Diabetes and pancreatic cancer risk in a multiracial cohort.

AIMS: To determine the relationship of diabetes with pancreatic cancer incidence among African American and Whites of similar socio-economic status. METHODS: Using the Southern Community Cohort Study, we conducted a follow-up during 2002-2015 of pancreatic cancer incidence of 73,378 mostly low-income participants aged 40-79 years; 15,913 reported diabetes at baseline. Multivariable Cox analysis controlling for sex, family history of pancreatic cancer, BMI, smoking status, alcohol consumption, education, income and other important covariates, and with age as the timescale was used. RESULTS: Totally, 265 incident pancreatic cancer cases were observed. Pancreatic cancer risk was increased among those with diabetes (HR 1.54, CI 1.16-2.05), with similar increases among African Americans (HR 1.51, CI 1.08-2.11) and Whites (HR 1.78, CI 1.00-3.16). No trend in risk was observed for diabetes duration among those with diabetes, with HRs of 1.39 (0.91-2.11), 2.31 (1.51-3.54) and 1.23 (0.80-1.89) for <5, 5-9 and 10+ years duration, respectively. African Americans were at increased risk of pancreatic cancer (HR = 1.40, 95% CI 1.05-1.87), which persisted after adjusting for diabetes (HR 1.36, CI 1.02-1.81). The effect sizes for other pancreatic cancer risk factors with pancreatic cancer were similar by diabetes status, although a stronger association with low BMI was evident among those with diabetes. CONCLUSIONS: Diabetes increases pancreatic cancer risk similarly among African Americans and Whites in this Southern U.S.

Diet quality and lung cancer incidence in a low-income population in the United States.

BACKGROUND: Although tobacco smoking is the leading cause of lung cancer, interest in the relationship of diet quality on risk has been growing. METHODS: We examined the association between Healthy Eating Index-2010 (HEI-10) at enrollment and lung cancer incidence among 70,802 participants in a predominantly African American and low-income prospective cohort in the southern United States. Outcomes were ascertained through linkages with state cancer registries and the National Death Index (NDI). Hazard ratios by HEI-10 quartiles were assessed using Cox proportional hazard models adjusted for potential confounders. RESULTS: During ≤16 years of follow-up, 1454 incident lung cancers were identified. The lowest HEI-10 quartile compared to the highest was adversely associated with lung cancer risk (HR: 1.89, 95% CI 1.16-3.07) among male former smokers and female never smokers (HR: 2.58, 95% CI 1.06-6.28). CONCLUSIONS: Low-quality diet was associated with increased lung cancer risk among male former smokers and female never smokers but cautious interpretation of the findings should be taken due to the small number of lung cancers among never smokers and the possibility of residual confounding by smoking in ever smokers.

Polypill for Cardiovascular Disease Prevention in an Underserved Population.

BACKGROUND: Persons with low socioeconomic status and nonwhite persons in the United States have high rates of cardiovascular disease. The use of combination pills (also called "polypills") containing low doses of medications with proven benefits for the prevention of cardiovascular disease may be beneficial in such persons. However, few data are available regarding the use of polypill therapy in underserved communities in the United States, in which adherence to guideline-based care is generally low. METHODS: We conducted a randomized, controlled trial involving adults without cardiovascular disease. Participants were assigned to the polypill group or the usual-care group at a federally qualified community health center in Alabama. Components of the polypill were atorvastatin (at a dose of 10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The two primary outcomes were the changes from baseline in systolic blood pressure and low-density lipoprotein (LDL) cholesterol level at 12 months. RESULTS: The trial enrolled 303 adults, of whom 96% were black. Three quarters of the participants had an annual income below $15,000. The mean estimated 10-year cardiovascular risk was 12.7%, the baseline blood pressure was 140/83 mm Hg, and the baseline LDL cholesterol level was 113 mg per deciliter. The monthly cost of the polypill was $26. At 12 months, adherence to the polypill regimen, as assessed on the basis of pill counts, was 86%. The mean systolic blood pressure decreased by 9 mm Hg in the polypill group, as compared with 2 mm Hg in the usual-care group (difference, -7 mm Hg; 95% confidence interval [CI], -12 to -2; P = 0.003). The mean LDL cholesterol level decreased by 15 mg per deciliter in the polypill group, as compared with 4 mg per deciliter in the usual-care group (difference, -11 mg per deciliter; 95% CI, -18 to -5; P<0.001). CONCLUSIONS: A polypill-based strategy led to greater reductions in systolic blood pressure and LDL cholesterol level than were observed with usual care in a socioeconomically vulnerable minority population. (Funded by the American Heart Association Strategically Focused Prevention Research Network and the National Institutes of Health; ClinicalTrials.gov number, NCT02278471.).

A pooled case-only analysis of obesity and breast cancer subtype among Black women in the southeastern United States.

PURPOSE: To evaluate the association between obesity and the relative prevalence of tumor subtypes among Black women with breast cancer (BC). METHODS: We conducted a pooled case-only analysis of 1,793 Black women with invasive BC recruited through three existing studies in the southeastern US. Multivariable case-only polytomous logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between obesity, measured by pre-diagnostic body mass index (BMI), and human epidermal growth factor receptor 2 + (HER2 +) and triple negative BC (TNBC) subtype relative to hormone receptor (HR) + /HER2- status (referent). RESULTS: Among 359 premenopausal women, 55.4% of cases were HR + /HER2 -, 20.1% were HER2 + , and 24.5% were TNBC; corresponding percentages among 1,434 postmenopausal women were 59.3%, 17.0%, and 23.6%. Approximately, 50-60% of both pre- and postmenopausal women were obese (BMI > 30 kg/m2), regardless of BC subtype. We did not observe a significant association between obesity and BC subtype. Among postmenopausal women, class I obesity (BMI 35 + kg/m2) was not associated with the development of HER2 + BC (OR 0.69; 95% CI 0.42-1.14) or TNBC (OR 0.93; 95% CI 0.60-1.45) relative to HR + /HER2- tumors. Corresponding estimates among premenopausal women were 1.03 (95% CI 0.43-2.48) and 1.13 (95% CI 0.48-2.64). CONCLUSION: In this large study of Black women with BC, there was no evidence of heterogeneity of BMI by BC subtype.

Investigating the associations of glycemic load and glycemic index with lung cancer risk in the Southern Community Cohort Study.

PURPOSE: Diets with a high glycemic load (GL) or glycemic index (GI) may increase cancer risk. Findings from prior studies on the relationship between GL, GI, and lung cancer risk are inconsistent. We investigated this relationship in a large prospective cohort. METHODS: We analyzed data from the Southern Community Cohort Study, a prospective cohort that includes diverse racial groups predominantly low-income adults aged 40-79 in 12 southeastern states of the USA. We estimated dietary GL and GI values using data collected from food frequency questionnaires at baseline. Dietary GL and GI were energy adjusted by residual method and categorized into sex-specific quintiles. Cox proportional hazard regression was used to assess the associations between dietary GL, GI, and lung cancer risk. We further performed stratified analyses by various factors. RESULTS: Intakes of individual food items or food groups that commonly contribute to GL were similar between blacks and whites in the cohort. After excluding the first two years of follow-up, 947 incident lung cancers were ascertained among 55,068 participants. Neither dietary GL nor GI was significantly associated with incident lung cancer risk in the overall population (GL: Q5 vs. Q1, HR = 0.88, 95% CI 0.72-1.07, ptrend = 0.29; GI: Q5 vs. Q1, HR = 1.06, 95% CI 0.86-1.30, ptrend = 0.71), nor in subgroups of populations (ptrend > 0.05), in multivariable-adjusted analyses. CONCLUSION: Dietary GL and GI were not independently associated with incident lung cancer risk in a large understudied population.

Food intake of folate, folic acid and other B vitamins with lung cancer risk in a low-income population in the Southeastern United States.

PURPOSE: We prospectively examined associations of lung cancer risk with food intake of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a low-income population of black and white adults in the Southeastern US. METHODS: Within the Southern Community Cohort Study, we included 1064 incident lung cancer cases among 68,236 participants aged 40-79 years at study enrollment. Food intake and the use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs). RESULTS: Folate and/or folic acid intake from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with lowest quartile were 1.08 (0.91-1.29) for total dietary folate, 1.00 (0.84-1.19) for food folate, and 1.09 (0.91-1.30) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR 1.46, 95% CI 1.04-2.05 for the highest quartile compared with the lowest quartile, P trend = 0.02). Neither the use of folic acid-containing supplements nor food intake of vitamin B6, vitamin B12 and riboflavin were associated with lung cancer risk. CONCLUSIONS: Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a low-income population of black and white adults in the Southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.

Menthol and Nonmenthol Cigarette Smoking: All-Cause Deaths, Cardiovascular Disease Deaths, and Other Causes of Death Among Blacks and Whites.

BACKGROUND: In contrast to whites, black smokers prefer menthol cigarettes over nonmenthol cigarettes by a large margin and tend to have higher mortality from several smoking-related diseases than whites, raising the possibility that menthol cigarettes contribute to racial disparities in risk. Evidence for differential associations between menthol and nonmenthol cigarettes indicates lower cancer risk for menthol smokers, but for cardiovascular disease (CVD) mortality, evidence has been inconsistent. METHODS AND RESULTS: Cox proportional hazards models were used to compute hazard ratios and accompanying 95% confidence intervals for all-cause and CVD mortality for menthol compared with nonmenthol cigarette smokers among 65 600 participants in the Southern Community Cohort Study, an ongoing community-based cohort with the largest number of menthol smokers being traced. Among the 27 619 current cigarette smokers, 4224 died during follow-up, with 1130 deaths attributed to CVD. Both all-cause (hazard ratio=0.93; 95% confidence interval=0.86-1.01; P=0.10) and CVD (hazard ratio=0.88; 95% confidence interval=0.76-1.03; P=0.10) mortality risks were similar in menthol compared with nonmenthol cigarette smokers. CONCLUSIONS: Smoking regardless of cigarette type is hazardous to health, but these results do not indicate that menthol cigarettes are associated with greater CVD risks than nonmenthol cigarettes.

Patterns and predictors of disclosure of a diagnosis of cancer.

BACKGROUND: The value of talking (i.e. disclosing ones innermost thoughts and feelings) has been recognised as playing an important role in helping people work through their difficulties. Although disclosing a diagnosis of cancer has been identified to be one of the hardest aspects of having the disease, relatively little is known about the extent to which people talk about their diagnosis of cancer. This study aimed to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure. METHODS: Patients (n = 120) who had received a diagnosis of either lung, colorectal or skin cancer completed a questionnaire assessing potential psychosocial predictors of disclosure. RESULTS: Results indicated that the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel (38% talked 'very much'), followed by family members (24%) and then friends (12%). There were no differences in disclosure across cancer types, with the exception of patients with colorectal cancer who disclosed information more to nurses and other cancer patients. Men disclosed information more than women to some social targets. Dispositional openness (B = .233, p < 0.05) and treatment type (B = -.240, p < 0.01) were found to predict 13% of the variance in degree of disclosure. CONCLUSIONS: The results suggest that individual differences and social and clinical factors impact on disclosure and that medical professionals play an important role in the disclosure process.

Socioeconomic status, race, and mortality: a prospective cohort study.

OBJECTIVES: We evaluated the independent and joint effects of race, individual socioeconomic status (SES), and neighborhood SES on mortality risk. METHODS: We conducted a prospective analysis involving 52 965 non-Hispanic Black and 23 592 non-Hispanic White adults taking part in the Southern Community Cohort Study. Cox proportional hazards modeling was used to determine associations of race and SES with all-cause and cause-specific mortality. RESULTS: In our cohort, wherein Blacks and Whites had similar individual SES, Blacks were less likely than Whites to die during the follow-up period (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.73, 0.84). Low household income was a strong predictor of all-cause mortality among both Blacks and Whites (HR = 1.76; 95% CI = 1.45, 2.12). Being in the lowest (vs highest) category with respect to both individual and neighborhood SES was associated with a nearly 3-fold increase in all-cause mortality risk (HR = 2.76; 95% CI = 1.99, 3.84). There was no significant mortality-related interaction between individual SES and neighborhood SES among either Blacks or Whites. CONCLUSIONS: SES is a strong predictor of premature mortality, and the independent associations of individual SES and neighborhood SES with mortality risk are similar for Blacks and Whites.

Consumption of ultra-processed foods and all-cause and cause-specific mortality in the Southern Community Cohort Study.

BACKGROUND & AIMS: Higher intake of ultra-processed foods (UPF) has been linked with higher risks of cancer, cardiovascular disease, and diabetes, as well as all-cause mortality. However, studies on UPF and cause-specific mortality remain limited, especially among disadvantaged populations. We aimed to examine associations of UPF intake with all-cause and cause-specific mortality among low-income Americans. METHODS: In the Southern Community Cohort Study (SCCS), a prospective cohort of mostly low-income Black and White Americans, we included 77,060 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had at least 1 year follow-up. All 89 items in the FFQ were categorized using the Nova classification. UPF intake was calculated as % of daily foods intake by weight (grams). Cox regression was used to estimate HR (95% CI) for the association of UPF intake (quartile or per 10% increase) with total and cause-specific mortality (cancer, coronary heart disease [CHD], stroke, and diabetes) after adjusting for sociodemographics, lifestyles, and disease history. RESULTS: Of 77,060 participants, 46,175 (59.9%) were women, 49,857 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. The mean intake of UPF was 41.0% (SD: 15.7%). UPF intake was inversely associated with Healthy Eating Index and intakes of fiber, minerals, and vitamins but positively associated with intakes of sugars and fats (all PFDR<0.0001). During an average follow-up of 12.2 years, we documented 17,895 total deaths, including 4267 from cancer, 2208 from CHD, 867 from stroke, and 997 from diabetes. In the fully adjusted model, higher UPF intake was not associated with all-cause, cancer, CHD, or stroke mortality but showed a significant association with increased diabetes mortality (HR [95% CI] = 1.32 [1.07, 1.62] for the highest versus lowest quartiles [>51.1% vs. <29.3%] and 1.09 [1.04, 1.15] per 10% increase). The adverse UPF-diabetes mortality association was noted regardless of sex, race, income, neighborhood deprivation, lifestyles, and cardiometabolic disease history, while particularly evident in participants with no more than high school education or a history of hypercholesterolemia (HR [95% CI] per 10% increase = 1.12 [1.05, 1.18] and 1.14 [1.07, 1.22], respectively; both Pinteraction<0.05). CONCLUSIONS: Among predominantly low-income Black and White American adults, UPF intake was associated with increased diabetes mortality, especially for individuals with limited education or hypercholesterolemia. Our findings suggest the potential impact of increasing access and intake of un/minimally processed food to replace UPF on reducing diabetes-related mortality among populations facing socioeconomic and health disparities.

Reproducibility of serum 25-hydroxyvitamin d and vitamin D-binding protein levels over time in a prospective cohort study of black and white adults.

Prospective epidemiologic studies generally rely on 1 baseline biologic sample from participants for measurement of prediagnostic biomarkers, assuming that 1 measurement adequately represents the participant's "typical" level. The body of work assessing the reproducibility of circulating serum 25-hydroxyvitamin D (25(OH)D) levels over time focuses almost exclusively on populations of European descent, and data for vitamin D-binding protein (VDBP) are virtually nonexistent. Thus, the authors measured levels of serum 25(OH)D and VDBP twice in samples collected between 2005 and 2008 from 225 participants (155 black, 70 white) in the Southern Community Cohort Study. Reproducibility for 25(OH)D was uniformly high, with adjusted intraclass correlation coefficients (ICCs) of 0.84 (95% confidence interval (CI): 0.79, 0.88) for blacks and 0.92 (95% CI: 0.87, 0.95) for whites, and there was substantial agreement for assignment of 25(OH)D quartile (κ = 0.83, 95% CI: 0.78, 0.87) and vitamin D adequacy status (κ = 0.76, 95% CI: 0.69, 0.83). VDBP levels were highly stable over time, with adjusted ICCs of 0.97 (95% CI: 0.96, 0.98) for blacks and 0.96 (95% CI: 0.93, 0.97) for whites. These findings suggest that single, baseline 25(OH)D and VDBP serum measurements provide reasonably representative measures of these compounds for both white and black adults, demonstrating their utility as epidemiologic biomarkers in prospective studies.

Smoking Quit Rates Among Menthol vs Nonmenthol Smokers: Implications Regarding a US Ban on the Sale of Menthol Cigarettes.

BACKGROUND: A ban on the sale of menthol cigarettes in the United States is currently under consideration. A justification is that menthol cigarettes are harder to quit, particularly for African American smokers who use menthols much more frequently than White smokers, but epidemiologic data are limited. METHODS: In a cohort of 16 425 mostly low-income African American and White current cigarette smokers enrolled during 2002-2009, we computed smoking quit and reuptake rates at 3 follow-ups conducted means of 4.6, 7.7, and 11 years after entry. Generalized estimation equations were used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for quitting and resuming smoking for menthol vs nonmenthol smokers adjusted for race, age, education, income, and smoking pack-years. RESULTS: Crude annual quit rates among current smokers were 4.3% for menthol and 4.5% for nonmenthol smokers, with adjusted odds ratios of quitting for menthol vs nonmenthol smokers of 1.01 (95% CI = 0.91 to 1.11) overall, 0.99 (95% CI = 0.87 to 1.12) among African American smokers, and 1.02 (95% CI = 0.88 to 1.20) among White smokers. Crude annual smoking reuptake rates were somewhat higher among menthol smokers (8.4%) than nonmenthol smokers (7.1%), with an adjusted odds ratio of 1.19 (95% CI = 0.97 to 1.47), but net quit rates remained similar (OR = 1.01, 95% CI = 0.90 to 1.13 overall; OR = 1.00, 95% CI = 0.86 to 1.15 among African American participants; and OR = 1.04, 95% CI = 0.87 to 1.24 among White participants). CONCLUSIONS: This large-scale prospective survey revealed similar quit rates among menthol and nonmenthol smokers. Results contribute to policy discussions, especially if, as a meta-analysis suggests, lung cancer risk is higher for nonmenthol smokers and a ban leads menthol smokers to switch to nonmenthol cigarettes.

Dietary polyphenols and the risk of colorectal cancer in the prospective Southern Community Cohort Study.

BACKGROUND: Polyphenols are antioxidants with promising anticancer properties, but few studies have examined the associations of specific dietary polyphenols with colorectal cancer (CRC) risks or among Black individuals in the United States. OBJECTIVES: We examined the associations between dietary polyphenols and CRC and assessed differences in these associations or polyphenol intakes by subgroups, including race (Black and White), that may contribute to cancer disparities. METHODS: The Southern Community Cohort Study prospectively enrolled individuals from the southeastern United States during 2002-2009, most of whom had a low income or are Black. Validated FFQ data and polyphenol databases were used to estimate polyphenol intakes. Cox proportional hazards models were used to obtain HRs and 95% CIs for the highest compared to the lowest intake quintiles (Qs) of specific polyphenols. Median intakes of quintiles were used to obtain linear trends, and restricted cubic splines were used to obtain nonlinear trends. Subgroup analyses were conducted by cancer site, sex, race, household income, and BMI-defined obesity status. RESULTS: Among 71,599 participants, the median polyphenol intake was lower for Black individuals (452 mg/day; IQR, 277-672 mg/day) than White individuals (958 mg/day; IQR, 587-1597 mg/day). A significant, inverse, nonlinear association was observed for total polyphenol intake with the CRC risk (HR, 0.57; 95% CI, 0.38-0.86; P = 0.008 comparing 650 mg/day of intake to 0 mg/day). In addition, inverse linear associations were observed for tyrosols and the CRC risk (HRQ5vsQ1, 0.68; 95% CI, 0.50-0.91; P = 0.0014) and for hydroxybenzoic acids and the rectal cancer risk (HRQ5vsQ1, 0.49; 95% CI, 0.29-0.82; P = 0.0007). Associations were consistent by sex, race, income, and BMI. CONCLUSIONS: Increasing intakes of total polyphenols, tyrosols, and hydroxybenzoic acids were associated with decreased CRC or rectal cancer risks, and associations were consistent across subgroups. Differences in polyphenol intakes may contribute to the increased CRC incidence among Black US individuals.

Avoidance of Emergency Care in the Southeastern United States During the COVID-19 Pandemic.

In a low-income cohort in the Southeastern United States, 5% of participants avoided emergency medical care during the coronavirus disease 2019 pandemic, primarily due to fear and visitor restrictions. Younger age, self-perceived lower health status, lack of a personal doctor, and decreased income were associated with greater likelihood of deferring emergency care.

Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study.

BACKGROUND: The reproductive implications of mutagenic treatments given to children with cancer are not clear. By studying the risk of untoward pregnancy outcomes, we indirectly assessed the risk of transmission of germline damage to the offspring of survivors of childhood cancer who were given radiotherapy and chemotherapy. METHODS: We did a retrospective cohort analysis, within the Childhood Cancer Survivor Study (CCSS), of the risk of stillbirth and neonatal death among the offspring of men and women who had survived childhood cancer. Patients in CCSS were younger than 21 years at initial diagnosis of an eligible cancer, were treated at 25 US institutions and one Canadian institution, and had survived for at least 5 years after diagnosis. We quantified the chemotherapy given to patients, and the preconception radiation doses to the testes, ovaries, uterus, and pituitary gland, and related these to the risk of stillbirth or neonatal death using Poisson regression analysis. FINDINGS: Among 1148 men and 1657 women who had survived childhood cancer, there were 4946 pregnancies. Irradiation of the testes (16 [1%] of 1270; adjusted relative risk 0.8 [95% CI 0.4-1.6]; mean dose 0.53 Gy [SD 1.40]) and pituitary gland (17 [3%] of 510, 1.1 [0.5-2.4] for more than 20.00 Gy; mean dose 10.20 Gy [13.0] for women), and chemotherapy with alkylating drugs (26 [2%] of 1195 women, 0.9 [0.5-1.5]; ten [1%] of 732 men, 1.2 [0.5-2.5]) were not associated with an increased risk of stillbirth or neonatal death. Uterine and ovarian irradiation significantly increased risk of stillbirth and neonatal death at doses greater than 10.00 Gy (five [18%] of 28, 9.1 [3.4-24.6]). For girls treated before menarche, irradiation of the uterus and ovaries at doses as low as 1.00-2.49 Gy significantly increased the risk of stillbirth or neonatal death (three [4%] of 69, 4.7 [1.2-19.0]). INTERPRETATION: Our findings do not support concern about heritable genetic changes affecting the risk of stillbirth and neonatal death in the offspring of men exposed to gonadal irradiation. However, uterine and ovarian irradiation had serious adverse effects on the offspring that were probably related to uterine damage. Careful management is warranted of pregnancies in women given high doses of pelvic irradiation before puberty. FUNDING: Westlakes Research Institute, National Cancer Institute, and Children's Cancer Research Fund.

Obesity, physical activity and lower urinary tract symptoms: results from the Southern Community Cohort Study.

PURPOSE: Obesity and physical activity have been posited as modifiable risk factors to delay lower urinary tract symptom progression. In this study we determined the independent associations of physical activity and obesity with lower urinary tract symptoms at followup among white and African-American men. MATERIALS AND METHODS: Male participants 40 to 79 years old were identified from the Southern Community Cohort Study, a prospective cohort based in the southeastern United States. Baseline data collection included a validated physical activity questionnaire, height and weight, health history and other information. We excluded participants with a history of or medication use for benign prostatic hyperplasia or prostate cancer. Participants (7,318, 60% African-American) completed the International Prostate Symptom Score approximately 5 years after baseline. Patients with an International Prostate Symptom Score greater than 8 or 20 were classified as having moderate or severe lower urinary tract symptoms, respectively, at followup. Multivariable logistic regression was used to assess the relationships among obesity, physical activity and lower urinary tract symptoms. RESULTS: Moderate to severe lower urinary tract symptom severity at followup was significantly associated with a body mass index of 35 kg/m(2) or more (OR 1.38, 95% CI 1.17-1.63). Similarly the lowest categories of physical activity were associated with the onset of severe lower urinary tract symptoms in men with a normal body mass index (OR 1.38, 95% CI 1.05-1.82). These associations were independent of race. CONCLUSIONS: Severe obesity is associated with an increased risk of lower urinary tract symptoms at followup, while physical inactivity may permit progression of lower urinary tract symptoms in normal weight men regardless of race. These variables should be considered in future research into modifiable risk factors for lower urinary tract symptoms.

Association between socioeconomic status (SES) and lower urinary tract symptom (LUTS) severity among black and white men.

BACKGROUND: A higher prevalence of moderate or severe lower urinary tract symptoms (LUTS) has been reported among African Americans, but the separate effects of race and socioeconomic status (SES) on LUTS severity are unclear. OBJECTIVE: We investigated the roles of education, income, marital status, and source of health insurance on LUTS reporting among black and white U.S. men. DESIGN: A prospective cohort within the Southern Community Cohort Study MAIN MEASURES: The International Prostate Symptom Score (IPSS) was completed during follow-up by 2488 white men and 4188 black men. Multivariable linear and logistic regression methods were used to compare IPSS scores and LUTS severity by race and SES after adjusting for age, duration of follow-up, benign prostatic hyperplasia (BPH) treatment, source of recruitment, smoking status, BMI, mode of follow-up ascertainment, and prior diagnosis of hypertension, diabetes, or hypercholesterolemia. KEY RESULTS: Overall IPSS scores and the prevalence of moderate/severe LUTS were not significantly associated with race. Instead, higher IPSS scores were significantly associated (p < 0.05) with a lower income, marital status, and source of insurance. Education was also marginally associated with IPSS scores (p = 0.06) among black men. Furthermore, moderate/severe LUTS onset was significantly associated with a household income less than $15,000/year (OR = 1.56 (1.23, 1.96)) and having private health insurance (OR = 0.79 (0.67, 0.93)). CONCLUSIONS: Social or behavioral factors related to SES affect LUTS reporting, and suggests a potential affect on BPH diagnosis.

Disruption of medical care among individuals in the southeastern United States during the COVID-19 pandemic.

BACKGROUND: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences. DESIGN AND METHODS: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data. RESULTS: Among 4,463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare.  Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; p-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare. CONCLUSIONS: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.

Biochemical validation of food frequency questionnaire-estimated carotenoid, alpha-tocopherol, and folate intakes among African Americans and non-Hispanic Whites in the Southern Community Cohort Study.

Few food frequency questionnaires (FFQs) have been developed specifically for use among African Americans, and reports of FFQ performance among African Americans or low-income groups assessed using biochemical indicators are scarce. The authors conducted a validation study within the Southern Community Cohort Study to evaluate FFQ-estimated intakes of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, folate, and alpha-tocopherol in relation to blood levels of these nutrients. Included were 255 nonsmoking participants (125 African Americans, 130 non-Hispanic whites) who provided a blood sample at the time of study enrollment and FFQ administration in 2002-2004. Levels of biochemical indicators of each micronutrient (alpha-tocopherol among women only) significantly increased with increasing FFQ-estimated intake (adjusted correlation coefficients: alpha-carotene, 0.35; beta-carotene, 0.28; beta-cryptoxanthin, 0.35; lutein/zeaxanthin, 0.28; lycopene, 0.15; folate, 0.26; alpha-tocopherol, 0.26 among women; all P's < 0.05). Subjects in the top decile of FFQ intake had blood levels that were 27% (lycopene) to 178% (beta-cryptoxanthin) higher than those of subjects in the lowest decile. Satisfactory FFQ performance was noted even for participants with less than a high school education. Some variation was noted in the FFQ's ability to predict blood levels for subgroups defined by race, sex, and other characteristics, but overall the Southern Community Cohort Study FFQ appears to generate useful dietary exposure rankings in the cohort.

Patterns and correlates of sleep duration in the Southern cohort community study.

OBJECTIVE: To investigate whether race (African American (AA) and white) is associated with sleep duration among adults from low socioeconomic (SES) strata and whether SES status, lifestyle behaviors, or health conditions are associated with sleep duration within race-sex groups. METHODS: This cross-sectional study includes 78,549 participants from the Southern Community Cohort Study (SCCS). Averaged daily sleep duration was assessed by weighted averages of self-reported sleep duration on weekdays and weekends. Adjusted odds ratios (ORs) of very short (<5 h/day), short (5-6 h/day), and long sleep (≥9 h/day) associated with pre-selected risk factors in each race-sex group were determined by multinomial logistic models. RESULTS: The prevalence of very short and short sleep was similar among AAs (6.2% and 29.1%) and whites (6.5% and 29.1%). Long sleep was considerably more prevalent among AAs (19.3%) than whites (13.0%). Very short sleep was associated with lower education and family income, with stronger associations among whites. Higher physical activity levels significantly decreased odds for both very short (OR = 0.80) and long sleep (OR = 0.78). Smoking, alcohol use, and dietary intake were not associated with sleep duration. Regardless of race or sex, very short, short, and long sleep were significantly associated with self-reported health conditions, especially depression (ORs were 2.06, 1.33, and 1.38, respectively). CONCLUSIONS: Sleep duration patterns differed between AAs and whites from the underrepresented SCCS population with low SES. Sleep duration was associated with several socioeconomic, health behaviors, and health conditions depending on race and sex.