Aims: To evaluate cancer incidence among workers at two facilities in the USA that made semiconductors and electronic storage devices. Methods: 89 054 men and women employed by International Business Machines (IBM) were included in the study. We compared employees’ incidence rates with general population rates and examined incidence patterns by facility, duration of employment, time since first employment, manufacturing era, potential for exposure to workplace environments other than offices and work activity. Results: For employees at the semiconductor manufacturing facility, the standardised incidence ratio (SIR) for all cancers combined was 81 (1541 observed cases, 95% confidence interval (CI) 77 to 85) and for those at the storage device manufacturing facility the SIR was 87 (1319 observed cases, 95% CI 82 to 92). The subgroups of employees with ≥15 years since hiring and ≥5 years worked had 6–16% fewer total incidents than expected. SIRs were increased for several cancers in certain employee subgroups, but analyses of incidence patterns by potential exposure and by years spent and time since starting in specific work activities did not clearly indicate that the excesses were due to occupational exposure. Conclusions: This study did not provide strong or consistent evidence of causal associations with employment factors. Data on employees with long potential induction time and many years worked were limited. Further follow-up will allow a more informative analysis of cancer incidence that might be plausibly related to workplace exposures in the cohort.

OBJECTIVE:This study evaluated mortality during 1962 through 2003 and cancer incidence during 1995 through 2003 at a tire manufacturing plant. METHODS:The mortality study included 3425 men and women, employed for at least one year. Of these, 3069 were eligible for the cancer incidence study. RESULTS:Employees experienced 390 deaths compared with 608 expected (standardized mortality ratio (SMR)=64; 95% confidence interval (CI)=58-71). Total cancer mortality (123 observed, SMR=75, CI=62-89) and lung cancer mortality (47 observed, SMR=72, CI=53-96) were lower than expected. Hourly white men had small increases in stomach cancer, bladder cancer, and leukemia deaths. During 1995 through 2003, 169 incident cancers were observed compared with 197 expected (SIR=86, 95% CI=74-100). Three mesothelioma cases occurred among hourly white men (SIR=653, CI=135-1907); all were exposed potentially to asbestos before starting at the rubber plant. CONCLUSIONS:Small numbers and limited information on jobs, occupational agents, and lifestyle preclude attribution of observed increases to workplace exposures.

Risk AnalysisVolume 27, Issue 1 p. 9-10 Estimating Past Dioxin Exposure: Response to Steenland and Bartell Lesa L. Aylward, Lesa L. AylwardSearch for more papers by this authorHong Cheng, Corresponding Author Hong Cheng *Address correspondence to Hong Cheng, Department of Epidemiology, UAB School of Public Health, 527C RPHB, 1665 University Boulevard, Birmingham, AL 35294-0022, USA; tel: (205) 975-8679; heheng@ms.soph.uab.edu.Search for more papers by this authorColleen Beall, Colleen BeallSearch for more papers by this authorThomas B. Starr, Thomas B. StarrSearch for more papers by this authorRobert Brunet, Robert BrunetSearch for more papers by this authorGaétan Carrier, Gaétan CarrierSearch for more papers by this authorElizabeth Delzell, Elizabeth DelzellSearch for more papers by this author Lesa L. Aylward, Lesa L. AylwardSearch for more papers by this authorHong Cheng, Corresponding Author Hong Cheng *Address correspondence to Hong Cheng, Department of Epidemiology, UAB School of Public Health, 527C RPHB, 1665 University Boulevard, Birmingham, AL 35294-0022, USA; tel: (205) 975-8679; heheng@ms.soph.uab.edu.Search for more papers by this authorColleen Beall, Colleen BeallSearch for more papers by this authorThomas B. Starr, Thomas B. StarrSearch for more papers by this authorRobert Brunet, Robert BrunetSearch for more papers by this authorGaétan Carrier, Gaétan CarrierSearch for more papers by this authorElizabeth Delzell, Elizabeth DelzellSearch for more papers by this author First published: 13 March 2007 https://doi.org/10.1111/j.1539-6924.2006.00877.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume27, Issue1February 2007Pages 9-10 RelatedInformation

PURPOSE:Incidence studies of occupational factors and cancer in the United States are problematic because the use of population-based registries to identify cases requires development of historical data on subjects' residences and often severely restricts the time period of follow up. This article describes procedures for addressing these challenges.METHODS:We used data from studies of cancer incidence and mortality among microelectronics industry employees to assess various methods for developing residential histories and the relative informativeness of the two studies.RESULTS:We developed residential histories for 98% of 99,229 mortality study subjects. Analyses making alternative assumptions about residential histories yielded standardized incidence ratios varying by at most 6%. Use of postemployment residential histories increased person-years by up to 62% and increased the observed number of cancers by up to 28%. The proportion of mortality study person-years included in the cancer incidence study ranged from 40% to 77% among work activity subcohorts. The number of observed cancer cases in the incidence study was 60% higher than the number of observed cancer deaths in the mortality study.CONCLUSIONS:Assumptions about residential history had little impact on validity. Use of information sources with national coverage to develop residential histories increased the incidence study's precision. Despite geographic and temporal restrictions, incidence studies provide more data than mortality studies on cancers with good survival. However, the potential for selection bias in incidence studies may vary considerably among subcohorts, indicating the need for cautious interpretation of such research.

We examined the relation between cancer mortality and time‐dependent cumulative exposure to 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin (TCDD) estimated from a concentration‐ and age‐dependent kinetic model of elimination, and we estimated incremental cancer risks at age 75. Data from the National Institute for Occupational Safety and Health study of 3,538 workers with occupational exposure to TCDD were analyzed using standardized mortality ratios and Cox regression procedures. Analyses adjusted for potential confounding by age, year of birth, and race and considered exposure lag periods of 0, 10, or 15 years. Other potential confounders including smoking and other occupational exposures were evaluated indirectly. To explore the influence of extreme values of cumulative TCDD ppt‐years, we restricted the analysis to observations with exposure below the 95th percentile or used logarithmic (ln) transformed exposure values. We applied penalized smoothing splines to examine variation in the exposure‐response relation across the exposure range. TCDD was not statistically significantly associated with cancer mortality using the full data set, regardless of the lag period. When we restricted the analysis to observations with exposure below the 95th percentile, TCDD was associated positively with cancer mortality, particularly when a 15‐year lag was applied (untransformed exposure data: regression coefficient , standard error (s.e.) = 1.4 × 10−6, p < 0.05; ln‐transformed exposure data: , s.e. = 2.9 × 10−2, p < 0.05). The estimated incremental lifetime risk of mortality at age 75 from all cancers was about 6 to more than 10 times lower than previous estimates derived from this cohort using exposure models that did not consider the age and concentration dependence of TCDD elimination.

Recent studies demonstrating a concentration dependence of elimination of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) suggest that previous estimates of exposure for occupationally exposed cohorts may have underestimated actual exposure, resulting in a potential overestimate of the carcinogenic potency of TCDD in humans based on the mortality data for these cohorts. Using a database on U.S. chemical manufacturing workers potentially exposed to TCDD compiled by the National Institute for Occupational Safety and Health (NIOSH), we evaluated the impact of using a concentration- and age-dependent elimination model (CADM) (Aylward et al., 2005) on estimates of serum lipid area under the curve (AUC) for the NIOSH cohort. These data were used previously by Steenland et al. (2001) in combination with a first-order elimination model with an 8.7-year half-life to estimate cumulative serum lipid concentration (equivalent to AUC) for these workers for use in cancer dose-response assessment. Serum lipid TCDD measurements taken in 1988 for a subset of the cohort were combined with the NIOSH job exposure matrix and work histories to estimate dose rates per unit of exposure score. We evaluated the effect of choices in regression model (regression on untransformed vs. ln-transformed data and inclusion of a nonzero regression intercept) as well as the impact of choices of elimination models and parameters on estimated AUCs for the cohort. Central estimates for dose rate parameters derived from the serum-sampled subcohort were applied with the elimination models to time-specific exposure scores for the entire cohort to generate AUC estimates for all cohort members. Use of the CADM resulted in improved model fits to the serum sampling data compared to the first-order models. Dose rates varied by a factor of 50 among different combinations of elimination model, parameter sets, and regression models. Use of a CADM results in increases of up to five-fold in AUC estimates for the more highly exposed members of the cohort compared to estimates obtained using the first-order model with 8.7-year half-life. This degree of variation in the AUC estimates for this cohort would affect substantially the cancer potency estimates derived from the mortality data from this cohort. Such variability and uncertainty in the reconstructed serum lipid AUC estimates for this cohort, depending on elimination model, parameter set, and regression model, have not been described previously and are critical components in evaluating the dose-response data from the occupationally exposed populations.

OBJECTIVE:Smokeless tobacco (ST) use remains a prevalent form of tobacco use among certain US populations. The purpose of this paper is to clarify its role in cancer development.METHODS:Using data from a prospective cohort of the US population, we categorized 6,779 subjects 45-75 years of age as ST users or non-ST users. Subjects were further stratified by cigarette smoking status in order to differentiate 'exclusive' ST users (n=414) from never tobacco users (n=2,979).RESULTS:In this cohort, exclusive ST use was not associated with increased incidence of all cancer in males (hazard ratio=0.8, 95% CI: 0.4, 1.6) or females (HR=1.2, 95% CI: 0.7-2.1) or oral cancer (standardized incidence ratio=30, 95% CI: 3, 95). No synergistic effect was observed between ST and cigarette smoking among male combined users (females were not analyzed for combined use) for the major cancers.CONCLUSIONS:In contrast to the well-known deleterious effects of cigarette smoking, ST use did not substantially increase the risk for cancer incidence above that of non-tobacco users, particularly among males. Although the use of tobacco in any form is to be discouraged, our data suggests that cancer risks are much lower from ST use than from cigarette smoking.

BACKGROUND:Many cancer risk factors are correlated with one another, and the presence of 1 risk factor may be a marker for other unhealthy behaviors. In this article, we focus on smokeless tobacco (ST), a known risk factor for oral leukoplakia and oral cancer, and the cancer risk factors associated with its use. METHODS:We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) I and the 1982-1984 NHANES I Epidemiologic Follow-up Study. Risk factor information was available on individuals 25-74 years of age, most of whom would be middle age or elderly today. RESULTS:Older subjects, Black males, and those living in the Southern Unite States had the highest prevalence of ST use. ST use was associated with current smoking (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.5), former smoking (OR, 1.6; 95% CI, 1.4-2.0), low fruit and vegetable intake, low SES, increased alcohol consumption (among nonsmoking ST users), and increased body mass index, all of which elevate cancer risk. CONCLUSION. Physicians and dentists should ask their patients about current or former ST use. Identification of ST users should prompt the physician or dentist to inquire about other chronic disease risk factors that the patient may have and to educate the ST using patient about ways to reduce their risk of cancer.

PROBLEM:We evaluated mortality during 1965 to 1999 among 126,836 workers at two semiconductor facilities and one storage device facility. METHOD:We compared employees' cause-specific mortality rates with general population rates and examined mortality patterns by facility, duration of employment, time since first employment, and work activity. RESULTS:Employees had lower-than-expected mortality overall (6579 observed deaths, standardized mortality ratio [SMR] = 65; 95% confidence interval [CI] = 64-67), for all cancers combined (2159 observed, SMR = 78, 95% CI = 75-81) and for other major diseases. Central nervous system cancer was associated with process equipment maintenance at one of the semiconductor facilities (10 observed, SMR = 247, 95% CI = 118-454). Prostate cancer was associated with facilities/laboratories at the storage device facility (18 observed, SMR = 198, (5% CI = 117-313). CONCLUSIONS:Further evaluation of workplace exposures or independent investigations of similar occupational groups may clarify the interpretation of associations observed in this study.

BACKGROUNDThis study evaluated mortality among workers at a talc mining and milling facility.METHODSSubjects were white men actively employed between 1948 and 1989 and known to have been alive in or after 1950. Analyses assessed cancer mortality during the period 1950-89 (809 subjects) and non-cancer mortality during 1960-89 (782 subjects).RESULTSComparisons with regional general population death rates for 1960-89 indicated that the workers had more than expected deaths from all causes combined [209 observed/160 expected, standardized mortality ratio (SMR) = 131, 95% confidence interval (CI) = 114-150], due mainly to increased mortality from lung cancer (31/13, SMR = 232, CI = 157-329) and non-malignant respiratory disease (NMRD) (28/13, SMR = 221, CI = 147-320). The lung cancer excess was concentrated in miners (18/4.6, SMR = 394, CI = 233-622); millers had only a small increase (7/5.5, SMR = 128, CI = 51-263). An excess of NMRD occurred both in miners (10/4.2, SMR = 241, CI = 116-444) and in millers (11/4.8, SMR = 227, CI = 113-407). The median estimated exposure to respirable dust was 511 mg/m(3)-days for all exposed employees, 739 mg/m(3)-days for mine workers and 683 mg/m(3)-days for mill workers. Employees with high, compared with low, estimated exposure to dust had a rate ratio of 0.5 (CI = 0.2-1.3) for lung cancer and of 11.8 (CI = 3.1-44.9) for pulmonary fibrosis.CONCLUSIONSExposure to talc ore dust may not have been responsible for the lung cancer excess among these workers but probably contributed to the elevated rate of NMRD, particularly pulmonary fibrosis.

The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. Using data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study, the authors assessed the 20-year mortality experience of smokeless tobacco users. Subjects aged 45 years or more at baseline (1971-1975) were categorized as either smokeless tobacco users (n = 1,068) or non-smokeless tobacco users (n = 5,737). Subjects were further stratified by smoking status and gender. Proportional hazard ratios were used to assess associations. After adjustment for confounders, no association between smokeless tobacco use and all-cause (hazard ratio = 1.1, 95% confidence interval (CI): 0.9, 1.3), all cancer (hazard ratio = 1.1, 95% CI: 0.6, 1.9), or all cardiovascular (hazard ratio = 1.1, 95% CI: 0.8, 1.5) mortality was found. There was an increase in all cancer mortality of borderline significance among female smokeless tobacco users (hazard ratio = 1.7, 95% CI: 1.0, 2.8). The lung cancer mortality rate among combined users (smokeless tobacco and cigarettes), based on the rates for exclusive smokeless tobacco users and exclusive smokers, was higher than expected, possibly because of heavier smoking among these subjects. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products.

This case-control study evaluated the relation between potential exposure to chemical and physical agents and the occurrence of intracranial tumors among employees at a petrochemical research facility. Cases were employees with glioma (n = 6) or benign intracranial tumors (n = 6). Controls (n = 119) were individually matched to cases on gender and birth year, and they were alive and did not have an intracranial tumor at the case’s diagnosis date. Exposure information came from interviews with subjects or surrogates and from corporate records on agents used in research projects. Analyses computed matched odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for self-reported exposure to 15 agents and project-based estimates of exposure to 29 agents. For gliomas, the OR was elevated for self-reported exposure to ionizing radiation (OR, 15.7; CI, 1.4 to 179.4), n-hexane (OR, ∞; CI, 1.4 to ∞), organometallics (OR, 9.4; CI, 1.5 to 59.7), and amines other than nitrosamines (OR, 6.0; CI, 1.0 to 35.7). The OR also was elevated for project-based potential use of ionizing radiation (OR, 9.6; CI, 1.7 to 55.2) and for potential use of n-hexane lasting at least 4 years (OR, 16.2; CI, 1.1 to 227.6). For benign intracranial tumors, the OR was elevated only for self-reported exposure to ionizing radiation (OR, 5.4; CI, 1.7 to 43.1) and other amines (OR, 5.2; CI, 0.9 to 29.5). Occupational exposure may have contributed to the glioma excess, but the specific causal agents remain unknown. The study indicated that benign intracranial tumors were unlikely to be work-related.

This investigation evaluated cancer incidence among workers at a petrochemical research facility in Illinois. A cluster of brain cancer and other intracranial tumors had occurred at the facility before the study began. The subjects were 5641 people who had worked at the facility from 1970 through 1996 and who had lived in Illinois at any time between 1986 and 1997. Data on cancer cases came primarily from the Illinois State Cancer Registry. Analyses compared the 1986-to-1997 cancer incidence rates of employees with Illinois general population rates. Subjects had 18% fewer than expected total cancers (125 observed/153 expected cases; standardized incidence ratio [SIR], 82; 95% confidence interval [CI], 68 to 98), which was primarily attributed to a large deficit of lung cancer (10/26; SIR, 39; CI, 19 to 72). Brain cancer was increased in the overall study group (6/2.7; SIR, 222; CI, 81 to 484). This excess was restricted to white men who were scientists or technicians for one of the three companies at the facility (6/0.8; SIR, 750; CI, 275 to 1633); all cases in this group had worked in the "500 building complex" (6/0.6; SIR, 968; CI, 355 to 2106). Subjects also had an increased incidence of thyroid cancer (7/2.6; SIR, 265; CI, 106 to 546) that was not concentrated in particular occupational or building groups. The brain cancer incidence patterns indicated that an unidentified occupational exposure might have been responsible for the excess. Chance, socioeconomic factors leading to better case detection in facility employees than in the general population, and confounding by potential nonoccupational risk factors are plausible explanations of the observed increase in thyroid cancer.

The detection of several intracranial tumors among employees in one building complex (C500) at a petrochemical research facility prompted investigation of a possible workplace cause. This retrospective follow-up study included 1847 subjects, of whom 1735 had worked in C500. Medical records, death certificates, and Illinois State Cancer Registry data confirmed self-reported cancers and tumors. Analyses compared the subjects' cancer and benign intracranial tumor incidence rates with national general population rates. C500 employees had 15% fewer than expected total cancers (92 observed/108 expected; standardized incidence ratio [SIR], 85; 95% confidence interval [95% CI], 69 to 104). An excess of brain cancer (6/2.0; SIR, 302; 95% CI, 111 to 657) was concentrated among white men who had 10 or more years since hire and 5 or more years of C500 employment (4/0.7; SIR, 602; 95% CI, 165 to 1552) and who had worked in a particular building of C500 (5/0.7; SIR, 735; 95% CI, 239 to 1716). An excess of benign intracranial tumors (6/1.6; SIR, 385; 95% CI, 142 to 839) was not restricted to a single type of tumor and was not concentrated in any particular building. Occupational exposure may have caused the increased rate of brain cancer but is a less likely explanation for the elevated rate of benign intracranial tumors.

BACKGROUND:From 1970 through 1997, 17 intracranial neoplasms were identified among 6,800 employees of a petrochemical research facility. This investigation describes the case-series.METHODS:The intracranial neoplasms were identified by self reports and record linkages, and were confirmed by medical records and a pathology review. Standardized incidence ratios (SIRs) compare observed and expected numbers of cases according to certain work characteristics.RESULTS:Overall, there were 17 observed and 10.5 expected intracranial neoplasms, including 11/4.7 benign intracranial tumors and 6/5.9 brain cancers. All brain cancers occurred among male research scientists or technicians. Four had worked at some time on the same floor of one building (SIR=12.6, 95% CI=3.4-32.1), and several had worked on a research project with at least one other brain cancer case. The benign intracranial neoplasm cases did not have common building assignments or work activities.CONCLUSIONS:The occurrence pattern of brain cancers, but not that of benign tumors, suggests a possible occupational etiology.

We evaluated the relation between work experience in the United States operations of an electronics company and brain tumor mortality, focusing on video display terminal (VDT) development jobs. Subjects were 149 brain tumor cases and 591 matched controls selected from a company registry of all employees dying between 1975 and 1989. Company databases and interviews with company personnel constituted the basis for work histories, including information on whether subjects had held VDT development jobs. Subjects who worked at plants with hardware or VDT development operations had slightly but imprecisely elevated odds ratios (OR). The study found no meaningful association between VDT development work and brain tumor mortality. Other results included an elevated OR for 10 or more years of employment in engineering/technical jobs [OR = 1.7; 95% confidence interval (CI) = 1.0-3.0] or in programming jobs (OR = 2.8; 95% CI = 1.1-7.0). The OR for glioma for all subjects who had accrued 5 years of programming work 10 years before the case's death was 3.9 (95% CI = 1.2-12.4). These associations were limited in large part to one of four division groups. Also, only male programmers experienced an elevated OR. These patterns indicate that the associations may be due to chance, although unidentified causal exposures present in a subset of engineering/technical and programming jobs cannot be ruled out.

This article summarizes published data on employment and cancer patterns in the motor vehicle manufacturing (MVM) industry and presents results from a new study of female MVM workers. Historically, female MVM employees worked primarily in aerospace; electric and electronic equipment manufacturing; and paint, plastic, and trim operations. Women are now moving into vehicle assembly and metal parts production. Investigations of cancer have focused on men and reported excesses of lung cancer in foundry operations, of gastrointestinal cancer in metal processing operations involving exposure to machining fluids, and of colorectal cancer in wood pattern making. Numbers of women were insufficient for a meaningful evaluation of their cancer patterns. A recent study found that white women employed at a MVM company, compared to the female general US population, had small excesses of lung cancer (standardized mortality ratio (SMR) = 1.26; 95% confidence interval (CI) = 0.96-1.63) and of colorectal cancer (SMR = 1.27, 95% CI = 0.87-1.78) and a deficit of breast cancer (SMR = 0.68, 95% CI = 0.48-0.92). The lung cancer increase was concentrated among women in assembly jobs (SMR = 1.58, 95% CI = 1.07-2.26); the colorectal cancer increase, among women in nonproduction jobs (SMR = 1.78, 95% CI = 0.97-2.98); and the breast cancer deficit, among women in production-related jobs (SMR = 0.60, 95% CI = 0.37-0.91). Further investigation is needed to determine if these patterns are due to the occupational environment and to clarify causes of cancer among women in the MVM industry.

The current shortage of nurses has resulted in increased competi tion between health care institutions and other agencies in the re cruitment of nursing personnel (Regan, 1990). Job dissatisfaction among nurses leads to retention problems at all levels, further reduc ing the number of qualified professionals working in the field. Current trends indicate an increased demand for both hospital and community-based health services (National Institute on Aging, 1987). Although a number of studies have addressed job satisfaction in hospitals and other institutions, little research has been conducted examining satisfaction among public health nurses. Because commu nity-based nursing differs from other nursing situations in both job requirements and in clinical conditions, results obtained in studies of nurses in other settings may not be directly applicable to community nursing. Therefore an investigation of job satisfaction among public health nurses is warranted. In their study of job satisfaction among hospital nurses, Weis man, Alexander, and Chase (1980) noted that there is a relationship among satisfaction levels, job performance, and turnover. The impact of this relationship is reflected in the quality of care provided by an institution and recruitment costs associated with turnover. High levels of job satisfaction are associated with high productivity (Hernandez et al.9 1988), high organizational commitment, and low intent to leave nursing (Curry et al.91985).

Alzheimer's disease (AD) is a debilitating disease that poses many physical, social, psychological, and management problems for family and professional caregivers. Nursing students' ability to meet this challenge was measured using Palmore's (1988) Facts on Aging Quiz, Version 2 (FAQ2) and the Alzheimer's Disease Knowledge (ADK) Test developed by Dieckmann, Zarit, Zarit, and Gatz (1988). No significant difference in ADK Test scores was found for students who had previous personal or educational experiences with AD. However, older students, seniors, and those who reported knowing more about AD had significantly better scores on the ADK Test. Knowledge about AD was not found to be related to knowledge of aging, and subjects as a group were found to exhibit a negative bias toward the elderly as measured by Palmore's FAQ2.