Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study

STUDY OBJECTIVE

To examine the association between light at night (LAN) and multiple sleep health dimensions.

METHODS

Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity.

RESULTS

Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women.

CONCLUSIONS

Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.

Ambient fine particulate matter and breast cancer incidence in a large prospective US cohort

BACKGROUND

Fine particulate matter (PM2.5) has been inconsistently associated with breast cancer incidence, however, few studies have considered historic exposure when levels were higher.

METHODS

Outdoor residential PM2.5 concentrations were estimated using a nationwide spatiotemporal model for women in the National Institutes of Health-AARP Diet and Health Study, a prospective cohort located in 6 states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and 2 metropolitan areas (Atlanta, GA, and Detroit, MI) and enrolled in 1995-1996 (n = 196 905). Annual average PM2.5 concentrations were estimated for a 5-year historical period 10 years prior to enrollment (1980-1984). We used Cox regression to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between a 10 µg/m3 increase in PM2.5 and breast cancer incidence overall and by estrogen receptor status and catchment area.

RESULTS

With follow-up of participants through 2017, a total of 15 870 breast cancer cases were identified. A 10 ug/m3 increase in PM2.5 was statistically significantly associated with overall breast cancer incidence (HR = 1.08, 95% CI = 1.02 to 1.13). The association was evident for estrogen receptor-positive (HR = 1.10, 95% CI = 1.04 to 1.17) but not estrogen receptor-negative tumors (HR = 0.97, 95% CI = 0.84 to 1.13; Pheterogeneity = .3). Overall breast cancer hazard ratios were more than 1 across the catchment areas, ranging from a hazard ratio of 1.26 (95% CI = 0.96 to 1.64) for North Carolina to a hazard ratio of 1.04 (95% CI = 0.68 to 1.57) for Louisiana (Pheterogeneity = .9).

CONCLUSIONS

In this large US cohort with historical air pollutant exposure estimates, PM2.5 was associated with risk of estrogen receptor-positive breast cancer. State-specific estimates were imprecise but suggest that future work should consider region-specific associations and the potential contribution of PM2.5 chemical constituency in modifying the observed association.

Screening for Autism Spectrum Condition Through Inner City Homeless Services in the Republic of Ireland

Homeless service users were screened for autism spectrum disorder through one of Ireland's leading not for profit service providers. Keyworkers acted as proxy informants; their caseloads were screened using the DSM-5-Autistic Traits in the Homeless Interview (DATHI). Client current and historical health and behaviour data was collated. A representative sample of 106 eligible keyworkers caseloads were screened, identifying 3% "present" and 9% "possibly present" for autistic traits with the DATHI. These findings suggest a high estimate of autism prevalence and support emerging evidence that, people with autism are overrepresented in the homeless population, compared to housed populations. Autism may be a risk factor for entry into homelessness and a challenge to exiting homeless and engaging with relevant services.

Light at night and the risk of breast cancer: Findings from the Sister study

BACKGROUND

Light at night (LAN) may alter estrogen regulation through circadian disruption. High levels of outdoor LAN may increase breast cancer risk, but studies have largely not considered possible residual confounding from correlated environmental exposures. We evaluated the association between indoor and outdoor LAN and incident breast cancer.

METHODS

In 47,145 participants in the prospective Sister Study cohort living in the contiguous U.S., exposure to outdoor LAN was determined using satellite-measured residential data and indoor LAN was self-reported (light/TV on, light from outside the room, nightlight, no light). We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between outdoor and indoor LAN and breast cancer risk. Models were adjusted for age, race/ethnicity, educational attainment, annual household income, neighborhood disadvantage, latitude, and population density as a proxy for urbanicity. To evaluate the potential for residual confounding of the outdoor LAN and breast cancer relationship by factors associated with urbanicity, we considered further adjustment for exposures correlated with outdoor LAN including NO2 [Spearman correlation coefficient, rho (ρ) = 0.78], PM2.5 (ρ = 0.36), green space (ρ =  - 0.41), and noise (ρ = 0.81).

RESULTS

During 11 years of follow-up, 3,734 breast cancer cases were identified. Outdoor LAN was modestly, but non-monotonically, associated with a higher risk of breast cancer (Quintile 4 vs 1: HR = 1.10, 95% CI: 0.99-1.22; Quintile 5 vs 1: HR = 1.04, 95% CI: 0.93-1.16); however, no association was evident after adjustment for correlated ambient exposures (Quintile 4 vs 1: HR = 0.99, 95% CI: 0.86-1.14; Quintile 5 vs 1: HR = 0.89, 95% CI: 0.74-1.06). Compared to those with no indoor LAN exposure, sleeping with a light or TV on was associated with a HR = 1.09 (95% CI: 0.97-1.23) in the adjusted model.

CONCLUSIONS

Outdoor LAN does not appear to increase the risk of breast cancer after adjustment for correlated environmental exposures.

An exploratory study of the level of folic acid in food staples in Ireland in 2021

Background

Ireland previously had widespread voluntary fortification but there has been a major decline in the number of food staples fortified with folic acid in Irish supermarkets in the past 15 years. In this research we set out to examine the level of folic acid in food staples in supermarkets with the leading market share in the Republic of Ireland.

Methods

The food labels of food staples (breads, spreads, milk, cereals, cereal bars, yoghurt/yoghurt drinks) were photographed in supermarkets with the leading market share in the Republic of Ireland (Tesco's, Dunnes, SuperValu, Lidl, Aldi, and M&S) between 2017 and 2021.The data was extracted and collated in an excel spreadsheet. The data was analysed to examine the level of folic acid in each product. We compared the levels captured at the current times with the levels previously captured in 2017.

Results

Preliminary analysis suggests that folic acid level in food staples in Ireland continues to decline. Folic acid was not found in any breads (except a number of gluten free breads), milks, spreads but was found in several cereals marketed mainly at children.

Conclusions

This study reports on the declining levels of folic acid in the food chain in Ireland. The number of food staples fortified with folic acid continues to decline demonstrating that voluntary fortification in Ireland is no longer an effective measure for passively augmenting the folic acid levels of consumers. This is of concern due to the incidence of neural tube defects in Ireland largely preventable by folic acid.

Key messages

An exploration of reformulation efforts by the food industry in Ireland

Background

Previous research conducted in 2020 by our team examined the progress made by food manufacturers in reformulation between 2014 and 2017 (i.e., improving the nutrition profile of food staples by reducing salt, sugar, saturated fat and overall energy contribution). Our previous study showed improvements in salt and sugars levels across many food staples, but we found rising energy levels, total fat, and saturated fat in many food categories.

Methods

This study aimed to explore the ongoing progress in reformulation between 2017 to 2021. We photographed the labels of food staples in supermarkets with the leading market share in the Republic of Ireland (Tesco's, Dunnes, SuperValu, Lidl, Centra, Aldi, and M&S). We extracted the data, collated it in an excel spreadsheet, and analysed it to examine the nutrients of interest to the study (i.e., salt, sugar, fat, saturated fat, energy, carbohydrates, protein, fibre, and micronutrients). We compared the levels captured at this time point with those previously recorded in 2017.

Results

Eight hundred and seventy-two products were directly compared, including 80 spreads, 34 cereal snacks, 87 fruit juices, 193 cereals, 210 breads, 88 milks, and 169 yoghourts. This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

Conclusions

Fat and saturated fat levels that were once on the increase now appear to be reducing, possibly implying that as salt and sugar go up, fat levels go down and vice versa. This may relate to product taste and palatability.

Key messages

• This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

• Fat and saturated fat levels that were once on the increase now appear to be reducing, as salt and sugar go up, fat levels go down.

Integrating biology and access to care in addressing breast cancer disparities: 25 years' research experience in the Carolina Breast Cancer Study

Purpose of Review

To review research on breast cancer mortality disparities, emphasizing research conducted in the Carolina Breast Cancer Study, with a focus on challenges and opportunities for integration of tumor biology and access characteristics across the cancer care continuum.

Recent Findings

Black women experience higher mortality following breast cancer diagnosis, despite lower incidence compared to white women. Biological factors, such as stage at diagnosis and breast cancer subtypes, play a role in these disparities. Simultaneously, social, behavioral, environmental, and access to care factors are important. However, integrated studies of biology and access are challenging and it is uncommon to have both data types available in the same study population. The central emphasis of Phase 3 of the Carolina Breast Cancer Study, initiated in 2008, was to collect rich data on biology (including germline and tumor genomics and pathology) and health care access in a diverse study population, with the long term goal of defining intervention opportunities to reduce disparities across the cancer care continuum.

Summary

Early and ongoing research from CBCS has identified important interactions between biology and access, leading to opportunities to build greater equity. However, sample size, population-specific relationships among variables, and complexities of treatment paths along the care continuum pose important research challenges. Interdisciplinary teams, including experts in novel data integration and causal inference, are needed to address gaps in our understanding of breast cancer disparities.

Shift Work and Working at Night in Relation to Breast Cancer Incidence

BACKGROUND

Night shift work has been classified by the International Agency for Research on Cancer as a probable carcinogen in humans. Several studies have assessed night shift work in relation to breast cancer risk, with inconsistent results.

METHODS

In the prospective Sister Study cohort, current and past occupational history was collected for 48,451 participants. We used Cox proportional hazards models to estimate adjusted HRs and 95% confidence intervals (CI) for the association between baseline work schedule characteristics and incident breast cancer.

RESULTS

During follow-up (mean = 9.1 years), 3,191 incident cases were diagnosed. We observed little to no increase in risk associated with work schedule characteristics (ever working rotating shifts: HR = 1.04, 95% CI, 0.91-1.20; ever working rotating night shifts: HR = 1.08, 95% CI, 0.92-1.27; ever working at night: HR = 1.01, 95% CI, 0.94-1.10; and ever working irregular hours: HR = 0.98, 95% CI, 0.91-1.06). Although short-term night work (>0 to 5 years vs. never: HR = 1.12; 95% CI, 1.00-1.26) and rotating shift work at night (>0 to 5 years vs. never: HR = 1.30; 95% CI, 1.05-1.61) were associated with increased breast cancer risk, working nights for more than 5 years was not associated with risk.

CONCLUSIONS

Overall, we observed little evidence that rotating shift work or work at night was associated with a higher risk of breast cancer, except possibly among those who participated in such work for short durations of time.

IMPACT

This study indicates that if night shift work is associated with breast cancer, the increase in risk is small.

Operationalisation of the European Protocol for Autism Prevalence (EPAP) for Autism Spectrum Disorder Prevalence Measurement in Ireland

The European Autism Information System project highlighted the lack of systematic and reliable data relating to the prevalence of autism spectrum disorders in Europe. A protocol for the study of ASD prevalence at European level was developed to facilitate a common format for screening and diagnosing children across the EU. This is the first study to operationalise and screen national school children for ASDs using this protocol. National school children 6-11 years (N = 7951) were screened males 54 % (N = 4268) females 46 % (N = 3683). Screening children for ASD implementing the EAIS protocol using the Social Communication Questionnaire (Rutter et al. in Social Communication Questionnaire (SCQ). Western Psychological Services, Los Angeles, ) as a first level screening instrument in a non-clinical setting of Irish national schools was demonstrated.

What would encourage blood donation in Ireland?

BACKGROUND

Recent changes have resulted in the loss of 4% of the donor panel in the Republic of Ireland and 3% in Northern Ireland. In order to increase the number of donors in these two regions, it is important that transfusion service providers explore and understand the reasons, which prevent individuals from donating. The aim of this study was to explore these issues particularly in non-donors and those who had lapsed.

METHODS

This 7-month all-Ireland study was conducted by computer-assisted telephone interview. Data collected included sociodemographic history, donation status, as well as barriers/deterrents to donation.

RESULTS

There were 4166 completed questionnaires (44% donors; 56% non-donors). Of the donors, 13% had donated blood within the last 2 years. Current donors cited 'awareness of patients needs' (88%), 'trust in the blood transfusion service' (70%), and 'an advertising campaign' (70%) as reasons encouraging them to donate blood. Lapsed donors and non-donors cited 'more frequent mobile clinics/sessions' (30% lapsed donors; 53% non-donors), 'if I was asked' (28% lapsed donors; 53% non-donors), and 'more flexible opening hours' (23% lapsed donors; 44% non-donors) as reasons that would encourage them to donate. The main reasons cited by non-donors for never having donated included 'medical reasons' (41% Republic of Ireland; 43% Northern Ireland), 'lack of information' (20% Republic of Ireland; 22% Northern Ireland), 'fear of needles' (15% Republic of Ireland; 17% Northern Ireland), and 'time constraints' (12% Republic of Ireland; 13% Northern Ireland). Among the non-donor group, 10% (Republic of Ireland) and 6% (Northern Ireland) claimed that they are not permitted to donate.

CONCLUSION

Replacing regular donors is a major challenge for the transfusion service providers. This study shows that by facilitating the general public by introducing more mobile clinics/sessions, more flexible opening hours and having a better level of knowledge in the community about blood donation may encourage lapsed donors and new donors to become regular donors.

Emerging advantages and drawbacks of telephone surveying in public health research in Ireland and the U.K

BACKGROUND

Telephone surveys have been used widely in public health research internationally and are being increasingly used in Ireland and the U.K.

METHODS

This study compared three telephone surveys conducted on the island of Ireland from 2000 to 2004, examining study methodology, outcome measures and the per unit cost of each completed survey. We critically examined these population-based surveys which all explored health related attitudes and behaviours.

RESULTS

Over the period from 2000 to 2005 the percentage of calls which succeeded in contacting an eligible member of the public fell, from 52.9% to 31.8%. There was a drop in response rates to the surveys (once contact was established) from 58.6% to 17.7%. Costs per completed interview rose from 4.48 euro to 15.65 euro. Respondents were prepared to spend 10-15 minutes being surveyed, but longer surveys yielded poorer completion rates. Respondents were willing to discuss issues of a sensitive nature. Interviews after 9 pm were less successful, with complaints about the lateness of the call. Randomisation from electronic residential telephone directory databases excluded all ex-directory numbers and thus was not as representative of the general population as number generation by the hundred-bank method. However the directory database was more efficient in excluding business and fax numbers.

CONCLUSION

Researchers should take cognisance of under-representativeness of land-line telephone surveys, of the increasing difficulties in contacting the public and of mounting personnel costs. We conclude that telephone surveying now requires additional strategies such as a multimode approach, or incentivisation, to be a useful, cost-effective means of acquiring data on public health matters in Ireland and the U.K.

An investigation of the impact of prolonged waiting times on blood donors in Ireland

BACKGROUND AND OBJECTIVES

The aim of this study was to investigate the impact of prolonged queuing times on blood donors, by measuring their satisfaction levels, and positive and negative affects. As donation times have increased over the past number of years within the Irish Blood Transfusion Service, this is an important issue to examine in a climate where voluntary donors are becoming scarce and demands on people's time are increasing.

MATERIALS AND METHODS

Eighty-five blood donors were sampled from one urban and one rural blood donor clinic. The respondents conducted a questionnaire by means of face-to-face interview, while waiting in the clinic. The questionnaire contained the Positive and Negative Affect Scale (PANAS), and a waiting satisfaction scale. Both actual and perceived waiting times of the donors were noted.

RESULTS

Waiting time was found to be negatively related to satisfaction. Inexperienced donors expressed higher levels of negative affect than experienced donors. Urban donors were significantly more satisfied than rural donors. There was a significant difference in perceived waiting time between lone donors and those queuing in a group, with those waiting alone perceiving their wait as shorter. While all respondents stated that they intended to donate again, over one-third stated that prolonged waiting times would be their most likely deterrent. However, only 15% stated that long queuing times might actually prevent them from donating in the future, and almost all respondents said that they would recommend donation to a friend, despite long queuing times.

CONCLUSIONS

Although our results show that the respondents were not satisfied with current waiting times, it did not seem to affect their future intentions to donate. These findings provide some optimism for the future of blood donation in Ireland, as they suggest a strong sense of commitment to donation within the population sampled. Future research could explore the application of 'the service industry' approach to waiting times to blood donation clinics.