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oai:open-archive.highwire.org:amjepid:135/10/10772015-05-11HighWireOUPamjepid:135:10
Multi-level Analysis in Epidemiologic Research on Health Behaviors and Outcomes
Von Korff, Michael
Koepsell, Thomas
Curry, Susan
Diehr, Paula
REVIEWS AND COMMENTARY
Individual-level health behaviors and outcomes have multi-level determinants (individual and environmental). Multi-level analysis seeks to explain individual outcomes in terms of both individual and environmental or aggregate variables. Ecologic fallacy (improper inference about individual-level associations based on associations measured only at the aggregate level) can result from confusion about the level of inference that is of ultimate interest. The perspective of multi-level analysis acknowledges the importance of both individual and environmental variables in determining health behaviors and outcomes at the level of the indivisible unit—the individual. The authors review concepts and methods of multi-level analysis and their application to epidemiologic research on health behavior and health outcomes. Am J Epidemiol 1992; 135: 1077–82
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1077
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/10832015-05-11HighWireOUPamjepid:135:10
Vitamin Supplement Use and Reduced Risk of Oral and Pharyngeal Cancer
Gridley, Gloria
McLaughlin, Joseph K.
Block, Gladys
Blot, William J.
Gluch, Maria
Fraumeni, Joseph F.
ORIGINAL CONTRIBUTIONS
Use of vitamin and mineral supplements was assessed in a population-based case-control study of oral and pharyngeal cancer, conducted during 1984–1985 in four areas of the United States. There was no association with intake of multivitamin products, but users of supplements of individual vitamins, including vitamins A, B, C, and E, were at lower risk after controlling for the effects of tobacco, alcohol, and other risk factors for these cancers. After further adjustment for use of other supplements, vitamin E was the only supplement that remained associated with a significantly reduced cancer risk. The adjusted odds ratio of oral and pharyngeal cancer for “ever regularly used” vitamin E was 0.5 (95% confidence interval 0.4–0.6). To the authors' knowledge, this is the first epidemiologic study to show a reduced oral cancer risk with vitamin E use. Although it is not clear that the lower risk among consumers of vitamin E supplements is due to the vitamin per se, the findings are consistent with experimental evidence and should prompt further research on the role of vitamin E and other micronutrients as inhibitors of oral and pharyngeal cancer. Am J Epidemiol 1992; 135: 1083–92
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1083
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/10932015-05-11HighWireOUPamjepid:135:10
Human Papillomaviruses, Herpes Simplex Viruses, and the Risk of Oral Cancer in Men
Maden, Christopher
Beckmann, Anna Marie
Thomas, David B.
McKnight, Barbara
Sherman, Karen J.
Ashley, Rhoda L.
Corey, Lawrence
Daling, Janet R.
ORIGINAL CONTRIBUTIONS
A population-based case-control study was conducted in western Washington state to examine the relations between infection with human papilloma viruses (HPV), herpes simplex viruses (HSV), and risk of oral squamous cell cancer in men. Interviews were completed on 131 oral cancer cases diagnosed between January 1985 and December 1989 and 136 controls frequency matched to cases on age and date of diagnosis who were obtained by random digit dialing. The risk for oral cancer among men with 30 or more sexual partners was 2.4 times that of men with four or fewer partners (95% confidence.interval (Cl) 1.0–5.9). Men who ever practiced oral sex had lower risk for oral cancer relative to men who never practiced oral sex (relative risk (RR) = 0.4, 95% Cl 0.2–0.8). Analyses of exfoliated oral cavity cells for the presence of HPV-6 DNA with polymerase chain reaction revealed that men with an oral HPV-6 infection had 2.9 times the risk for oral cancer of noninfected men (95% Cl 1.1–7.3), whereas men with an oral HPV-16 infection had 6.2 times the risk for oral cancer of noninfected men (crude RR = 6.2, 95% Cl 0.7–52.2). Relative risks associated with serologically detected HSV-1 and HSV-2 infections were 0.8 (95% Cl 0.3–1.7) and 1.8 (95% Cl 0.7–4.6), respectively. The authors conclude that HPV-6 is associated with oral cancer. Although men infected with HPV-16 and HSV-2 were at elevated risk, these associations may have been due to chance. The role of specific sexual practices in the transmission of viruses to the oral cavity remains unclear. <it>Am J Epidemiol</it> 1992; 135: 1093–1102
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1093
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11032015-05-11HighWireOUPamjepid:135:10
Mortality from Melanoma in Migrants to Australia: Variation by Age at Arrival and Duration of Stay
Khlat, Myriam
Vail, Andy
Parkin, Max
Green, Adèle
ORIGINAL CONTRIBUTIONS
All death records in Australia during the period 1964–1985 were analyzed to compare mortality from melanoma in immigrants and Australian-born individuals, and to investigate changes in risk in the immigrants according to their duration of stay and age at arrival. About 450, 000 deaths were from cancer, and risks of melanoma were estimated by logistic regression relative to those of the Australian-born, with deaths from other cancers used as controls. Estimates were adjusted for age at death, time period, birth cohort, and state of registration of death in Australia. Region of birth was defined as New Zealand, other Oceania, England, Ireland/Scotland/Wales (including Northern Ireland and the Republic of Ireland), Central Europe, Eastern Europe, Southern Europe, Western Asia, or Eastern Asia, bearing in mind that many migrants born in Asia were of European descent. Overall, migrants from outside Oceania were at lower risk than the Australian-born, and the lowest risks in males were in Southern Europeans and Eastern Asians, reflecting the protective effect of a darker complexion. Risk of melanoma was related both to duration of stay in Australia and to age at arrival; although their relative importance cannot be measured, the patterns of change suggested that childhood migration may be more important in determining risk than number of years in Australia. The authors believe this study to be based on the largest data set ever used in migrant studies, and note that the previously found differences in melanoma risk between immigrants and Australian-born remained after adjustment for major temporal and geographic confounders. The results confirm the importance of the interaction between environmental and genetic risk factors in the etiology of melanoma. <it>Am J Epidemiol</it> 1992; 135: 1103–13
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1103
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11142015-05-11HighWireOUPamjepid:135:10
Reproducibility and Validity of an Expanded Self-Administered Semiquantitative Food Frequency Questionnaire among Male Health Professionals
Rimm, Eric B.
Giovannucci, Edward L.
Stampfer, Meir J.
Colditz, Graham A.
Litin, Lisa B.
Willett, Walter C.
ORIGINAL CONTRIBUTIONS
The authors assessed the reproducibility and validity of an expanded 131-item semiquantitative food frequency questionnaire used in a prospective study among 51, 529 men. The form was administered by mail twice to a sample of 127 participants at a one-year interval. During this interval, men completed two one-week diet records spaced approximately 6 months apart. Mean values for intake of most nutrients assessed by the two methods were similar. Intraclass correlation coefficients for nutrient intakes assessed by questionnaires one year apart ranged from 0.47 for vitamin E without supplements to 0.80 for vitamin C with supplements. Correlation coefficients between the energy-adjusted nutrient intakes measured by diet records and the second questionnaire (which asked about diet during the year encompassing the diet records) ranged from 0.28 for iron without supplements to 0.86 for vitamin C with supplements (mean r = 0.59). These correlations were higher after adjusting for week-to-week variation in diet record intakes (mean r = 0.65). These data indicate that the expanded semiquantitative food frequency questionnaire is reproducible and provides a useful measure of intake for many nutrients over a one-year period. Am J Epidemiol 1992; 135: 1114–26
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1114
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11272015-05-11HighWireOUPamjepid:135:10
Invited Commentary: Some Limitations of Semiquantitative Food Frequency Questionnaires
Sempos, Christopher T.
ORIGINAL CONTRIBUTIONS
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1127
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11332015-05-11HighWireOUPamjepid:135:10
Authors' Response to "Invited Commentary: Some Limitations of Semiquantitative Food Frequency Questionnaires"
Rimm, Eric B.
Giovannucci, Edward L.
Stampfer, Meir J.
Colditz, Graham A.
Litin, Lisa B.
Willett, Walter C.
ORIGINAL CONTRIBUTIONS
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1133
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11372015-05-11HighWireOUPamjepid:135:10
Body Mass Index and Body Girths as Predictors of Mortality in Black and White Men
Stevens, J.
Keil, J. E.
Rust, P. F.
Verdugo, R. R.
Davis, C. E.
Tyroler, H. A.
Gazes, P. C.
ORIGINAL CONTRIBUTIONS
Anthropometric measurements collected from black and white men in the 1960 (n = 946) and 1963 (n = 456) examinations of the Charleston Heart Study cohort (Charleston County, South Carolina) were examined as predictors of all cause and coronary heart disease mortality. Anthropometric measurements included body mass index, chest girth (at the third intercostal space), abdominal girth (at the umbilicus) and midarm circumference. Vital status of 98 percent of the cohort was determined through 1988. Body mass index was not associated with mortality in the white men; however, it was predictive of all cause and coronary heart disease mortality in the black men. Analyses conducted separately in the lower and upper range of body mass index in black men showed the adjusted relative hazard at the 50th versus the 10th percentile of body mass index was 0.54 for all cause mortality, but was not significant for coronary heart disease mortality; whereas the adjusted relative hazard for the 90th relative to the 50th percentile was 1.7 for coronary heart disease deaths, but not significant for deaths from all causes. The circumference measurements were not predictive of all cause or coronary heart disease mortality in the white men. In the black men, the adjusted relative hazard ratios for all cause mortality for the 85th relative to the 15th percentiles were 0.22 for midarm circumference and 2.0 for abdominal circumference. Am Epidemiol 1992; 135: 1137–46
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1137
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11472015-05-11HighWireOUPamjepid:135:10
Predictors of the Risk of Development of Acquired Immunodeficiency Syndrome within 24 Months among Gay Men Seropositive for Human Immunodeficiency Virus Type 1: A Report from the Multicenter AIDS Cohort Study
Saah, Alfred J.
Muñoz, Alvaro
Kuo, Victor
Fox, Robin
Kaslow, Richard A.
Phair, John P.
Rinaldo, Charles R.
Detels, Roger
Polk, B. Frank
ORIGINAL CONTRIBUTIONS
The natural history of infection with human immunodeficiency virus type 1 (HIV-1) is characterized by a relentless decline in CD4-positive lymphocytes and the ultimate development of acquired immunodeficiency syndrome (AIDS). However, variables other than the CD4-positive lymphocyte level contribute to the measurement of risk for AIDS and can be used as predictors of AIDS onset. This study was undertaken to identify factors that, independently of the CD4-positive lymphocyte level, would predict the risk of AIDS over 24 months in a cohort of HIV-1 seropositive homosexual men receiving no antiretroviral therapy. Demographic, clinical, and laboratory data from 1, 325 white, HIV-1 seropositive participants in the Multicenter AIDS Cohort Study who have been studied for 4 years were analyzed with univariate and multivariate methods. To control for stage of infection, the baseline percentage of CD4-positive lymphocytes (a known marker of disease progression), and the decline of CD4-positive cells during the first 6 months of observation were used as continuous variables. The variables that were independently associated with an increased risk of developing AIDS were: low baseline CD4 percentage, decline in the CD4 percentage during the first 6 months of follow-up, the presence of serum immunoglobulin A at baseline, decrease in hemoglobin during the first 6 months of follow-up, incident fatigue, and the interaction of decline in the CD4 percentage and incident thrush. While low CD4 percentage and other variables have been previously described as prognostic markers, decline in the CD4 percentage and the interaction of that decline and incident thrush have not previously been described as being of prognostic importance. These variables and the analytic method for estimating prognosis may prove useful for selecting and evaluating antiretroviral therapy, instituting prophylactic measures against certain opportunistic infections, and recruitment into clinical trials. Because study participants received no antiretroviral prophylaxis during the period under analysis, the method could be used to estimate the prognosis for those receiving investigational treatment were they to remain untreated, effectively making any participant in a clinical trial his own untreated control. <it>Am J Epidemiol</it> 1992; 135: 1147–55
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1147
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11562015-05-11HighWireOUPamjepid:135:10
Methods for Inference on Transmission in Seroprevalence Data for Multiple Infections
Evans, Alison A.
Lefkopoulou, Myrto
Mueller, Nancy E.
ORIGINAL CONTRIBUTIONS
When risk factors for an infectious disease are unknown, a method commonly employed is to investigate parallels with known infections (covariate infections). Data sets of value here are those for specified populations in which the seroprevalence of antibodies for multiple infections has been ascertained. The use of markers of covariate infections in multivariable analyses is problematic when the covariate infection is not itself an independent risk factor for the outcome of interest. In the performance of these analyses, the authors recommend the following strategy: 1) For estimates of the effects of measured risk factors on the outcome, adjustment for the covariate infection should not be done; this will avoid problems of overadjustment. 2) After control for the measured risk factors, an estimate of the “effect” of the covariate infection may be used as an indicator of the presence of unmeasured shared risk factors. 3) When shared, measured risk factors exist, the authors propose the use of methods developed for analysis of repeated measures of categorical variables to assist in inference about shared mechanisms of action of these risk factors. This analytic strategy takes advantage of the method of analogy for building understanding of transmission of new agents through their parallels with better known ones and is useful in the development of hypotheses. Am J Epidemiol 1992: 135: 1156–65
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1156
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11662015-05-11HighWireOUPamjepid:135:10
Serial Changes in Blood Pressure from Adolescence into Adulthood
Beckett, Laurel A.
Rosner, Bernard
Roche, Alex F.
Guo, Shumei
ORIGINAL CONTRIBUTIONS
High blood pressure is an established risk factor for cardiovascular disease outcomes in adulthood. Furthermore, numerous longitudinal studies of blood pressure in childhood with length of follow-up from 1 to 17 years indicate that blood pressure levels track over the short term. This study addresses the question of the predictive value of childhood blood pressure readings for adult levels, using repeated blood pressure determinations from a sample of 501 participants in the Fels Longitudinal Study, and ongoing cohort study in southwestern Ohio that began in 1929. A damped autoregressive model indicated tracking correlations from 0.39 (4-year intervals) to 0.24 (20 years) for systolic pressure and 0.37 (4 years) to 0.20 (20 years) for diastolic pressure. These results indicate that tracking of blood pressure persists from age 13 years to age 40 years, which translates into moderate levels of relative risk for adult hypertension (diastolic pressure above 90 mmHg) for adolescents with high normal blood pressure. The estimated relative risks of hypertension at age 35 for white 15-years-olds with a true mean diastolic pressure of 80 mmHg were 1.9 for males and 2.6 for females, relative to 15-year-olds with a true diastolic pressure of 60 mmHg. Am J Epidemiol 1992: 135: 1166–77
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1166
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11782015-05-11HighWireOUPamjepid:135:10
BOOK REVIEWS
Beaty, Terri H.
BOOK REVIEWS
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1178
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11802015-05-11HighWireOUPamjepid:135:10
BOOK REVIEWS
Byers, Tim
BOOK REVIEWS
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1180
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11822015-05-11HighWireOUPamjepid:135:10
Book Reviews
Chinn, Susan
BOOK REVIEWS
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1182
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11832015-05-11HighWireOUPamjepid:135:10
ERRATUM
ERRATUM
The <it>Journal</it> has been notified by Dr. Jennifer L. Kelsey of an error in the placement of figures 1 and 2 in the paper by Kelsey et al., “Risk Factors for Fractures of the Distal Forearm and Proximal Humerus” (<it>Am J Epidemiol</it> 1992; 135:477–89). On page 481. the bar graph currently labeled figure 1 is in fact figure 2, and vice versa. Dr. Kelsey notes that otherwise the figure legends and text are correct as printed.
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1183
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11842015-05-11HighWireOUPamjepid:135:10
RE: "BREAST CANCER AND CIGARETTE SMOKING: A HYPOTHESIS"
Lemon, Henry M.
Ewertz, Marianne
LETTERS TO THE EDITOR
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1184
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11862015-05-11HighWireOUPamjepid:135:10
RE: "STATISTICAL REASONING IN EPIDEMIOLOGY"
Greenland, Sander
LETTERS TO THE EDITOR
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1186
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11872015-05-11HighWireOUPamjepid:135:10
THE AUTHOR REPLIES
Zeger, Scott L.
LETTERS TO THE EDITOR
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1187
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Copyright (C) 1992, Oxford University Press
oai:open-archive.highwire.org:amjepid:135/10/11851992-05-15HighWireOUPamjepid:135:10
Re: "Breast cancer and cigarette smoking: a hypothesis"
Ewertz, M
LETTERS TO THE EDITOR
Oxford University Press
1992-05-15 00:00:00.0
TEXT
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http://aje.oxfordjournals.org/cgi/content/short/135/10/1185
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Copyright (C) 1992, Oxford University Press