in national cancer registration unit were extracted. Age-specific incidence rate and age standardized rate (ASR) of cancer cases from 2006 to 2010 was calculated for Isfahan province and its different districts. Distribution of ASR was determined according to sex and age groups. Spatial maps were drawn with the help of Arc GIS version 10 (ESRI, Redland, CA, USA) software in choropleth based maps. The data are classified in GIS environment by means of quantile method. Data were described with the help of maps spatially. RESULTS Age standardized rate of cancers was higher in men than in women (134.58 vs. 115.4). The highest ASR was reported in the Isfahan (ASR: 133) and lowest in the Chadegan counties (ASR: 28). Different geographical distribution patterns of cancers were seen in district level. Cancer incidence was higher in the Isfahan, Lenjan, Fereidon Shahr and Falavarjan districts (134.3, 117.2, 113.5 and 111.1 respectively) among men and in Isfahan, Shahin Shahr, Lenjan and Najafabad districts (122.8, 102.3, 94 and 93 respectively) among women. The incidence rates of most cancers were lowest in the North East region of the province compared to the rest of the region. CONCLUSIONS Using GIS for visual displaying of cancers facilitated communication with the policymakers and community. This study provided hypotheses about differences in the incidence of cancer in Isfahan districts. Higher age-specific incidence rate in the Isfahan city is probably a reflection of problems in addressing the patients in cancer registration. Complementary studies are needed to evaluate lower ASR in the North East regions of the province.
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Affiliation(s)
- Maryam Tabatabaeian
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moazam
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Tavazohi
- Department of Cancer Control and Prevention, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamal Heidari
- Social Determinants of Health (SDH) Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Baharloo
- Department of Cancer Control and Prevention, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Lu Y, Song S, Wang R, Liu Z, Meng J, Sweetman AJ, Jenkins A, Ferrier RC, Li H, Luo W, Wang T. Impacts of soil and water pollution on food safety and health risks in China. ENVIRONMENT INTERNATIONAL 2015; 77:5-15. [PMID: 25603422 DOI: 10.1016/j.envint.2014.12.010] [Citation(s) in RCA: 419] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/25/2014] [Accepted: 12/31/2014] [Indexed: 05/21/2023]
Abstract
Environmental pollution and food safety are two of the most important issues of our time. Soil and water pollution, in particular, have historically impacted on food safety which represents an important threat to human health. Nowhere has that situation been more complex and challenging than in China, where a combination of pollution and an increasing food safety risk have affected a large part of the population. Water scarcity, pesticide over-application, and chemical pollutants are considered to be the most important factors impacting on food safety in China. Inadequate quantity and quality of surface water resources in China have led to the long-term use of waste-water irrigation to fulfill the water requirements for agricultural production. In some regions this has caused serious agricultural land and food pollution, especially for heavy metals. It is important, therefore, that issues threatening food safety such as combined pesticide residues and heavy metal pollution are addressed to reduce risks to human health. The increasing negative effects on food safety from water and soil pollution have put more people at risk of carcinogenic diseases, potentially contributing to 'cancer villages' which appear to correlate strongly with the main food producing areas. Currently in China, food safety policies are not integrated with soil and water pollution management policies. Here, a comprehensive map of both soil and water pollution threats to food safety in China is presented and integrated policies addressing soil and water pollution for achieving food safety are suggested to provide a holistic approach.
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Affiliation(s)
- Yonglong Lu
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China.
| | - Shuai Song
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Ruoshi Wang
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhaoyang Liu
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jing Meng
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Andrew J Sweetman
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK; Centre for Ecology & Hydrology, Wallingford, OX10 8BB, UK
| | - Alan Jenkins
- Centre for Ecology & Hydrology, Wallingford, OX10 8BB, UK
| | | | - Hong Li
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK; Centre for Ecology & Hydrology, Wallingford, OX10 8BB, UK
| | - Wei Luo
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Tieyu Wang
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
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Kearney GD, Namulanda G, Qualters JR, Talbott EO. A decade of environmental public health tracking (2002-2012): progress and challenges. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21 Suppl 2:S23-35. [PMID: 25621442 PMCID: PMC5667361 DOI: 10.1097/phh.0000000000000181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. OBJECTIVE To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. DESIGN A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. MAIN OUTCOMES Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development. CONCLUSIONS Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.
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Affiliation(s)
- Gregory D Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville North Carolina (Dr Kearney); Division of Environmental Hazards & Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Namulanda and Dr Qualters); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Talbott)
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Thompson JA, Bissett WT, Sweeney AM. Evaluating geostatistical modeling of exceedance probability as the first step in disease cluster investigations: very low birth weights near toxic Texas sites. Environ Health 2014; 13:47. [PMID: 24906417 PMCID: PMC4063235 DOI: 10.1186/1476-069x-13-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The first step in evaluating potential geographic clusters of disease calls for an evaluation of the disease risk comparing the risk in a defined location to the risk in neighboring locations. Environmental exposures, however, represent continuous exposure levels across space not an exposure with a distinct boundary. The objectives of the current study were to adapt, apply and evaluate a geostatistical approach for identifying disease clusters. METHODS The exceedance probability for very low birth weight (VLBW; < 1.5 kg) infants was mapped using an Intrinsic Conditional Autoregressive model. The data were applied to a 20 by 20 grid of 1 km2 pixels centered on each of the 13 National Priority List Superfund Sites in Harris County, Texas. RESULTS Large clusters of VLBW were identified in close proximity to four of the 13 Superfund Sites. Three of the Superfund Sites, associated with disease clusters, were located close together in central Houston and these sites may have been surrounded by a single, confluent disease cluster. CONCLUSIONS Geostatistical modeling of the exceedance probability for very low birth weights identified disease clusters of varying size, shape and statistical certainty near Superfund Sites in Harris County, Texas. The approach offers considerable potential as the first step for investigating potential disease clusters.
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Affiliation(s)
- James A Thompson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4475, USA
| | - Wesley T Bissett
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4475, USA
| | - Anne M Sweeney
- Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, College Station, TX 77843-1266, USA
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Simpson BW, Truant P, Resnick BA. Stop and listen to the people: an enhanced approach to cancer cluster investigations. Am J Public Health 2014; 104:1204-8. [PMID: 24832152 DOI: 10.2105/ajph.2013.301836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cancer cluster investigations need to address the disconnect between traditional public health approaches and human needs. Cancer cluster investigations often magnify fear and uncertainty because they rarely find a definitive environmental cause. Traditional approaches emphasize population-level data analysis and undervalue active listening. Because few studies have explored active listening in cancer cluster investigations, we conducted a descriptive oral history case study of a Frederick, Maryland, investigation. We interviewed 12 community members and 9 public health professionals about the investigation of a perceived cancer cluster. Many believed it was linked to environmental contamination at Fort Detrick, a local US Army base. We propose enhanced active listening that seeks out peoples' perspectives, validates their concerns, and engages them in the investigative process.
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Affiliation(s)
- Brian W Simpson
- Brian W. Simpson is with the Office of Communications, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Patti Truant and Beth A. Resnick are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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Amin R, Burns JJ. Clusters of adolescent and young adult thyroid cancer in Florida counties. BIOMED RESEARCH INTERNATIONAL 2014; 2014:832573. [PMID: 24868551 PMCID: PMC4020503 DOI: 10.1155/2014/832573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/10/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Thyroid cancer is a common cancer in adolescents and young adults ranking 4th in frequency. Thyroid cancer has captured the interest of epidemiologists because of its strong association to environmental factors. The goal of this study is to identify thyroid cancer clusters in Florida for the period 2000-2008. This will guide further discovery of potential risk factors within areas of the cluster compared to areas not in cluster. METHODS Thyroid cancer cases for ages 15-39 were obtained from the Florida Cancer Data System. Next, using the purely spatial Poisson analysis function in SaTScan, the geographic distribution of thyroid cancer cases by county was assessed for clusters. The reference population was obtained from the Census Bureau 2010, which enabled controlling for population age, sex, and race. RESULTS Two statistically significant clusters of thyroid cancer clusters were found in Florida: one in southern Florida (SF) (relative risk of 1.26; P value of <0.001) and the other in northwestern Florida (NWF) (relative risk of 1.71; P value of 0.012). These clusters persisted after controlling for demographics including sex, age, race. CONCLUSION In summary, we found evidence of thyroid cancer clustering in South Florida and North West Florida for adolescents and young adult.
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Affiliation(s)
- Raid Amin
- Department of Mathematics and Statistics, University of West Florida, Pensacola, FL 32514, USA
| | - James J. Burns
- Florida State University College of Medicine, P.O. Box 33655, Pensacola, FL 32508, USA
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Goodman M, LaKind JS, Fagliano JA, Lash TL, Wiemels JL, Winn DM, Patel C, Van Eenwyk J, Kohler BA, Schisterman EF, Albert P, Mattison DR. Cancer cluster investigations: review of the past and proposals for the future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1479-99. [PMID: 24477211 PMCID: PMC3945549 DOI: 10.3390/ijerph110201479] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 12/18/2022]
Abstract
Residential clusters of non-communicable diseases are a source of enduring public concern, and at times, controversy. Many clusters reported to public health agencies by concerned citizens are accompanied by expectations that investigations will uncover a cause of disease. While goals, methods and conclusions of cluster studies are debated in the scientific literature and popular press, investigations of reported residential clusters rarely provide definitive answers about disease etiology. Further, it is inherently difficult to study a cluster for diseases with complex etiology and long latency (e.g., most cancers). Regardless, cluster investigations remain an important function of local, state and federal public health agencies. Challenges limiting the ability of cluster investigations to uncover causes for disease include the need to consider long latency, low statistical power of most analyses, uncertain definitions of cluster boundaries and population of interest, and in- and out-migration. A multi-disciplinary Workshop was held to discuss innovative and/or under-explored approaches to investigate cancer clusters. Several potentially fruitful paths forward are described, including modern methods of reconstructing residential history, improved approaches to analyzing spatial data, improved utilization of electronic data sources, advances using biomarkers of carcinogenesis, novel concepts for grouping cases, investigations of infectious etiology of cancer, and "omics" approaches.
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Affiliation(s)
- Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Judy S LaKind
- LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, MD 21228, USA.
| | - Jerald A Fagliano
- Division of Epidemiology, Environmental and Occupational Health, New Jersey Department of Health, P.O. Box 369, Trenton, NJ 08625, USA.
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Joseph L Wiemels
- Division of Cancer Epidemiology, Department of Epidemiology & Biostatistics, School of Medicine, University of California, Helen Diller Family Cancer Research Building, HD 274 1450 3rd Street, San Francisco, MC 0520, San Francisco, CA 94158, USA.
| | - Deborah M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
| | - Chirag Patel
- School of Medicine, Stanford University, 1265 Welch Road, Stanford, CA 94305, USA.
| | - Juliet Van Eenwyk
- Washington State Department of Health, P.O. Box 47812, Olympia, WA 98504, USA.
| | - Betsy A Kohler
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Enrique F Schisterman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Paul Albert
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Donald R Mattison
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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Coory MD, Jordan S. Assessment of chance should be removed from protocols for investigating cancer clusters. Int J Epidemiol 2013; 42:440-7. [PMID: 23569183 DOI: 10.1093/ije/dys205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael D Coory
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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Iwatsubo Y, Bénézet L, Boutou-Kempf O, Févotte J, Garras L, Goldberg M, Luce D, Pilorget C, Imbernon E. An extensive epidemiological investigation of a kidney cancer cluster in a chemical plant: what have we learned? Occup Environ Med 2013; 71:4-11. [DOI: 10.1136/oemed-2013-101477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Guidelines for the mapping of cancer registry data: results from a breast cancer expert panel study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:E1-E10. [PMID: 23364274 DOI: 10.1097/phh.0b013e318268aef1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Small area (eg, subcounty) cancer mapping is one of the analytic services most commonly requested of cancer registries and local public health agencies, and difficulties in providing it have been noted to undermine public confidence. Although a great many statistical protocols have been published to enable this practice, none of them are in common use to generate information for the general public. OBJECTIVES To evaluate the utility of subcounty breast cancer mapping and articulate guidelines and a possible protocol for its implementation by cancer registries and local public health agencies. METHODS We convened an Expert Advisory Group of breast cancer stakeholders from around California to elicit values, priorities, and preferred characteristics of protocols for proactive subcounty breast cancer mapping. Upon formulating a protocol, we applied it to 9 years of data (2000-2008) describing invasive breast cancer in California for evaluation by the Expert Advisory Group. RESULTS Maps with subcounty resolution were seen to provide important information with a wide range of applications. Priorities included the avoidance of false-positive findings, scientific credibility, and the provision of information elucidating social and environmental characteristics. A protocol using Kulldorff's Scan Statistic along with postanalytic steps for refining results was elaborated; when applied to the data, 4 discrete regions with elevated rates of invasive breast cancer were identified and described. CONCLUSIONS Expert Advisory Group priorities were readily translatable into a scientifically rigorous protocol that protected confidentiality and avoided statistically unstable rate estimates. The resulting maps enabled participants to visualize geographically defined populations falling within and crossing county boundaries. These findings support the enactment of policies for the routine and proactive analysis of breast cancer surveillance data to provide subcounty information.
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Stewart BW. Cancer clusters: what have we learned? Intern Med J 2013; 43:5-6. [PMID: 23324087 DOI: 10.1111/imj.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 11/28/2022]
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Condon SK, Sullivan J, Netreba B. Cancer clusters in the USA: what do the last twenty years of state and federal investigations tell us? Crit Rev Toxicol 2012. [PMID: 23190217 DOI: 10.3109/10408444.2012.743504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lam NSN. Geospatial Methods for Reducing Uncertainties in Environmental Health Risk Assessment: Challenges and Opportunities. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/00045608.2012.674900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Colquhoun A, Aplin L, Geary J, Goodman KJ, Hatcher J. Challenges created by data dissemination and access restrictions when attempting to address community concerns: individual privacy versus public wellbeing. Int J Circumpolar Health 2012; 71:1-7. [PMID: 22584511 PMCID: PMC3417584 DOI: 10.3402/ijch.v71i0.18414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 12/05/2011] [Accepted: 01/30/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Population health data are vital for the identification of public health problems and the development of public health strategies. Challenges arise when attempts are made to disseminate or access anonymised data that are deemed to be potentially identifiable. In these situations, there is debate about whether the protection of an individual's privacy outweighs potentially beneficial public health initiatives developed using potentially identifiable information. While these issues have an impact at planning and policy levels, they pose a particular dilemma when attempting to examine and address community concerns about a specific health problem. METHODS Research currently underway in northern Canadian communities on the frequency of Helicobacter pylori infection and associated diseases, such as stomach cancer, is used in this article to illustrate the challenges that data controls create on the ability of researchers and health officials to address community concerns. RESULTS Barriers are faced by public health professionals and researchers when endeavouring to address community concerns; specifically, provincial cancer surveillance departments and community-driven participatory research groups face challenges related to data release or access that inhibit their ability to effectively address community enquiries. The resulting consequences include a limited ability to address misinformation or to alleviate concerns when dealing with health problems in small communities. CONCLUSIONS The development of communication tools and building of trusting relationships are essential components of a successful investigation into community health concerns. It may also be important to consider that public wellbeing may outweigh the value of individual privacy in these situations. As such, a re-evaluation of data disclosure policies that are applicable in these circumstances should be considered.
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Affiliation(s)
- Amy Colquhoun
- Department of Public Health Sciences and Centre of Excellence in Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, AB, Canada.
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Goodman M, Naiman JS, Goodman D, LaKind JS. Cancer clusters in the USA: what do the last twenty years of state and federal investigations tell us? Crit Rev Toxicol 2012; 42:474-90. [PMID: 22519802 PMCID: PMC3408895 DOI: 10.3109/10408444.2012.675315] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Cancer clusters garner considerable public and legislative attention, and there is often an expectation that cluster investigations in a community will reveal a causal link to an environmental exposure. At a 1989 national conference on disease clusters, it was reported that cluster studies conducted in the 1970s and 1980s rarely, if ever, produced important findings. We seek to answer the question: Have cancer cluster investigations conducted by US health agencies in the past 20 years improved our understanding of cancer etiology, or informed cancer prevention and control? Methods We reviewed publicly available cancer cluster investigation reports since 1990, obtained from literature searches and by canvassing all 50 states and the District of Columbia. Investigations were categorized with respect to cancer type(s), hypothesized exposure, whether perceived clusters were confirmed (e.g. by elevated incidence), and conclusions about a link between cancer(s) of concern and hypothesized environmental exposure(s). Results We reviewed 428 investigations evaluating 567 cancers of concern. An increase in incidence was confirmed for 72 (13%) cancer categories (including the category “all sites”). Three of those were linked (with variable degree of certainty) to hypothesized exposures, but only one investigation revealed a clear cause. Conclusions It is fair to state that extensive efforts to find causes of community cancer clusters have not been successful. There are fundamental shortcomings to our current methods of investigating community cancer clusters. We recommend a multidisciplinary national dialogue on creative, innovative approaches to understanding when and why cancer and other chronic diseases cluster in space and time.
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Affiliation(s)
- Michael Goodman
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA.
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Abstract
This review gives a comprehensive overview of cancer development and links it to the current understanding of tumorigenesis and malignant progression in colorectal cancer. The focus is on human and murine colorectal carcinogenesis and the histogenesis of this malignant disorder. A summary of a model of colitis-associated colon tumorigenesis (an AOM/DSS model) will also be presented. The earliest phases of colorectal oncogenesis occur in the normal mucosa, with a disorder of cell replication. The large majority of colorectal malignancies develop from an adenomatous polyp (adenoma). These can be defined as well-demarcated masses of epithelial dysplasia, with uncontrolled crypt cell proliferation. When neoplastic cells pass through the muscularis mucosa and infiltrate the submucosa, they are malignant. Carcinomas usually originate from pre-existing adenomas, but this does not imply that all polyps undergo malignant changes and does not exclude de novo oncogenesis. Besides adenomas, there are other types of pre-neoplasia, which include hyperplastic polyps, serrated adenomas, flat adenomas and dysplasia that occurs in the inflamed colon in associated with inflammatory bowel disease. Colorectal neoplasms cover a wide range of pre-malignant and malignant lesions, many of which can easily be removed during endoscopy if they are small. Colorectal neoplasms and/or pre-neoplasms can be prevented by interfering with the various steps of oncogenesis, which begins with uncontrolled epithelial cell replication, continues with the formation of adenomas and eventually evolves into malignancy. The knowledge described herein will help to reduce and prevent this malignancy, which is one of the most frequent neoplasms in some Western and developed countries.
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Affiliation(s)
- Takuji Tanaka
- Department of Oncologic Pathology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan.
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Kennedy MG, Turf EE, Wilson-Genderson M, Wells K, Huang GC, Beck V. Effects of a television drama about environmental exposure to toxic substances. Public Health Rep 2011; 126 Suppl 1:150-9. [PMID: 21563723 DOI: 10.1177/00333549111260s119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study assessed short-term outcomes of viewing an episode of a prime-time television drama in which a child developed cancer after environmental exposure to an illegal pesticide. The study explored the effects among viewers of feeling transported into a narrative world. METHODS Respondents (n = 2,139) to a post-episode Internet panel survey were asked if they had seen the show and asked questions about their demographic information, their frequency of viewing the television show, the degree to which they had felt transported into a narrative world created by the drama, and their knowledge and beliefs about the health effects of environmental exposure. Conversations with key informants from federal agencies and advocacy groups were also held. RESULTS Episode viewing and narrative transportation were positively associated with knowledge of toxic exposure effects, and transported viewers reported being more likely to report an unusually high number of cancer cases to authorities. The show also appeared to have prompted a clarification of federal pesticide-testing policy. CONCLUSIONS Entertainment Education is a promising strategy for disseminating key points of information about environmental health.
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Affiliation(s)
- May G Kennedy
- Virginia Commonwealth University, Department of Social and Behavioral Health, Richmond, VA 23298, USA.
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Jacquez GM, Slotnick MJ, Meliker JR, AvRuskin G, Copeland G, Nriagu J. Accuracy of commercially available residential histories for epidemiologic studies. Am J Epidemiol 2011; 173:236-43. [PMID: 21084554 DOI: 10.1093/aje/kwq350] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A key problem facing epidemiologists who wish to account for residential mobility in their analyses is the cost and difficulty of obtaining residential histories. Commercial residential history data of acceptable accuracy, cost, and coverage would be of great value. The present research evaluated the accuracy of residential histories from LexisNexis, Inc. The authors chose LexisNexis because the Michigan Cancer Registry has considered using their data, they have excellent procedures for privacy protection, and they make available residential histories at 25 cents per person. Only first and last name and address at last-known residence are required to access the residential history. The authors compared lifetime residential histories collected through the use of written surveys in a case-control study of bladder cancer in Michigan to the 3 residential addresses routinely available in the address history from LexisNexis. The LexisNexis address matches, as a whole, accounted for 71.5% of participants' lifetime addresses. These results provided a level of accuracy that indicates routine use of residential histories from commercial vendors is feasible. More detailed residential histories are available at a higher cost but were not analyzed in this study. Although higher accuracy is desirable, LexisNexis data are a vast improvement over the assumption of immobile individuals currently used in many spatial and spatiotemporal studies.
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Mazumdar S, King M, Liu KY, Zerubavel N, Bearman P. The spatial structure of autism in California, 1993-2001. Health Place 2010; 16:539-46. [PMID: 20097113 PMCID: PMC2835822 DOI: 10.1016/j.healthplace.2009.12.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 11/13/2009] [Accepted: 12/14/2009] [Indexed: 12/21/2022]
Abstract
This article identifies significant high-risk clusters of autism based on residence at birth in California for children born from 1993 to 2001. These clusters are geographically stable. Children born in a primary cluster are at four times greater risk for autism than children living in other parts of the state. This is comparable to the difference between males and females and twice the risk estimated for maternal age over 40. In every year roughly 3% of the new caseload of autism in California arises from the primary cluster we identify-a small zone 20 km by 50 km. We identify a set of secondary clusters that support the existence of the primary clusters. The identification of robust spatial clusters indicates that autism does not arise from a global treatment and indicates that important drivers of increased autism prevalence are located at the local level.
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Affiliation(s)
- Soumya Mazumdar
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, +3472517975
| | - Marissa King
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, +1 212 854 7530
| | - Ka-Yuet Liu
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, : +1 212 854 7918
| | - Noam Zerubavel
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, @columbia.edu: +1 212 854 7918
| | - Peter Bearman
- Institute for Social and Economic Research and Policy, Columbia University, New York, New York, Peter S. Bearman, *, +1 212 854 3094, Fax:+1 212-854-8925
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Johnson KJ, Puumala SE. Childhood cancer clustering in Florida: weighing the evidence. Pediatr Blood Cancer 2010; 54:493-4. [PMID: 20054843 DOI: 10.1002/pbc.22425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kimberly J Johnson
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Coory MD, Wills RA, Barnett AG. Bayesian versus frequentist statistical inference for investigating a one-off cancer cluster reported to a health department. BMC Med Res Methodol 2009; 9:30. [PMID: 19426561 PMCID: PMC2694210 DOI: 10.1186/1471-2288-9-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 05/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background The problem of silent multiple comparisons is one of the most difficult statistical problems faced by scientists. It is a particular problem for investigating a one-off cancer cluster reported to a health department because any one of hundreds, or possibly thousands, of neighbourhoods, schools, or workplaces could have reported a cluster, which could have been for any one of several types of cancer or any one of several time periods. Methods This paper contrasts the frequentist approach with a Bayesian approach for dealing with silent multiple comparisons in the context of a one-off cluster reported to a health department. Two published cluster investigations were re-analysed using the Dunn-Sidak method to adjust frequentist p-values and confidence intervals for silent multiple comparisons. Bayesian methods were based on the Gamma distribution. Results Bayesian analysis with non-informative priors produced results similar to the frequentist analysis, and suggested that both clusters represented a statistical excess. In the frequentist framework, the statistical significance of both clusters was extremely sensitive to the number of silent multiple comparisons, which can only ever be a subjective "guesstimate". The Bayesian approach is also subjective: whether there is an apparent statistical excess depends on the specified prior. Conclusion In cluster investigations, the frequentist approach is just as subjective as the Bayesian approach, but the Bayesian approach is less ambitious in that it treats the analysis as a synthesis of data and personal judgements (possibly poor ones), rather than objective reality. Bayesian analysis is (arguably) a useful tool to support complicated decision-making, because it makes the uncertainty associated with silent multiple comparisons explicit.
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Affiliation(s)
- Michael D Coory
- School of Population Health, Mayne Medical School, University of Queensland, Herston, Australia.
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Empfehlungen für den Umgang mit Beobachtungen von räumlich-zeitlichen Krankheitsclustern. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:239-55. [DOI: 10.1007/s00103-009-0783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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How does one approach a perceived occupational cluster? Prelude to the investigation. J Occup Environ Med 2008; 50:1321-3. [PMID: 19001958 DOI: 10.1097/jom.0b013e318187cfce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Coory M. Statistical inference is overemphasized in cluster investigations: the case of the cluster of breast cancers at the Australian Broadcasting Corporation studios in Brisbane, Australia. Intern Med J 2008; 38:288-91. [DOI: 10.1111/j.1445-5994.2007.01617.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stewart BW. Banding carcinogenic risks in developed countries: A procedural basis for qualitative assessment. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2008; 658:124-151. [DOI: 10.1016/j.mrrev.2007.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Tajik M, Gottlieb K, Lowndes N, Stewart G. Environmental policies, politics, and community risk perception: case study of community contamination in Casper, Wyoming. New Solut 2007; 17:345-361. [PMID: 18184626 DOI: 10.2190/ns.17.4.i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES We identify and explain factors that affected a community's perception of risk due to extensive industrial contamination and people's distrust of government agencies regarding the environmental investigations. METHODS Intrinsic bounded case study methodology was used to conduct research about extensive environmental contaminations due to activities of an oil refinery in North Casper, Wyoming, and the citizens' response. Data were collected from multiple sources that included public testimonies, observations, public hearings and meetings minutes, newspaper articles, archived records obtained from federal and state environmental and health agencies, as well as industry records obtained through Freedom of Information Act (FOIA) requests. FINDINGS The overarching theme that emerged was lack of trust due to several critical events and factors such as no response or delay in response time to community concerns, lack of transparency, perceived cover up, vague and fragmented communication by government and state officials, perception of pro-industry stance, and perceived unfair treatment. DISCUSSION AND CONCLUSION People's perception of environmental risks and their willingness to accept official explanations and outcomes of environmental investigations are strongly affected by their direct experiences with government agencies and the evidence of influence the powerful industries exert over relevant investigations. The government cannot successfully address public and community concerns about environmental health impacts of contaminations and in turn the public perception of risk unless it adopts and implements policies, procedures, and protocols that are clear, timely, transparent, and free from industry influence.
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Affiliation(s)
- Mansoureh Tajik
- Department of Community Health and Sustainability, 3 Solomont Way, Lowell, MA 01854, USA.
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