Determinants of the excessive rates of lung cancer in northeast Florida.

BACKGROUND: Age-adjusted rates of lung cancer among whites, but not blacks, in Duval County Jacksonville), Florida, have been among the highest of any metropolitan area of the United States for three decades. METHODS: We conducted a case-control study, interviewing 507 patients with lung cancer diagnosed from 1993 to 1996 and 1,007 control subjects, randomly selected from the county population. RESULTS: Cigarette smoking was the dominant cause of lung cancer (odds ratios, 59 among male current smokers; 30 among female current smokers). Both prevalence and intensity of smoking were excessive for whites but less for blacks when compared with national norms. Little association was found with residential patterns, indices of air quality, or occupation. Risk doubled with increased intake of dietary fat and with a family history of lung cancer. CONCLUSIONS: Life-style factors, especially smoking, but not environmental factors, appear responsible for the high rates of lung cancer in northeast Florida.

Southern cooking and lung cancer.

Dietary associations were examined as part of a case-control study exploring reasons for exceptionally high rates of lung cancer in northeast Florida. Interviews, which included a nationally standardized food frequency questionnaire, were conducted with 507 patients diagnosed with lung cancer during 1993-1996 or their next of kin and 1,007 persons of similar age, race, and gender randomly selected from the general population. A substantial reduction in risk was associated with high consumption of nutrient-dense fruits and vegetables. Risk was nearly doubled among men and women in the highest quartile of fat intake. The effects were most prominent for saturated and monounsaturated fats and not apparent for polyunsaturated fat consumption. Increased risk was linked to consumption of several individual high-fat foods, including some traditional Southern foods or methods of cooking, such as cooking vegetables with lard/fatback/bacon fat. Reported use of vitamin/mineral supplements was associated with decrease risk of lung cancer as well as dietary consumption of vitamins A, C, and E and some carotenoids. The findings are consistent with emerging evidence that risk of lung cancer rises with increasing dietary fat consumption. They indicate the need for further research to determine whether the association between fat intake and lung cancer is causal and, if so, to clarify the relationships with individual fat fractions.

Low-back injuries in a heavy industry. I. Worker and workplace factors.

The costs and circumstances of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of an offshore petroleum drilling company, 1979-1985, were compared. The objectives were to identify worker and workplace factors associated with low-back injuries, to identify factors differentially associated with lost-time injuries, and to formulate recommendations for the control of low-back injuries. Low-back-impact injuries resulted largely from falls. Efforts to prevent falls would have a potential to reduce other serious consequences as well as back injuries. Workers performing the heaviest physical labor were at highest risk of low-back strains. Based on activities precipitating the injury, modifications of work site, equipment, and procedures to help reduce low-back strains are recommended. Only job was a predictor of whether a low-back strain was likely to be associated with lost time. Even this association was lacking for low-back impact injuries. Cost control by preventing the small proportion of high cost injuries may not be feasible. Rather, subsets of low-back injuries defined, for example, by work site or activity can suggest options for intervention.

Low-back injuries in a heavy industry. II. Labor market forces.

Trends in rates of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of a petroleum drilling company, 1979-1985, were examined to investigate the relationship between economic factors and the incidence of low-back and other injuries. Economic indicators included the rate of resignations, a surrogate for turnover, and the rate of layoffs. Only lost-time low-back strain rates increased during times of worker layoffs. Non-low-back injury rates were highest during periods of high turnover and no layoffs. Although the increasing age of the work force and the anxiety generated by an industry-wide depression may have played a role, it is likely that the increase in lost-time low-back strain injuries was a worker response to possible layoff.

Evaluation of an occupational injury intervention in the petroleum drilling industry.

Installation of power makeup equipment (PME) on 13 of 30 mobile offshore drilling units (MODUs) under study in the Gulf of Mexico provided an opportunity to evaluate the effectiveness of this device in reducing drill floor injuries. Two groups of injuries were defined on the basis of worker activity at the time of injury and the vehicle of mechanical energy; one group, "related" injuries, were preventable by the PME; the other group, "unrelated" injuries, should not have been affected by the PME. Two quasiexperimental evaluation designs were employed. The first, a multiple time series comparison of MODUs equipped and not equipped with PME, yielded a quantitative estimate of injuries averted. The second, a pretest-posttest design, compared related and unrelated injuries before and after PME installation. Because this method was subject to bias if different trends were present for related and unrelated injuries, only qualitative results could be obtained. Both methods indicated a significant reduction in related injuries attributable to the PME. A cost-savings analysis indicated savings that could conservatively pay for the equipment within six years time.

The "accident prone" worker: an example from heavy industry.

A study of workers in a heavy industry shows that the proportion of workers with excessive injuries in two successive time periods did not exceed that expected by chance. While accident repeaters may exist, they were not a stable component of this workforce. Removing individuals with excessive injuries in a given time would not appreciably reduce the number of injuries in succeeding periods. Unlike earlier studies, this analysis was based on medically attended injuries only and controlled for job hazards, exposure, age, and changes in job and location.

Factors affecting individual injury experience among petroleum drilling workers.

To identify factors affecting the number of injuries experienced by petroleum drilling workers, we carried out a 44-month incidence density study on a cohort employed in January 1979 on mobile drilling units in the Gulf of Mexico. To control for job-related hazards, we computed a standardized ratio of observed to expected injuries for each worker based on his job history. The effect of personal and work history factors was then examined using analysis of variance. Age, rate of job changes, and rate of rig transfers had independent effects on injury rates. Length of service had little effect when age was controlled. The findings suggest that younger workers under stress such as job change may be more susceptible to injury than older workers, regardless of job. If so, targeted changes in procedures and environment which protect workers of all ages are important alternatives to reliance on supervision and experience in injury reduction.