Overwintering fires in boreal forests.

Forest fires are usually viewed within the context of a single fire season, in which weather conditions and fuel supply can combine to create conditions favourable for fire ignition-usually by lightning or human activity-and spread1-3. But some fires exhibit 'overwintering' behaviour, in which they smoulder through the non-fire season and flare up in the subsequent spring4,5. In boreal (northern) forests, deep organic soils favourable for smouldering6, along with accelerated climate warming7, may present unusually favourable conditions for overwintering. However, the extent of overwintering in boreal forests and the underlying factors influencing this behaviour remain unclear. Here we show that overwintering fires in boreal forests are associated with hot summers generating large fire years and deep burning into organic soils, conditions that have become more frequent in our study areas in recent decades. Our results are based on an algorithm with which we detect overwintering fires in Alaska, USA, and the Northwest Territories, Canada, using field and remote sensing datasets. Between 2002 and 2018, overwintering fires were responsible for 0.8 per cent of the total burned area; however, in one year this amounted to 38 per cent. The spatiotemporal predictability of overwintering fires could be used by fire management agencies to facilitate early detection, which may result in reduced carbon emissions and firefighting costs.

High-Throughput Screening of Streptavidin-Binding Proteins in Self-Assembled Solid Films for Directed Evolution of Materials.

Evolution has shaped the development of proteins with an incredible diversity of properties. Incorporating proteins into materials is desirable for applications including biosensing; however, high-throughput selection techniques for screening protein libraries in materials contexts is lacking. In this work, a high-throughput platform to assess the binding affinity for ordered sensing proteins was established. A library of fusion proteins, consisting of an elastin-like polypeptide block, one of 22 variants of rcSso7d, and a coiled-coil order-directing sequence, was generated. All selected variants had high binding in films, likely due to the similarity of the assay to magnetic bead sorting used for initial selection, while solution binding was more variable. From these results, both the assembly of the fusion proteins in their operating state and the functionality of the binding protein are key factors in the biosensing performance. Thus, the integration of directed evolution with assembled systems is necessary to the design of better materials.

Changes in uptake of stool-based colorectal cancer screening during the Covid-19 pandemic.

PURPOSE: Colorectal cancer (CRC) screening is underutilized and endoscopic colon screening includes a number of barriers that were exacerbated by the Covid-19 pandemic. At-home stool-based screening (SBS) increased during the pandemic and potentially reached eligible adults hesitant to be screened by endoscopy. The purpose of this analysis was to examine the change in uptake of SBS during the pandemic among adults not screened within guidelines by endoscopy. METHODS: We used data from the 2019 and 2021 National Health Interview Surveys to estimate uptake of SBS among adults aged 50-75 years, without a previous diagnosis of CRC and without guideline-concordant endoscopic screening. We also examined provider recommendations for screening tests. To examine if changes in uptake differed during the pandemic by demographic and health characteristics, we combined survey years and ran logistic regression models with an interaction term for each factor and survey year. RESULTS: In our study population, SBS increased 74% overall from 2019 to 2021 (8.7% to 15.1%; p < 0.001), with the largest percent increase among those aged 50-52 years (3.5% to 9.9%; p < 0.001). Among those aged 50-52 years, the ratio of endoscopy to SBS changed from 83%/17% in 2019 to 55%/45% in 2021. Cologuard was the only screening test where recommendations by healthcare providers significantly increased from 2019 (10.6% to 16.1%; p = 0.002). CONCLUSIONS: Use and recommendations for SBS increased substantially during the pandemic. Increased awareness among patients could potentially improve future CRC screening rates if uptake of SBS occurs among those unable or unwilling to be screened by endoscopy.

Cervical cancer screening and predictors of screening by diabetes status.

PURPOSE: Women with diabetes have lower survival rates after a cervical cancer diagnosis compared to women without diabetes. Pap smears and human papilloma virus (HPV) testing are highly effective screening tests for cervical cancer, therefore, it is important to know the prevalence of guideline-concordant screening among women with diabetes and understand if their predictors of screening differ. The purpose of this analysis was to assess guideline-concordant cervical cancer screening and predictors by diabetes status. METHODS: We used the 2019 National Health Interview Survey data, limited to women aged 21-65 years without a previous diagnosis of cancer, a hysterectomy, or diagnosed with diabetes in the year prior to the survey. We considered the Pap and HPV tests together and concordance as being tested within the past 3 years as part of a routine exam. We calculated weighted, adjusted prevalence, and prevalence ratios (PRs) of screening concordance comparing women with diabetes to those without. RESULTS: The unadjusted prevalence of concordant screening was 66.5% for women with diabetes compared to 73.3% for women without diabetes (PR = 0.91 95% CI 0.84-0.98). In the fully adjusted model adjusting for factors known to be associated with diabetes and access to healthcare, the association was attenuated and no longer statistically significant (PR = 0.96 95% CI 0.89-1.04). CONCLUSION: Cervical cancer screening concordance was lower in women with diabetes compared to those without overall but the deficit appears to be due primarily to underlying differences in sociodemographic characteristics and access to healthcare and not diabetes independently.

Robust and replicable measurement for prepulse inhibition of the acoustic startle response.

Measuring animal behavior in the context of experimental manipulation is critical for modeling, and understanding neuropsychiatric disease. Prepulse inhibition of the acoustic startle response (PPI) is a behavioral phenomenon studied extensively for this purpose, but the results of PPI studies are often inconsistent. As a result, the utility of this phenomenon remains uncertain. Here, we deconstruct the phenomenon of PPI and confirm several limitations of the methodology traditionally utilized to describe PPI, including that the underlying startle response has a non-Gaussian distribution, and that the traditional PPI metric changes with different stimuli. We then develop a novel model that reveals PPI to be a combination of the previously appreciated scaling of the startle response, as well as a scaling of sound processing. Using our model, we find no evidence for differences in PPI in a rat model of Fragile-X Syndrome (FXS) compared with wild-type controls. These results in the rat provide a reliable methodology that could be used to clarify inconsistent PPI results in mice and humans. In contrast, we find robust differences between wild-type male and female rats. Our model allows us to understand the nature of these differences, and we find that both the startle-scaling and sound-scaling components of PPI are a function of the baseline startle response. Males and females differ specifically in the startle-scaling, but not the sound-scaling, component of PPI. These findings establish a robust experimental and analytical approach that has the potential to provide a consistent biomarker of brain function.

Differences in the relationship between diabetes and prostate cancer among Black and White non-Hispanic men.

PURPOSE: Studies finding lower incidence rates of prostate cancer among men with diabetes have been primarily conducted in White non-Hispanic (WNH) populations. The purpose of this analysis is to compare the relationship between diabetes and prostate cancer among Black (BNH) and White non-Hispanic men. METHODS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2011 to 2015 to compare incidence rates and tumor characteristics between BNH and WNH men by diabetes status. Age-adjusted incidence rates and corresponding rate ratios (RR) by diabetes status were calculated overall and by tumor grade, stage, and PSA level separately for BNH and WNH men. We used multivariable logistic regression to compare tumor characteristics among men with prostate cancer in the numerator, both within and across race/ethnic groups. RESULTS: Overall age-adjusted incidence rates were significantly lower in men with diabetes compared to those without among WNH men [RR = 0.88 95% Confidence Interval (CI) 0.86-0.90] but there was no difference in rates by diabetes status among BNH men (RR = 1.01 95% CI 0.96-1.07). Men with diabetes were less likely to be diagnosed with distant-staged tumors compared to those without diabetes in both race/ethnic groups but the magnitude of difference by diabetes status was greater in BNH [Odds Ratio (OR) = 0.52 95% CI 0.42-0.64] than WNH (OR = 0.88 95% CI 0.81-0.95) men (p-value for interaction < 0.001). CONCLUSION: The relationship between diabetes and prostate cancer differed between BNH and WNH men. The differences could have implications in evaluating the effectiveness of prostate cancer screening in men with diabetes across racial/ethnic subgroups.

Healthcare Access, Utilization, and Preventive Health Behaviors by Eligibility for Lung Cancer Screening.

In 2013, the US Preventive Services Task Force recommended low-dose computed tomography screening for smokers at high risk of lung cancer; however, use remains low. Efforts to promote lung cancer screening need to consider how receptive this population is to preventive healthcare and cancer screening. In addition, because of demonstrated heterogeneity in behaviors by smoking status, interventions may need to differ among eligible high-risk subgroups. To assess the engagement of high-risk smokers in other preventive healthcare behaviors, we examined healthcare use, including non-lung cancer screening, and healthcare provider discussions regarding screening by eligibility for lung cancer screening. We used the 2015 National Health Interview Survey to assess smoking history, healthcare use, cancer screening, vaccinations, and healthcare provider discussions regarding non-lung cancer screening. We calculated weighted prevalence estimates and prevalence ratios comparing eligible and ineligible current and former smokers to never smokers. Eligible current and former smokers had significantly different healthcare utilization and screening concordance compared to never smokers and to each other. Compared to never smokers, eligible current smokers were significantly less likely to be concordant with breast, colorectal, and cervical cancer screening while eligible former smokers were only less likely to be concordant with breast cancer screening. Eligible current smokers were less likely to report physician discussions about non-lung screening tests. Provider discussions about screening and engagement in preventive healthcare differed among current and former smokers eligible for lung cancer screening. Intervention efforts to increase lung cancer screening levels will likely need to differ as well.

Examining the relationship between diabetes and prostate cancer through changes in screening guidelines.

PURPOSE: Previous studies have found that men with diabetes are at reduced risk of prostate cancer compared to men without diabetes. The lower risk could be due to biologic differences and/or a diagnosis bias from use of the prostate-specific antigen (PSA) test as a screening and diagnostic tool. We sought to further examine the relationship between diabetes and incidence of prostate cancer and examine the potential impact of changes in PSA screening guidelines in 2008 and 2012. METHODS: We used 2004-2015 Surveillance, Epidemiology and End Results (SEER)-Medicare data and limited the study population to men aged 67-74 with at least 2 years of continuous enrollment. Using the 5% Medicare sample as the denominator and prostate cancer cases as the numerator, we calculated age-adjusted rate ratios (RR) in 2006-2011 and 2012-2015 by diabetes status, overall and by tumor grade. We used multivariable logistic regression to compare tumor characteristics by diabetes status. RESULTS: Men with diabetes had lower incidence rates of prostate cancer compared to men without diabetes in 2006-2011 [RR = 0.89 95% confidence interval (CI) 0.87-0.91] and 2012-2015 (RR = 0.92 95% CI 0.89-0.95) but the slight attenuation toward the null in 2012-2015 was primarily due to the change in RRs for low-grade tumors. CONCLUSION: We found differences in the risk and characteristics of prostate cancer by diabetes status and that some risks have changed over time as guidelines have changed. With lower PSA use in the more recent time-period, rates of low-grade tumors have become more similar by diabetes status.

Functional comparison of paper-based immunoassays based on antibodies and engineered binding proteins.

Binding protein scaffolds, such as rcSso7d, have been investigated for use in diagnostic tests; however, the functional performance of rcSso7d has not yet been studied in comparison to antibodies. Here, we assessed the analyte-binding capabilities of rcSso7d and antibodies on cellulose with samples in buffer and 100% human serum.

Correction to: The relationship between diabetes, prostate-specific antigen screening tests, and prostate cancer.

In the original publication of the article, the categories of PSA levels among the subpopulation of men diagnosed with prostate cancer were published incorrectly in Table 4. The corrected Table 4 is given in this Correction.

Secondary prostate cancer screening outcomes by race in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial.

BACKGROUND: Despite disparities in prostate cancer incidence and mortality rates between black and white men, there is still insufficient data available to assess potential differences in the benefits and harms of prostate cancer screening by race. Although the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial is underpowered to detect a difference by race in prostate-cancer specific mortality, because of the large study size, there are still sufficient numbers to examine secondary screening outcomes. The objective of this analysis is to examine whether differences exist between black and white participants with respect to screening false-positive rates, biopsy follow-up of men with positive screens, tumor characteristics, and overdiagnosis of prostate cancer. METHODS: Participants from the PLCO included men aged 55-74 years at baseline. Cancer diagnoses and deaths were identified through study update questionnaires, records of biopsy procedures, and linkage with the National Death Index. Cancer characteristics were obtained by medical abstractors. We used chi-squared tests to assess differences in false-positive rates, biopsy follow-up, and tumor characteristics. We used Cox proportional hazards models to compare incidence and mortality rates adjusting for age and survival rates adjusting for Gleason scores. RESULTS: Black men were slightly more likely (14.5%) to have a false-positive PSA test compared to white men (12.4%; P = 0.02) but less likely to have a false-positive digital rectal exam (DRE) (10.9% vs 14.2%, respectively; P < 0.001). Among all men who were screened, black men were significantly more likely to undergo a biopsy than white men (16.5% vs 13.8%, respectively [P = 0.003]) but there was no difference when limited to those with a positive PSA test. Prostate cancer tumors were more likely to be aggressive and to have metastasized in black men compared to white men. Disparities in incidence, mortality, and survival rates were comparable to those seen in population-based data. CONCLUSIONS: There was evidence that false-positive test results differed by race and screening test. Consistent with previous studies, cancer outcomes, and tumor characteristics were all more unfavorable in black men.

Design Principles for Enhancing Sensitivity in Paper-Based Diagnostics via Large-Volume Processing.

In this work, we characterize the impact of large-volume processing upon the analytical sensitivity of flow-through paper-based immunoassays. Larger sample volumes feature greater molar quantities of available analyte, but the assay design principles which would enable the rapid collection of this dilute target are ill-defined. We developed a finite-element model to explore the operating conditions under which processing large sample volumes via pressure-driven convective flow would yield an improved binding signal. Our simulation results underscore the importance of establishing a high local concentration of the analyte-binding species within the porous substrate. This elevated abundance serves to enhance the binding kinetics, matching the time scale of target capture to the period during which the sample is in contact with the test zone (i.e., the effective residence time). These findings were experimentally validated using the rcSso7d-cellulose-binding domain (CBD) fusion construct, a bifunctional binding protein which adsorbs to cellulose in high abundance. As predicted by our modeling efforts, the local concentration achieved using the rcSso7d-CBD species is uniquely enabling for sensitivity enhancement through large-volume processing. The rapid analyte depletion which occurs at this high surface density also permits the processing of large sample volumes within practical time scales and flow regimes. Using these findings, we present guidance for the optimal means of processing large sample volumes for enhanced assay sensitivity.

Muscle-strengthening and aerobic activities and mortality among 3+ year cancer survivors in the U.S.

PURPOSE: This study examined the association between adherence to American College of Sports Medicine and American Cancer Society guidelines on aerobic and muscle-strengthening activities and mortality risks among 3+ year cancer survivors in the U.S. METHODS: The observational study was based on 1999-2009 National Health Interview Survey Linked Mortality Files with follow-up through 2011. After applying exclusion criteria, there were 13,997 observations. The hazard ratios (HRs) for meeting recommendations on muscle-strengthening activities only, on aerobic activities only, and on both types of physical activity (i.e., adhering to complete guidelines) were calculated using a reference group of cancer survivors engaging in neither. Unadjusted and adjusted HRs of all-cause, cancer-specific, and cardiovascular disease-specific mortalities were estimated using Cox proportional hazards models. RESULTS: In all models, compared to the reference group, cancer survivors adhering to complete guidelines had significantly decreased all-cause, cancer-specific, and cardiovascular disease-specific mortalities (HRs ranged from 0.37 to 0.64, p's < 0.05). There were no statistically significant differences between hazard rates of cancer survivors engaging in recommended levels of muscle-strengthening activities only and the reference group (HRs ranged from 0.76 to 0.94, p's > 0.05). Wald test statistics suggested a significant dose-response relationship between levels of adherence to complete guidelines and cancer-specific mortality. CONCLUSIONS: While muscle-strengthening activities by themselves do not appear to reduce mortality risks, such activities may provide added cancer-specific survival benefits to 3+ year cancer survivors who are already aerobically active.

The relationship between diabetes, prostate-specific antigen screening tests, and prostate cancer.

PURPOSE: Men with diabetes have been found to have a reduced risk of prostate cancer (PCa), potentially due to detection bias from lower prostate-specific antigen (PSA) levels or inhibition of tumor growth. Understanding if lower PCa rates are due to a lower risk of the disease or a detection bias from PSA testing can help inform the benefits and harms from prostate cancer screening. METHODS: We used data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial to assess the impact of PSA screening on PCa in men with diabetes and the potential role of detection bias and/or slower tumor growth. Comparing men by diabetes status, we calculated age-adjusted incidence rates by tumor grade and compared screening results, PSA levels, and tumor characteristics. RESULTS: Men with diabetes had lower rates of PCa but was limited to low- and intermediate-grade tumors. Men with diabetes were less likely to be biopsied after their first positive screening test and men diagnosed with low/intermediate-grade tumors had significantly more advanced tumors with higher PSA levels. CONCLUSIONS: Our findings provide additional evidence that detection bias is likely contributing to the lower rates of low- and intermediate-grade prostate cancers.

Improved Ordering in Low Molecular Weight Protein-Polymer Conjugates Through Oligomerization of the Protein Block.

The self-assembly of protein-polymer conjugates incorporating oligomers of a small, engineered high-affinity binding protein, rcSso7d.SA, is studied to determine the effect of protein oligomerization on nanoscale ordering. Oligomerization enables a systematic increase in the protein molar mass without changing its overall folded structure, leading to a higher driving force for self-assembly into well-ordered structures. Though conjugates of monomeric rcSso7d.SA are found to only exist in disordered states, oligomers of this protein linked to a poly( N-isopropylacrylamide) (PNIPAM) block self-assemble into lamellar nanostructures. Conjugates of trimeric and tetrameric rcSso7d.SA are observed to produce the strongest ordering in concentrated solution, displaying birefringent lamellae at concentrations as low as 40 wt %. In highly concentrated solution, the oligomeric rcSso7d.SA-PNIPAM block copolymers exhibit ordering and domain spacing trends atypical from that of most block copolymers. Fluorescent binding assays indicate that oligomerized protein blocks retain binding functionality and exhibit limits of detection up to three times lower than that of surface-immobilized protein sensors. Therefore, oligomerization of the protein block in these block copolymers serves as an effective method to improve both nanoscale ordering and biosensing capabilities.

Physical activity levels and counseling by health care providers in cancer survivors.

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's<0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a 'window' of opportunity to increase physical activity levels among the U.S. cancer survivors.

Racial and Ethnic Differences in a Linkage with the National Death Index.

OBJECTIVES: Differences in the availability of a Social Security Number (SSN) by race/ethnicity could affect the ability to link with death certificate data in passive follow-up studies and possibly bias mortality disparities reported with linked data. Using 1989-2009 National Health Interview Survey (NHIS) data linked with the National Death Index (NDI) through 2011, we compared the availability of a SSN by race/ethnicity, estimated the percent of links likely missed due to lack of SSNs, and assessed if these estimated missed links affect race/ethnicity disparities reported in the NHIS-linked mortality data. METHODS: We used preventive fraction methods based on race/ethnicity-specific Cox proportional hazards models of the relationship between availability of SSN and mortality based on observed links, adjusted for survey year, sex, age, respondent-rated health, education, and US nativity. RESULTS: Availability of a SSN and observed percent linked were significantly lower for Hispanic and Asian/Pacific Islander (PI) participants compared with White non-Hispanic participants. We estimated that more than 18% of expected links were missed due to lack of SSNs among Hispanic and Asian/PI participants compared with about 10% among White non-Hispanic participants. However, correcting the observed links for expected missed links appeared to only have a modest impact on mortality disparities by race/ethnicity. CONCLUSIONS: Researchers conducting analyses of mortality disparities using the NDI or other linked death records, need to be cognizant of the potential for differential linkage to contribute to their results.

Structure and Mechanism of the Influenza A M218-60 Dimer of Dimers.

We report a magic angle spinning (MAS) NMR structure of the drug-resistant S31N mutation of M218-60 from Influenza A. The protein was dispersed in diphytanoyl-sn-glycero-3-phosphocholine lipid bilayers, and the spectra and an extensive set of constraints indicate that M218-60 consists of a dimer of dimers. In particular, ∼280 structural constraints were obtained using dipole recoupling experiments that yielded well-resolved (13)C-(15)N, (13)C-(13)C, and (1)H-(15)N 2D, 3D, and 4D MAS spectra, all of which show cross-peak doubling. Interhelical distances were measured using mixed (15)N/(13)C labeling and with deuterated protein, MAS at ωr/2π = 60 kHz, ω0H/2π = 1000 MHz, and (1)H detection of methyl-methyl contacts. The experiments reveal a compact structure consisting of a tetramer composed of four transmembrane helices, in which two opposing helices are displaced and rotated in the direction of the membrane normal relative to a four-fold symmetric arrangement, yielding a two-fold symmetric structure. Side chain conformations of the important gating and pH-sensing residues W41 and H37 are found to differ markedly from four-fold symmetry. The rmsd of the structure is 0.7 Å for backbone heavy atoms and 1.1 Å for all heavy atoms. This two-fold symmetric structure is different from all of the previous structures of M2, many of which were determined in detergent and/or with shorter constructs that are not fully active. The structure has implications for the mechanism of H(+) transport since the distance between His and Trp residues on different helices is found to be short. The structure also exhibits two-fold symmetry in the vicinity of the binding site of adamantyl inhibitors, and steric constraints may explain the mechanism of the drug-resistant S31N mutation.

Linkage of 1986-2009 National Health Interview Survey with 1981-2010 Florida Cancer Data System.

BACKGROUND: National survey data linked with state cancer registry data has the potential to create a valuable tool for cancer prevention and control research. A pilot project-developed in a collaboration of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and the Florida Cancer Data System (FCDS) at the University of Miami -links the records of the 1986-2009 National Health Interview Survey (NHIS) and the 1981-2010 FCDS. The project assesses the feasibility of performing a record linkage between NCHS survey data and a state-based cancer registry, as well as the value of the data produced. The linked NHIS-FCDS data allow researchers to follow NHIS survey participants longitudinally to examine factors associated with future cancer diagnosis, and to assess the characteristics and quality of life among cancer survivors. METHODS: This report provides a preliminary evaluation of the linked national and state cancer data and examines both analytic issues and complications presented by the linkage. CONCLUSIONS: Residential mobility and the number of years of data linked in this project create some analytic challenges and limitations for the types of analyses that can be conducted. However, the linked data set offers the ability to conduct analyses not possible with either data set alone.

Diabetes and colorectal cancer screening among men and women in the USA: National Health Interview Survey: 2008, 2010.

PURPOSE: Adults with diabetes are at increased risk of being diagnosed with and dying from colorectal cancer, but it is unclear whether colorectal cancer screening (CRCS) use is lower in this population. Using the 2008 and 2010 National Health Interview Survey data, we examined whether guideline-concordant CRCS is lower among men and women with self-reported diabetes. METHODS: We calculated the weighted percentage of guideline-concordant CRCS and unadjusted and adjusted prevalence ratios (PR) comparing adults aged 51-75 years with diabetes (n = 6,514) to those without (n = 8,371). We also examined effect modification by age (51-64 and 65-75), race/ethnicity, and number of medical office visits (0-3, ≥ 4). RESULTS: The unadjusted prevalence of CRCS among men with diabetes was significantly higher than men without (63.3 vs. 58.0 %; PR = 1.09 95 % CI 1.03-1.16). In adjusted models, this relationship was evident among older [adjusted PR (aPR) = 1.13 95 % CI 1.06-1.21] but not younger men (aPR = 0.99 95 % CI 0.91-1.08; p for interaction term ≤ 0.01). There was no significant association between diabetes and CRCS among women overall (56.6 vs. 57.9 %; PR = 0.98 95 % CI 0.92-1.04) or by age group. Race/ethnicity and the number of medical visits did not significantly modify the association between diabetes and CRCS for men or women. CONCLUSIONS: Men and women with self-reported diabetes were not less likely to be up to date with CRCS than those without diabetes. Older men with diabetes were more likely to be up to date with CRCS than those without diabetes.