Five-Year Secular Trends and Predictors of Nonconsent to Receive Donor Milk in the Neonatal Intensive Care Unit.

OBJECTIVE: To identify independent maternal and infant factors associated with donor milk nonconsent and to examine secular trends in nonconsent rates. MATERIALS AND METHODS: Mothers of infants eligible to receive donor milk (≤32 weeks of gestation or ≤1,800 g) born between August 2010 and 2015 were included. Multivariable logistic regression modeled odds of nonconsent. RESULTS: Of the 486 mother/infant dyads from the first 5 years of the donor milk program, nonwhite race (adjusted odds ratio [aOR] 1.69; 95% confidence interval [CI] 1.04-2.76) and increasing gestational age (aOR 1.11; 95% CI 1.03-1.21) independently predicted nonconsent. Each year the program existed, there was a 48% reduction in odds of nonconsent (aOR 0.52; 95% CI 0.43-0.62). The most common reason given for nonconsent was "it's someone else's milk." CONCLUSION: Program duration was associated with reduced nonconsent rates and may reflect increased exposure to information and acceptance of donor milk use among neonatal intensive care unit staff and parents. Despite overall improvements in consent rates, race-specific disparities in rates of nonconsent for donor milk persisted after 5 years of this donor milk program. Further research is warranted to clarify the basis for race-based disparities in donor milk nonconsent rates, with the goal of designing interventions to reduce donor milk refusal among minority mothers.

Calcitonin gene polymorphism CALCA-624 (T/C) and ovarian cancer.

In a previous analysis, we reported an inverse association of dietary calcium intake with the risk of ovarian cancer (Goodman et al. 2002. Am J Epidemiol 156:148-57). The CALCA gene codes for calcitonin, an important regulator of bone calcium metabolism. Data from a population-based case-control study conducted in Hawaii were used to examine the hypothesis that a T --> C transition 624 base pairs upstream (-624) of the translation initiation codon of the CALCA gene influences the risk of ovarian malignancy. A structured interview was conducted for 182 histologically confirmed ovarian cancer cases and 219 controls. Blood specimens were collected from the subjects at their homes. A significant negative trend (P for trend: 0.02) in the odds ratios (ORs) was found with increasing intake of calcium. Women with any CALCA C allele were at nonsignificantly higher risk of ovarian cancer (OR: 1.5, 95% CI: 0.9-2.3) compared to women with the TT genotype and the risk increased with the number of C alleles (P for trend: 0.05). When further analyzed within ethnic subgroups, a significant positive association was found among Japanese for CALCA CT (OR: 2.3, 95% CI: 1.0-5.3) and CALCA CC (OR: 7.2, 95% CI: 1.1-46.0) compared with Japanese women who were homozygous for the T allele. The trend in risk associated with the C allele was most significant among women who had used oral contraceptives (P for trend: 0.05), had been pregnant (P for trend: 0.04), and had nonmucinous histological types of ovarian cancer (P for trend: 0.02). However, the association of ovarian cancer risk with the CALCA genotype was not significantly modified by any of the dietary, nondietary, or clinical variables included in this study. These preliminary data suggest a strong positive association of the CALCA C allele with the risk of ovarian cancer among some subgroups.

A tailored multi-media campaign to promote the human papillomavirus cohort study to young women.

BACKGROUND: Human papillomavirus (HPV), a sexually transmitted disease, is now recognized as the major cause of cervical cancer. The Cancer Research Center of Hawaii developed a low-cost and culturally sensitive multimedia campaign to recruit Oahu women to their HPV cohort study, specifically targeting women 18 to 35 years of age. METHODS: Initial promotions and enrollment revealed the highest prevalence of HPV among women ages 18-35. Promotional content was restructured to recruit this age group, based on focus group findings that these women may be motivated by information pertaining to the sexual transmission of HPV rather than its role as a risk factor for cervical cancer. Data obtained during initial triage of participants were used to assess the efficacy of the campaign. RESULTS: The number of women, 18-35, who responded to study promotions increased by 54%. At the conclusion of recruitment, 77% of the 508 HPV-positive women were between 18 and 35 years of age. E-mail and newspaper articles and advertisements generated the biggest response and were cost- and time-efficient. CONCLUSIONS: Although not as effective as personal recruitment during clinic visits, a media campaign which targets the desired demographic can both increase study participation as well as promote cancer prevention and health education.

Polymorphisms of interleukin (IL)-1alpha, IL-1beta, IL-6, IL-10, and IL-18 and the risk of ovarian cancer.

OBJECTIVE: Recent studies of ovarian cancer have suggested a role for inflammation in carcinogenesis. Data from a population-based case-control study in Hawaii were examined to assess the relation between polymorphisms in cytokines involved with the inflammatory response, specifically members of the interleukin (IL) family and the incidence of ovarian cancer. PATIENTS AND METHODS: The analysis of 182 epithelial ovarian cancer cases and 219 controls focused on the polymorphisms in the following genes: IL-1alpha, IL-1beta, IL-6, IL-10, and IL-18. Genotype data were obtained from blood samples collected in participants' homes, and reproductive, demographic, and lifestyle histories were collected during interview. RESULTS: There were no significant odds ratios (ORs) for ovarian cancer by allelic variants in any of the IL genes after adjusting for age, ethnicity, education, oral contraceptive pill use, pregnancy, and history of tubal ligation. Although there was a significantly reduced risk of ovarian cancer risk among women with an IL-1alpha (-4845) T allele compared to women with two G alleles (OR: 0.59; 95% confidence interval: 0.37-0.97) after adjustment for age and ethnicity, the trend was not significant (p = 0.10). Further examination of the data suggested that women with at least one IL-18 variant allele (a G to C transition at position -137) were at significantly decreased risk of advanced ovarian cancer (OR: 0.51; 95% confidence interval: 0.28-0.90) compared to women with the IL-18 GG genotype. There was a significant difference in the risk of ovarian cancer associated with the IL-18 C allele by stage at diagnosis (p = 0.04 for homogeneity in the ORs): cases with IL-18 GC or CC genotypes were less likely to be diagnosed at regional/distant stages. Analysis of the data within ethnic subgroups revealed a significant positive association of the heterozygous IL-18 GC genotype with ovarian cancer risk among Native Hawaiian women (OR: 9.96; 95% CI: 1.88-52.90). The OR for ovarian cancer was not significant for Native Hawaiian women homozygous for the IL-18 C allele, but only one case and control had the IL-18 CC genotype. CONCLUSIONS: Overall, this study does not support an association of selected IL-1alpha, IL-1beta, IL-6, IL-10, or IL-18 polymorphisms with the risk for ovarian cancer. However, the IL-18 G137C variant may be a marker for ovarian cancer progression or metastasis.