Philip Morris
Environmental Tobacco Smoke and Lung Cancer Mortality in the American Cancer Society's Cancer Prevention Study II
Fields
- Author
- Austin, H.D.
- Cardenas, V.M.
- Clark, S.W.
- Greenberg, R.S.
- Heath, C.W., J.R.
- Jones, G.
- Thun, M.J.
- Cardenas, V.M.
- Type
- SCRT, REPORT, SCIENTIFIC
- BIBL, BIBLIOGRAPHY
- CHAR, CHART, GRAPH, TABLE, MAPS
- FOOT, FOOTNOTES
- QUES, QUESTIONNAIRE
- BIBL, BIBLIOGRAPHY
- Area
- CARCHMAN,RICHARD/OFFICE
- Litigation
- Iwoh/Produced
- Characteristic
- MISS, MISSING PAGES
- OVER, OVER SIZE DOCUMENT
- Site
- R530
- Named Organization
- Cancer Surveillance System of Western Wa
- Center for Public Health Research
- Centers for Disease Control
- Ct Tumor Registry
- Doctoral Dissertation Comm
- Ei Dupont De Nemours
- Emory Univ
- Epa, Environmental Protection Agency
- Ga Center for Cancer Statistics
- Hhs, Dept of Health and Human Services
- Ia State Health Registry
- Iarc
- Intl Agency for Research on Cancer
- Md Natl Univ
- Mi Cancer Foundation
- Ministry of Health
- Mmwr
- Natl Center for Health Statistics
- Natl Death Index
- Natl Inst of Public Health
- Natl Research Council
- Nchs
- NCI, Natl Cancer Inst
- Nhis Oh
- Niosh, Natl Inst for Occupational Safety & Health
- Nm Tumor Registry
- Northwestern Memorial Hospital
- Phreg
- San Francisco Bay Area Cancer Registry
- Sas
- School of Public Health of Mexico
- US Census Bureau
- US Natl Research Council
- US Public Health Service Centers
- Ut Cancer Registry
- Vmc
- Who, World Health Org
- Wk Kellogg Foundation
- Working Group on Passive Smoking
- 3rd Kreyberg Group
- American Cancer Society
- Cancer Research Center of Hi
- Center for Public Health Research
- Author (Organization)
- Emory Univ
- Natl Autonomous Univ of Mexico
- School of Public Health of Mexico
- Natl Autonomous Univ of Mexico
- Named Person
- Adler
- Alavanja
- Appel
- Auerbach
- Austin, H.D.
- Becker
- Blot
- Boffetta
- Boice
- Boring
- Boring, J.
- Breslow
- Brilliant
- Brownlee
- Brownson
- Buring
- Butler
- Calle
- Calle, E.
- Camposfilho
- Caporaso
- Cardenas, V.M.
- Cardenasayala, V.M.
- Chilmonczyk
- Churg
- Clark, S.W.
- Claxton
- Coates, R.
- Coleman
- Comstock
- Cox
- Cummings
- Daniels, D.
- Devesa
- Doll
- Emmons
- Enoex, S.
- Escobedo, L.
- Fielding
- Flanders, D.
- Flannery, J.T.
- Fleiss
- Fontham
- Fraumeni
- Friedman
- Frumkin, H.
- Gann
- Gao
- Garfinkel
- Glantz
- Glass
- Greenberg, R.S.
- Greenland
- Gross
- Guess
- Haenszel
- Hammond
- Hanf
- Heath, C.W., J.R.
- Hennekens
- Hill, J.
- Hinds
- Hirayama
- Hole
- Horn
- Ichikawa
- Kabat
- Kaiser
- Kellerman
- Kelsey
- Key, C.R.
- Kleinbaum
- Koch
- Kolonel, L.N.
- Kreyberg
- Lally, C.
- Landis
- Lee
- Letzel
- Levine
- Lickint
- Liff, J.M.
- Lofroth
- Longini, I.
- Lychou
- Mantel
- Mckeen, K.M.
- Mcwhorter, W.P.
- Mertz, R.D.
- Miettinen
- Minna
- Miracle, H.
- Molgaavkar
- Muller
- Mulvihill
- Myers, D.
- Namboodiri, M.
- Nechi
- Oneill
- Park, C.
- Percy
- Pershagen
- Peto
- Pott, P.
- Pron
- Redmond
- Reif
- Repace
- Rothman
- Schottenfeld
- Selikoff
- Shephard
- Shimkin
- Shopland
- Simons
- Sobin
- Spitzer
- Steenland
- Stellman
- Surgeon General
- Swanson, G.M.
- Terrell, D.
- Thomas, D.B.
- Thun, M.J.
- Trichopoulos
- Vandenbroucke
- Vincent
- Vita
- Wald
- Wall
- Wells
- West, D.
- Weston
- Wetzel
- Wuwilliams
- Wynder
- Xxangela
- Xxcarmen
- Yamagiwa
- Alavanja
- Master ID
- 2063620519/0720
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ENV[RONMENTAL TOBACCO SMOKE AND LUNG CANCER
MORTALITY
IN TI~ AMERICAN CANGER SOCIETY'S CANCER PREVENTION
STUDY [[
by
Victor M. Cardenas,
M.D., National Autonomous University of Mexico, 1978
Epidemiologist, School of Public Health of Mexico, 1981
M.P.H., Emory University, 1990
Adviser: Harland D. Austin, D.S.c.
A dissertation submitted to the Faculty of the Graduate School of
Emory University in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Division of Epidemiology
1994
i
Dedicated to dearest Carmen and Angela whose
love has been a constant source of support, always!
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Acknowledgments
Without the support, encouragement and help of many individuals the completion
of this dissertation and academic degree would have been an impossible task. I
am indebted to my mentors, Drs. John Boring, Jonathan Lift, Ira Longini, Ray
Greenberg, Ralph Coates, Harland Austin and Dana Flanders for their patient
instruction, the learning opportunities they provided me, and for their insistence
on excellence in epidemiologic research. The vision and encouragement of Dr.
Ray Greenberg was largely instrumental in my involvement in this program.
Our program advisor, Dollie Daniels, deserves special mention for her support
throughout the past four years has been much appreciated. I also wish to
acknowledge the excellent proofreading of Ms. Daniels and Dr. Louis Escobedo
of several versions of this manuscript.
I am especially grateful to each member of my doctoral dissertation committee,
Drs. Harland Austin, Michael Thun, Clark Heath, Scott Clark, and Ray
Greenberg for their support, patience and encouragement throughout this
experience.
I have been especially fortunate to have Harland Austin as advisor in the area of
cancer epidemiology and epidemiologic methods. He was always there to omaide
me through the different stages of this study.
At Emory Universfiy I have had the privilege to use the American Cancer Society
Cancer Prevention Study 1I data base and facilities for my research. It has been a
pleasure to work and receive advice on a daily basis from Drs. Michael Thun,
and Clark Heath. The programming guidance of Mohan Namboodiri first, and
then brilliantly embraced by Cathy Lally and Heidi Miracle, was decisive. I
also acknowlpdge the advice of Dena Myers, Dr. Eugenia Calle, and Diane
Terrell for their valuable suggestions throughout the study conduct.
To develop a definition of different categories of jobs/trades with potential
occupational exposure to asbestos, I was fortunate to count on with the advice of
an expert in the field such as Dr. Howard Frurnkin, and I also want to express
my gratitude to him.
I thank Dr. Christina Park, from the National Center for Health Statistics, for
providing unpublished data from the 1988 NHIS-OH supplement on the extent
of ETS exposure.
I thank the following persons, principal investigators of the National Cancer
Institute SEER program, who promptly replied to our inquiry to confirm the
diagnoses of lung cancer among nonsmoking CPS II participants who resided in
the Cancer Registries areas: Mrs. Kathleen M. McKeen; Director of the State
Health Registry of Iowa; Mr. J.T. Flannery, Director of the Connecticut Tumor
Registry; Dr. David B. Thomas, from the Cancer Surveillance System of
Western Washington; Dr. Dee West, Director of the San Francisco Bay Area
Cancer Registry; Dr. Charles R. Key, Medical Director of the New Mexico
Tumor Registry; to my professor, Dr. Jonathan M. Lift, Director of the Georgia
Center for Cancer Statistics; Dr. G. Marie Swanson Director, and Sherry Enoex,
Data Manager from the Michigan Cancer Foundation; Dr. L.N. Kolonel, Director
and Ruth D. Mertz, administrator from the Cancer Research Center of Hawaii;
and to Dr. W.P. McWhorter Director of the Utah Cancer Registry.
Finally, I acknowledge the generous support of the W.K. Kellogg Foundation
and Emory University for providing me with scholarships to complete my
studies.
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NOTICE TO BORROWERS -
Unpublished theses deposited in the Emory University Library must be used only in
accordance with the stipulations prescribed by the author in the preceding statement.
The author of this dissertation is:
Vfctor Manuel C~denas-Ayala
Transversal 13-124 Int 4-103
Santa F6 de Bogot~ Colombia
The director of this dissertation is:
Harland D. Austin
4870 Forestglade Ct.
Stone Mr. GA 30087
Users of this dissertation not reg~flarly enrolled as students at Emory University are
required to attest acceptance of the preceding stipulations by signing below.
Libraries borrowing this dissertation for the use of their patrons are required to see
that each user records here the information requested
Name of user Address Date
Type of Use
(Examination only
or copying)
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ENVIRONMENTAL TOBACCO SMOKE AND LUNG CANCER MORTALITY
IN THE AMERICAN CANCER SOCIETY'S CANCER PREVENTION STUDY II
by
Victor M. Cardenas, M.D., M.P.H.
Adviser: Harland Austin, D. Sc.
Division of Epidemiology
Approved for the Division
Adviser
Date
Accepted:
Date 0 /
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The dissertation of Victor M. Cardenas is approved.
Committee Members
Harland D. Austin, D. Sc., Chair
Michael J. Thun, M.D., M. Sc.
Clark W. Heath Jr., M.D.
Scott W. Clark, Ph.D.
Raymond S. Greenberg, H., Ph.D.
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ENVIRONMENTAL TOBACCO SMOKE AND LUNG CANCER MORTALITY
IN THE AMERICAN CANCER SOCIATY'S CANCER PREVENTION STUDY II
by
Victor M. Cardenas,
M.D., National Autonomous University of Mexico, 1978
Epidemiologist, School of Public Health of Mexico, 1981
M.P.H, Emory University, 1990
Adviser: Harland D. Austin, D. Sc.,
An Abstract of
A dissertation submitted to the Faculty of the Graduat~ School of
Emory University in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Division of Epidemiology
1994
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tt~aoie ot ~ontents
Chapter
1 Introduction 1
1.1. Backgound
1.2. Specific Aim
1.3. Hypotheses
1.4. Definitions of ETS, Lung Cancer, and Analytical Cohorts
ETS in General
ETS Exposure in CPS II
Lung Cancer in General
Ltmg Cancer in CPS II
Self-reported and Spousal Exposure to ETS
1.5. Significance and Relevance of the Study
1.6. Extent ofETS E.xposure
1.7 Organization of Thesis
Chapter 2 Literature Review and Metanalysis
2.1. Descriptive Lung Cancer Epidemiology
2.2 Smoking and Lung Cancer
2.3. Biological Plausibility
2.4 Epidemiological Evidence
2.5 Collateral Evidence
2.5 Collateral Evidence
2.6 Controversy
2.7 Other Risk Factors
2.8 Lung Cancer Classification
2.9 Measurement of ETS Exposure
Chapter 3 Methods
3.1 The Cancer Prevention Study II
Study Population
The Cancer Prevention Study II
a) Recruitment
b) Follow-up
c) Baseline Questionnaire
3.2. Published Results from CPS II
3.3 Main Design Features
3.4. Sub Cohort of Interest
Definition and Source Population
3.5. Eligibility
a) Inclusion Criteria
b) Exclusion Criteria
3.6. Variables
Status
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Mam Outcome
Exposure Variables
i.Main Exposure Variable (Self-reported ETS)
ii. Spousal Smoking Habits
Covariates
Denominator Information
3.7. Validation of ETS exposure data
3.8. Exposure Criteria Used In Analysis
i. Self-reported ETS Exposure
ii. Spousal ETS Exposure
3.9. Validation of Information from Death Certificates
3. I0. Statistical Analysis
Outline of the Analytic Approach
Exploratory Data Analysis
Simple and Stratified Analysis
Multivariate Analysis
3.11. Sample Size and Power Considerations
Chapter 4 Comparisons of Demographics and Smoking
l:[abits in the US, CPS II, and the Study Populations
Rationale
Race
Gender and Age Structure
Occupation
Schooling
Marital Status
Residence
Smoking Habits
Chapter 5 Validity and Completeness of the Information
On the Outcome Variable
i. Follow-up Procedures
ii. Results of Validation Study of Death Certificate
Diagnoses of Lung Cancer
Main Exposure Variables
i. Self Reported ETS Exposure in CPS II and NI-IIS
ii. CPS II Self-reported Exposure to
ETS and Spousal Smoking Habits
Chapter 6 Descriptive Statistics of Exposure Variables
Frequency of Self-reported and Spousal ETS
Correlates of ETS exposure
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