Tim Byers

Project TEACH (Teaching Equity to Advance Community Health) is a capacity-building training program to empower community-based organizations and regional public health agencies to develop data-driven, evidence-based, outcomes-focused public health interventions. TEACH delivers training modules on topics such as logic models, health data, social determinants of health, evidence-based interventions, and program evaluation. Cohorts of 7 to 12 community-based organizations and regional public health agencies in each of the 6 Colorado Area Health Education Centers service areas participate in a 2-day training program tailored to their specific needs. From July 2008 to December 2011, TEACH trained 94 organizations and agencies across Colorado. Training modules were well received and resulted in significant improvement in knowledge in core content areas, as well as accomplishment of self-proposed organizational goals, grant applications/awards, and several community-academic partnerships.

The incidence rate for malignant melanoma nearly tripled for white individuals in the United States from 1975 to 2004,¹ making melanoma the cancer with the fastest rising incidence rate in the United States. Melanoma rates in the United States are on a trajectory that mirrors Australia, where melanoma rates are the highest in the world.² The presence of numerous melanocytic nevi is the strongest risk factor for melanoma.³ Most nevi are developed in childhood, and several factors have been consistently shown to be related to higher numbers of nevi in childhood, including lighter skin, lighter hair color, blue or green eyes, and higher levels of sun exposure.^4-8 Because the risk factors for nevi closely match the risk factors for melanoma and because the number of nevi is the strongest risk factor for melanoma, nevi are studied as intermediate markers for melanoma, and understanding nevus development could lead to a better understanding of the causes of melanoma.

Background: Self-reports of dietary intake in the context of nutrition intervention research can be biased by the tendency of respondents to answer consistent with expected norms (social approval bias). The objective of this study was to assess the potential influence of social approval bias on self-reports of fruit and vegetable intake obtained using both food frequency questionnaire (FFQ) and 24-hour recall methods. Methods: A randomized blinded trial compared reported fruit and vegetable intake among subjects exposed to a potentially biasing prompt to that from control subjects. Subjects included 163 women residing in Colorado between 35 and 65 years of age who were randomly selected and recruited by telephone to complete what they were told would be a future telephone survey about health. Randomly half of the subjects then received a letter prior to the interview describing this as a study of fruit and vegetable intake. The letter included a brief statement of the benefits of fruits and vegetables, a 5-A-Day sticker, and a 5-a-Day refrigerator magnet. The remainder received the same letter, but describing the study purpose only as a more general nutrition survey, with neither the fruit and vegetable message nor the 5-A-Day materials. Subjects were then interviewed on the telephone within 10 days following the letters using an eight-item FFQ and a limited 24-hour recall to estimate fruit and vegetable intake. All interviewers were blinded to the treatment condition. Results: By the FFQ method, subjects who viewed the potentially biasing prompts reported consuming more fruits and vegetables than did control subjects (5.2 vs. 3.7 servings per day, p < 0.001). By the 24-hour recall method, 61% of the intervention group but only 32% of the control reported eating fruits and vegetables on 3 or more occasions the prior day (p = 0.002). These associations were independent of age, race/ethnicity, education level, self-perceived health status, and time since last medical check-up. Conclusion: Self-reports of fruit and vegetable intake using either a food frequency questionnaire or a limited 24-hour recall are both susceptible to substantial social approval bias. Valid assessments of intervention effects in nutritional intervention trials may require objective measures of dietary change.

BACKGROUND.: Understanding the ways in which socioeconomic status (SES) affects mortality is important for defining strategies to eliminate the unequal burden of cancer by race and ethnicity in the United States.METHODS.: Disease stage, treatment, and 5‐year mortality rates were ascertained by reviewing medical records, and SES was determined by analyzing income and education at the census tract level for 4844 women with breast cancer, 4332 men with prostate cancer, and 4422 men and women with colorectal cancer who were diagnosed in 7 U.S. states in 1997.RESULTS.: Low SES was associated with more advanced disease stage and with less aggressive treatment for all 3 cancers. The hazard ratio (HR) for 5‐year all‐cause mortality associated with low SES was elevated after a diagnosis of breast cancer when the analysis was adjusted for age (HR, 1.59; 95% confidence interval [CI], 1.35‐1.87). Adjustment for mediating factors of race/ethnicity, comorbid conditions, cancer stage, and treatment reduced the association. The age‐adjusted mortality risk associated with low SES was elevated after a diagnosis of prostate cancer (HR, 1.33; 95% CI, 1.13‐1.57), and multivariate adjustments for mediating factors also reduced that association. There was less association between SES and mortality after a diagnosis of colorectal cancer. For all 3 cancer sites, low SES was a much stronger predictor of mortality among individuals aged <65 years and among individuals from racial/ethnic minority groups.CONCLUSIONS.: The current results indicated that low SES is a risk factor for all‐cause mortality after a diagnosis of cancer, largely because of a later stage at diagnosis and less aggressive treatment. These findings support the need to focus on SES as an underlying factor in cancer disparities by race and ethnicity. Cancer 2008. © 2008 American Cancer Society.

Background: There is a need for early detection methods for lung cancer. Radiologic imaging may be more sensitive for peripheral cancers than for cancers arising in the central airways, from which bronchial epithelial cells are exfoliated into the sputum. Methods: Sputum samples were collected at baseline and periodically thereafter in a cohort of smokers and former smokers with chronic obstructive lung disease. The association between cytologic atypia and incident lung cancer was assessed by hazard ratios (HR; 95% confidence intervals) using Cox regression and by odds ratios (95% confidence intervals) using logistic regression, adjusting for potential confounding factors. Results: We observed 174 incident lung cancers in a cohort of 2,521 people over 9,869 person-years of observation. Risk for incident lung cancer was increased among those with cytologic atypia graded as moderate or worse (adjusted HR, 2.37; 1.68-3.34). The association between sputum atypia and lung cancer incidence was greatest for those sputum samples collected 5 months or less before the diagnosis of lung cancer (odds ratio, 10.32; 5.34-19.97). The association was substantially stronger for squamous cell lung cancers (HR, 5.13; 2.89-9.10) than for adenocarcinomas (HR, 1.85; 0.94-3.65). Conclusion: Cytologic atypia is a marker for increased lung cancer risk. These cytologic changes seem to arise from late events that are most apparent for cancers arising in the central respiratory airways. Whether cytologic atypia might complement radiologic imaging in a combined approach to lung cancer, early detection requires additional evaluation of those two methods used together. (Cancer Epidemiol Biomarkers Prev 2008;17(1):158–63)

BACKGROUND: Hispanic women with breast cancer present differently than do non‐Hispanic white (NHW) women. Lack of access to care has been offered as an explanation for these differences. In this study breast cancer presentation was examined in Hispanic women in a comprehensive, equal‐access health care system.METHODS: Hispanic and NHW breast cancer cases registered between 1995 and 2004 in the Kaiser Permanente of Colorado Tumor Registry were compared by age at diagnosis, stage, tumor grade, size, and receptor status. Multivariate logistic regression was performed to generate age‐adjusted odds ratios by ethnicity and each tumor characteristic.RESULTS: A total of 139 Hispanic women and 2118 NHW women with breast cancer were identified. Hispanic women had a mean average age at diagnosis of 56 years compared with 61 years for NHW women (P < .0001). Use of mammographic screening services in the prior 2 years was similar by ethnicity. Relative to NHW women, Hispanic women had age‐adjusted odds ratios of 2.70 (95% confidence interval [CI]: 1.26–5.77) for having stage IV disease, 2.25 (95% CI: 1.39–3.67) for having poorly differentiated tumors, 2.16 (95% CI: 1.26–3.69) for having a tumor greater than 5 cm, and 1.88 (95% CI: 1.24–2.81) for having estrogen receptor‐negative tumors.CONCLUSIONS: Despite equal access to health care services, differences persist in the size, stage, and grade of breast cancer for Hispanic women compared with NHW women. The results of the study suggest a biologic/genetic basis for these differences. Cancer 2007. © 2007 American Cancer Society.

Public health actions in response to new threats are often taken despite uncertainty about the efficacy of the action. The challenge, then, is to make ongoing judgments about whether actions are taken too soon, before a sufficient understanding of the efficacy of interventions is known, or too late, after much of the prevention potential is lost. The ongoing obesity epidemic presents exactly this type of challenge. General lessons learned from the AIDS and tobacco epidemics as well as others can be useful now as we contemplate options for reversing the ongoing epidemic of obesity in the United States. In this article we briefly review current evidence regarding the efficacy of obesity interventions in both clinical and community settings. We conclude that although little direct evidence is available on the efficacy of interventions for the obesity epidemic, there are some reasonable options derived from experience with other public health epidemics that can contribute to the solution of the obesity problem.

BACKGROUND.: The American Cancer Society has challenged the U.S. to reduce cancer mortality rates 50% over the 25 years from 1990 to 2015. The current report is an analysis and commentary on progress toward that goal through 2002, the midpoint of the challenge period.METHODS.: Cancer mortality rates were examined from 1990 through 2002, and projections to the Year 2015 were made. Cancer deaths that were prevented or deferred by the declining death rates were expressed as the difference between the observed and projected numbers of deaths and the numbers that would have been observed over that period had the 1990 death rates persisted.RESULTS.: Since 1990, cancer mortality rates have been declining in the U.S. by approximately 1% per year. Trends especially have been favorable for cancers of the breast, prostate, and colorectum and for lung cancer among men. Should this rate of decline continue over the coming decade, death rates from cancer will be approximately 23% lower in the Year 2015 than they were in 1990, and approximately 1.8 million deaths from cancer will have been prevented or deferred.CONCLUSIONS.: At this midpoint of the 25‐year challenge period, it appears that fully reaching the goal will require substantial breakthroughs in cancer early detection and/or in cancer therapy. Between now and 2015, however, many more cancer deaths can be averted by concerted action to control tobacco and obesity, by redoubling efforts in mammography and colorectal screening, and by enacting policies to close gaps in access to cancer detection and treatment services. Cancer 2006. ©2006 American Cancer Society.