Persistent and aggressive interactions with the police: potential mental health implications.

AIMS: Little is known about the potential health impact of police encounters despite a ubiquitous police presence in many disadvantaged urban environments. In this paper, we assess whether persistent or aggressive interactions with the police are associated with poor mental health outcomes in a sample of primarily low-income communities of colour in Chicago. METHODS: Between March 2015 and September 2016, we surveyed 1543 adults in ten diverse Chicago communities using a multistage probability design. The survey had over 350 questions on health and social factors, including police exposure and mental health status. We use sex-stratified logistic regression to examine associations between persistent police exposure (defined as a high number of lifetime police stops) or aggressive police exposure (defined as threat or use of police force during the respondent's most recent police stop) and the presence of post-traumatic stress disorder (PTSD) or depressive symptoms. RESULTS: Men reporting a high number of lifetime police stops have three times greater odds of current PTSD symptoms compared with men who did not report high lifetime police stops (OR 3.1, 95% CI 1.3-7.6), after adjusting for respondent age, race/ethnicity, education, history of homelessness, prior diagnosis of PTSD and neighbourhood violent crime rate. Women reporting a high number of lifetime police stops have two times greater odds of current PTSD symptoms, although the results are not statistically significant after adjustment (OR 2.0, 95% CI 0.9-4.2). Neither persistent nor aggressive police exposure is significantly associated with current depressive symptoms in our sample. CONCLUSIONS: Our findings support existing preliminary evidence of an association between high lifetime police stops and PTSD symptoms. If future research can confirm as causal, these results have considerable public health implications given the frequent interaction between police and residents in disadvantaged communities in large urban areas.

Pigeon allergens in indoor environments: a preliminary study.

BACKGROUND: Few studies have measured pigeon allergens in non pigeon coop environments. This study was conducted to determine approximate pigeon dropping allergen concentrations in indoor environments. METHODS: Polyclonal antibody serum was prepared by injecting a rabbit three times with crude wild pigeon dropping extract in 50 mM Tris buffer with Freund's adjuvant. One hundred and fifteen dust samples were collected in a pigeon-infested school, pigeon coops, homes and hospitals and analyzed by a direct competitive pigeon enzyme-linked immunosorbent assay (ELISA). RESULTS: The highest level of pigeon allergen inhibitory activity were recorded in four samples from pigeon coop bedding samples with a median activity of 11.2% relative to pigeon droppings. The second highest level of pigeon allergens was in a pigeon-infested high school with a median or 7.4% activity relative to pigeon droppings. At an entrance underneath pigeon roosts, one sample had a relative inhibitory activity of 62.3%. Pigeon allergen inhibitory levels were generally low in the home and hospital samples, but nevertheless 46 out of 89 of these samples were still above detection limit. CONCLUSIONS: This study suggests that large concentrations of pigeon allergens can be found in buildings without domestic pigeons such as the pigeon-infested high school.

The effects of PCB exposure and fish consumption on endogenous hormones.

Previous studies have suggested that exposure to polychlorinated biphenyls (PCBs) may alter thyroid function, but data on effects of PCB exposure on other endogenous hormones has been lacking. The current study is ancillary to a larger investigation of the effects of Great Lakes fish consumption on PCBs and reproductive function. In the current study we examine associations of PCBs, 1,1-bis (4-chlorophenyl)-2,2-dichloroethene (DDE), and fish consumption with thyroid and steroid hormones in 178 men and PCBs, DDE, and fish consumption with thyroid hormones in 51 women from the original study. Serum PCB level and consumption of Great Lakes fish are associated with significantly lower levels of thyroxine (T(4)) and free thyroxine index (FTI) in women and with significantly lower levels of T(4) in men. Fish consumption, but not PCB level, is significantly and inversely associated with triiodothyronine (T(3)) in men. Results for thyroid-stimulating hormone (TSH) are inconsistent. Among men, there are significant inverse associations of both PCB and fish consumption with sex hormone-binding globulin (SHBG)-bound testosterone, but no association with SHBG or free testosterone. There are no significant overall associations of PCB, DDE, or fish consumption with estrone sulfate, follicle-stimulating hormone, luteinizing hormone, or dehydroepiandrosterone sulfate. The results of this study are consistent with previous studies showing effects of fish consumption and PCB exposure on thyroid hormones and suggest that PCBs may also decrease steroid binding to SHBG. Elucidation of specific mechanisms must await future investigations.

Risk of disease in siblings of patients with hereditary hemochromatosis.

BACKGROUND: Parents of hereditary hemochromatosis (HH) homozygote patients, who are predominantly HH heterozygotes, have been found to have an increased risk of colonic neoplasia, diabetes, stroke death, stomach cancer and leukemia. The health histories of siblings of HH patients are reported. METHODS: Individuals homozygous for HH were mailed questionnaires concerning the health histories of their siblings. Spouses of the HH homozygotes were asked to complete accompanying questionnaires concerning their siblings. The frequencies of serious illness and, when specified, each reported disease were determined by zygosity, odds ratios and 95% confidence intervals estimated. RESULTS: Data were available for 279 siblings known to be HH homozygotes (HHs), and 1,265 other siblings of HH patients, who are predominantly hemochromatosis heterozygotes (HHhet). Controls consisted of 1,338 spouse siblings in whom only the general population prevalence of HH homozygosity and heterozygosity existed. Odds ratios comparing HH strata to controls were elevated for serious illness (1.12 in HHhet, 1.71 in HHs), diabetes (0.78, 2.45), arthritis (2.10, 1.69), and hepatoma (1.06, 11.96). CONCLUSIONS: There was a significant trend for increased risk of serious illness among siblings of HH patients with increasing exposure to the HH gene, especially for diabetes, arthritis and hepatoma.

Is hereditary hemochromatosis a balanced polymorphism: an analysis of family size among hemochromatosis heterozygotes.

BACKGROUND/AIMS: Hereditary hemochromatosis (HH) has a homozygote frequency of 0.5% and a heterozygote frequency of 13%, which suggests that hemochromatosis might be a balanced polymorphism. Evidence for this was sought by assessing reproductive success among hemochromatosis heterozygotes through determining their family size and incidence of miscarriage when compared to nongene carriers. METHODOLOGY: A cohort was defined in which the exposure variable was heterozygosity for hereditary hemochromatosis. Heterozygotes were identified by mailing individuals homozygous for hereditary hemochromatosis questionnaires concerning the number of siblings born alive and the number of miscarriages suffered by their mothers (predominantly heterozygotes, or HHH). Spouses of the hereditary hemochromatosis homozygotes were asked to complete accompanying questionnaires concerning their mothers (CONT). RESULTS: Five hundred and ninety-six responses were received from hereditary hemochromatosis homozygotes and 532 responses from spouses of the hereditary hemochromatosis homozygote respondents. The mothers of the hereditary hemochromatosis homozygote respondents had a mean family size of 3.699. The mothers of the unexposed spouse controls a mean family size of 3.639 (P = 0.66 by ANOVA). One hundred and twenty-three of the HHH mothers suffered a total of 201 miscarriages, whereas 94 of the CONT mothers suffered 147 miscarriages (P = 0.38 by ANOVA). CONCLUSIONS: In this cohort, no evidence among hemochromatosis heterozygotes of reproductive advantage and therefore heterozygous advantage by this mechanism was seen.

Prevalence of asthma and other allergic diseases in an adolescent population: association with gender and race.

OBJECTIVES: To estimate the prevalence and severity of asthma in an adolescent population by sex and race. METHODS: Cross-sectional, population-based survey of school children. SETTING: Midwestern city experiencing damage from the 1993 Mississippi River flood. PARTICIPANTS: 2,693 children attending grades 7 to 12. MEASUREMENTS: Questions from the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: Two thousand six hundred ninety-three children were surveyed, for a response rate of 90%. In this population, 16.4% reported having ever been diagnosed with asthma; 25% reported wheezing in the last 12 months; 32% reported symptoms of rhinitis in the last 12 months; and 22% reported ever having hay fever. The prevalence rate for current asthma was 12.6%. Female students had significantly greater prevalence rates for current asthma (16.4% vs 9.0%, OR = 1.85); ever-diagnosed asthma (18.5% vs 14.3%, OR = 1.36); wheezing > or = 4 times in the last 12 months (12.0% vs 5.6%, OR = 1.95); current rhinitis (38.7% vs 25.4%, OR = 1.73); and hay fever (26.4% vs 18.4%, OR = 1.57). All associations with sex remained significant, except ever-diagnosed asthma, after controlling for other known risk factors in logistic regression. African-Americans had higher prevalence rates than other races with differences reaching statistical significance for ever-diagnosed asthma and current asthma; however, these relationships did not remain significant after controlling for other known risk factors in logistic regression. CONCLUSIONS: Our prevalence rates were similar to those reported by other studies that used the ISAAC questionnaire. Female students reported significantly more asthma, wheezing, rhinitis, and hay fever than male students. Female students also reported more severe symptoms and a greater number of emergency room and hospital admissions.

Association of asthma symptoms and severity with indoor bioaerosols.

BACKGROUND: In this study, repeated measurements were made of levels of mold spores, bacteria, and dust-mite allergens over a 7-month period in the homes of asthmatics, and relationships with measures of asthma severity were evaluated. METHODS: A sample of 57 asthmatic individuals, living in 44 homes in East Moline, Illinois, and nearby communities, participated in a panel study. The homes were visited up to nine times during the study to collect air and dust samples. Asthma severity indicators were derived from questionnaire data and from the daily health records from the panel study. Associations between indoor levels of mold spores, bacteria, and dust-mite allergens were tested with several asthma severity indicators. RESULTS: There was evidence of associations between all asthma severity measures and levels of total and gram-negative bacteria, but mold-spore abundance was associated only with emergency room (ER) visits for asthma. No significant associations were found with house-dust-mite allergen and any of the asthma severity indicators, but the levels of dust-mite allergen were low, with median concentrations of 0.18 microg/g dust Der f 1 and 0.19 microg/g dust Der p 1. CONCLUSIONS: Some evidence was found for associations of increased concentrations of gram-negative bacteria and mold spores with asthma severity, particularly with ER visits. No association was found between house-dust-mite allergen and asthma severity indicators; however, the mite-allergen levels in the study homes were generally well below the proposed threshold level of 2 microg/g dust.

Chicago community-based asthma intervention trial: feasibility of delivering peer education in an inner-city population.

The most effective means of educating children with asthma and their families has not been clearly demonstrated in previous studies. Peer education is uniquely suited to the complex problems encountered in underserved populations. The purpose of this study was to show the feasibility of delivering a peer education program for children with asthma and the effect of the program on indoor allergen levels in an inner-city population in Chicago. Overall, the program was well received. Baseline allergen levels were consistent with some previous studies in showing low levels of mite allergens and high levels of cockroach allergens, with 79.6% of samples having levels > 8 U/g. A total of 28.2% of samples had cat allergen levels > 2 microg/g, although only 9.7% of homes had cats, confirming previous reports that cat allergen is ubiquitous. Mold levels were seasonal, with the highest levels in the summer. Results from this study suggest that intervention programs should focus more on elimination of cockroaches than was previously appreciated, while minimizing the use of pesticides, and on identification of the sources of cat allergen. Structural and psychosocial issues in homes need to be addressed in future studies. This study has demonstrated the feasibility of delivering peer education in a inner-city population and highlighted the need for comprehensive intervention strategies addressing complex issues facing underserved neighborhoods.

Carcinoma in situ of the colorectum: SEER trends by race, gender, and total colorectal cancer.

BACKGROUND AND OBJECTIVES: To determine if Americans of African origin (blacks) have less access to colonoscopic polypectomy than Americans of European origin (whites), the rate of carcinoma in situ of the colorectum (CIS), a disease more similar to benign adenoma of the colorectum than invasive cancer in its symptomatology, discovery, and treatment, was determined in the United States from 1973 to 1994. The hypothesis being tested is that CIS will be far less common in blacks than in whites and that rates of CIS should be increasing in whites from 1973 to 1994. METHODS: CIS and invasive carcinoma of the colorectum incidence data were obtained from Surveillance, Epidemiology, and End Results (SEER) Public Use Files from 1973 through 1994. Rates were age adjusted and proportions determined by division of CIS rates for each subsite by total carcinoma rates, for each year, race, and gender. The colorectum was divided anatomically in this analysis at the junction of the descending and sigmoid colon. RESULTS: The relationships between male/female and black/white CIS incidence rates were broadly similar to invasive cancer rates over the 21 years of SEER, demonstrating a white male predominance for distal disease, a black male predominance for proximal disease, and a decline in incidence since 1988. CIS as a proportion of total colorectal cancer increased in all races and genders from 1973 to 1987, but then declined in all groups. CONCLUSIONS: The majority of CIS is excised by endoscopic resection. Therefore, this might be considered a surrogate population for those individuals who have colonoscopic resection of benign adenomas. It is this latter treatment that has been hypothesized to be the cause for the declining incidence of invasive colorectal cancer. However, data presented herein do not support this hypothesis.

Determination of factors responsible for the declining incidence of colorectal cancer.

INTRODUCTION: After rising for 13 years in the United States, the incidence of colorectal cancer began to fall in 1986 and has continued to drop since then. This report contains an analysis of the pattern of declining colorectal cancer risk by colorectal subsite, race, and gender and a time trend investigation of suspected risk modifiers of colorectal cancer. METHOD: Colorectal cancer incidence data were obtained from the Surveillance, Epidemiology, and End Results Public Use Files from 1973 to 1994. The following exposure variables were assessed, focussing principally on the period 1970 to 1980: dietary fat, fiber, ethanolic beverages, vitamin A, vitamin C, iron, calcium, estrogen, aspirin, energy intake, body mass index, serum cholesterol, body iron stores, cholecystectomy, constipation, cigarette use, physical activity, and colonoscopic polypectomy. Data sources used in these analyses were principally National Health and Nutrition Examination Surveys I, II, and III. RESULTS: After 1985 colorectal cancer incidence declined predominantly in the distal colorectum almost equally in both white males and white females. Some exposures remained unchanged or trended in the wrong direction (dietary fat, calcium, ethanol, energy intake, physical activity, overweight prevalence, and cholecystectomy). Others did not apply equally to both genders (estrogen, aspirin, ethanol, calcium, and cholecystectomy). Others may become significant in the future, such as aspirin, estrogen, or calcium, because their supplementation is now prevalent, but were not in 1970 to 1975. Of all the risk factors or interventions assessed, the one most consistent with the observed pattern of change is increased use of colonoscopic polypectomy. CONCLUSION: The best method to diminish the incidence of colorectal cancer today may be to increase the use of screening colonoscopy and polypectomy.

Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children.

BACKGROUND: Asthma mortality rates in Chicago are among the highest in the United States, with substantially greater rates in poor and minority populations. How much of the differential can be attributed to differences in prevalence versus severity or access to care has not been determined. OBJECTIVE: To examine rates of asthma prevalence, severity, and symptoms and to explore the relationships of these rates to race and socioeconomic status in a random sample of Chicago school children. METHODS: Self-administered survey. RESULTS: Overall, rates of asthma were higher than previously reported, with 16% of students in the stratified cluster random sample of 3,670 children in the 7th and 8th grades having had asthma. Prevalence rates were significantly higher in schools with >98% African Americans than in other schools, with the highest prevalence rates seen in African American schools in low income neighborhoods. Rates were associated with the percent of African American children in the school and with median income of the school's census tract. Relationships were most consistent with indices of more severe disease. CONCLUSIONS: Asthma prevalence is higher than previously noted, with rates greatest in minority and low income populations. Differences are more striking for measures of severity than for symptoms of wheezing, but are far less than previously reported differences in mortality, suggesting that additional factors, such as differential access to continuous health care, may be affecting high death rates from asthma in Chicago.

Long-term intake of soy protein improves blood lipid profiles and increases mononuclear cell low-density-lipoprotein receptor messenger RNA in hypercholesterolemic, postmenopausal women.

The long-term clinical effects of soy protein containing various amounts of isoflavones on lipoproteins, mononuclear cell LDL receptor messenger RNA concentrations, and other selected cardiovascular risk factors are not well known. Sixty-six hypercholesterolemic, free-living, postmenopausal women were investigated during a 6-mo parallel-group, double-blind trial with 3 interventions. After a control period of 14 d, all subjects were randomly assigned to 1 of 3 dietary groups (all with 40 g protein): a National Cholesterol Education Program (NCEP) Step 1 diet with protein from casein and nonfat dry milk (control), an NCEP Step 1 diet with protein from isolated soy protein containing moderate amounts of isoflavones (ISP56), or an NCEP Step 1 diet with protein from isolated soy protein containing high amounts of isoflavones (ISP90). Non-HDL cholesterol in both the ISP56 and ISP90 groups was reduced compared with the control group (P < 0.05), whereas total cholesterol was not changed. HDL cholesterol increased in both the ISP56 and ISP90 groups (P < 0.05), whereas the ratio of total to HDL cholesterol decreased significantly in both groups compared with the control (P < 0.05). Mononuclear cell LDL receptor messenger RNA concentrations increased in subjects consuming ISP56 or ISP90 compared with the control (P < 0.05). These results indicate that soy protein, with different amounts of isoflavones, may decrease the risk of cardiovascular disease via improved blood lipid profiles, and that the mechanism by which apolipoprotein B-containing lipoproteins were depressed may be via alterations in LDL receptor quantity or activity.

A morbidity study of former pentachlorophenol-production workers.

Pentachlorophenol (PCP) is a pesticide that was once widely used for wood preservation. Commercial PCP contained impurities including higher chlorinated dibenzo-p-dioxins (CDDs) and chlorinated dibenzofurans (CDFs). We investigated the effects of occupational exposure to PCP and its CDD and CDF contaminants on the skin, liver, porphyrin metabolism, and central and peripheral nervous systems. In 1986 we conducted a medical survey of 366 workers who had been engaged in the production of PCP at a single plant between 1938 and 1978. The referent group consisted of 303 workers from the same plant who were not exposed to these or related compounds. Exposure was determined from computerized personnel records. The medical survey included an administered questionnaire, medical record review, physical examination by dermatologists, internists, and neurologists, and analysis of 24-hr urine for quantitative porphyrins among other tests. In this paper we present the results of analyses of the general health, chloracne, and porphyrin metabolism end points. The general health status of PCP workers was similar to unexposed workers, but 17.8% of PCP workers had evidence of current or past chloracne. PCP workers with chloracne had significantly higher mean urinary excretion of coproporphyrins (117. 0 vs. 90.6 microg/24 hr) than unexposed workers after controlling for potential confounders. Workers with chloracne who had worked with both PCP and polychlorinated biphenyls had significantly higher mean urinary excretions of hepta-, penta-, and coproporphyrins than unexposed workers. We conclude that occupational exposure to PCP is associated with chloracne and biochemical abnormalities which may persist years after exposure.

Asthma prevalence and risk factors in selected Head Start sites in Chicago.

Prevalence of and risk factors for asthma were examined in 1085 Head Start families at 18 Head Start sites in four high-risk community areas in 1994. A total of 13.9% of the families reported diagnosed asthma in their Head Start child and 18.8% reported that their child wheezed in the last 12 months. A total of 26.9% of respondents reported asthma in the immediate family of the child. Low birth weight (1500-2499 g), very low birth weight (<1500 g), and self-reported exposure to dampness or mold in the last 12 months were significantly associated with self-reported diagnosed asthma (OR = 1.93; 95% CI 1.17-8.73), (OR = 4.5; 95% CI 1.25-16.3), and (OR = 1.94; 95% CI 1.23-3.04), respectively. The young age of the children in Head Start, as well as the high prevalence of asthma in their families, suggest that the Head Start programs offer an unusual opportunity for asthma prevention programs.

Time trends in distal colorectal cancer subsite location related to age and how it affects choice of screening modality.

BACKGROUND AND OBJECTIVES: A time trend analysis of colorectal cancer (CRC) incidence in the distal colorectum as a proportion of total CRC is presented for the period 1977-1994 as a function of age, to determine the age at which Americans might best be served by screening fiberoptic sigmoidoscopy. METHODS: CRC incidence rates were obtained for each anatomic subsite from SEER Public Use Files for 1977, 1986, and 1994. The colorectum was divided anatomically for these analyses at the junction of the descending colon and sigmoid colon. Incidence in the distal colorectum was divided by total CRC incidence to determine the proportion of CRC in that age/race/gender/year cohort located in the distal colorectum. RESULTS: The proportion of distal CRC among African Americans was without a clear trend as they grew older in each of the years of observation and in both genders. However, in whites, with increasing age, the proportion of distal disease declined progressively in both genders, with the greatest decline in 1994. Distal CRC became less prevalent than proximal at about age 72 years in white women and at age 82 in white men in 1994. CONCLUSIONS: As the white population becomes older, and for African Americans of all ages, more total colon screening modalities are needed, although at the onset of recommended screening, among 50- to 60-year-olds, fiberoptic sigmoidoscopy would appear efficacious.

Lead exposure in ironworkers.

In adults, lead toxicity is most commonly caused by occupation in a lead industry. Whereas lead toxicity has been described in workers who are involved in bridge rehabilitation, as of this date there has been no systematic evaluation published regarding the conditions responsible for lead toxicity in ironworkers. This is a report of a study designed to identify risk factors for elevated blood-lead levels in ironworkers. One hundred fifty members of a 2,400-member local ironworkers union volunteered to have their blood drawn for lead and zinc protoporphyrin analysis and to complete a questionnaire regarding demographics, health, and occupation. The relationships between these variables and blood-lead level were analyzed using student's t-test, chi-square, and logistic regression. Current work on a lead job, rivet busting as the predominant job task, and cigarette smoking were all found to be significantly associated with elevated blood-lead level. Whereas cigarette smoking and current work with lead have been previously identified as risk factors for toxicity, interventions to prevent lead toxicity in ironworkers should also focus on work practices during rivet busting.