Young people's alcohol use in and around water: A scoping review of the literature

ISSUES

The surrounding social and commercial context, including alcohol advertising, heavily influences alcohol consumption. Alcohol use is a major risk factor for both fatal and non-fatal drowning, particularly for young people.

APPROACH

We conducted a scoping review to explore the peer-reviewed literature on the use of alcohol by young people (aged 15-34 years) in the context of aquatic environments. Five electronic academic databases were searched for English-language studies conducted in high-income countries and published in the last 15 years (since 2008). The MetaQAT framework was used to assess methodological quality of included studies.

KEY FINDINGS

The review included a total of 24 studies, including those addressing the prevalence of and/or risk factors for alcohol use in aquatic environments among young people (n = 13); the epidemiology of alcohol-related unintentional drowning in young people (n = 9); and interventions to reduce alcohol-related harm around water (n = 3). Findings suggest that young people commonly consume alcohol around water, particularly young men. We found multiple influences on this behaviour, including the perception of risk, location of aquatic activity and presence of others, particularly peers.

IMPLICATIONS

Understanding the literature addressing alcohol use around water among young people will assist in identifying and setting priorities for drowning prevention, including the need to mitigate the effects of alcohol advertising which promotes drinking in and around water.

CONCLUSION

There is a clear imperative to address the use of alcohol by young people in aquatic environments. These findings have key implications for public health policy, advocacy and practice.

E-cigarettes on Instagram: Exploring vape content via an Australian vaping influencer

INTRODUCTION

Mounting evidence suggests that electronic cigarettes (e-cigarettes) are extensively promoted and marketed using social media, including through user-generated content and social media influencers. This study explores how e-cigarettes are being promoted on Instagram, using a case-study approach, and the extent to which Meta's Restricted Goods and Services Policy (Meta's policy) is being applied and enforced.

METHODS

We identified the accounts followed by an Australian Instagram influencer who primarily posts e-cigarette-related content. The main foci of these 855 accounts were coded and 369 vaping-focused accounts were identified. These vaping-focused accounts were then further coded by two trained coders.

RESULTS

All (n=369; 100.0%) of the vape content posted by these accounts was positive in sentiment. One-third of the vape accounts (n=127; 34.4%) had a shared focus, indicating that vape content may permeate into other online communities through shared interests. A total of 64 accounts (17.3%) potentially violated Meta's policy by attempting to purchase, sell, raffle or gift e-cigarette products.

CONCLUSIONS

The findings of this study suggest that pro-vaping information is available and accessible on Instagram. Much of the content identified in this study promoted the purchase or gifting of e-cigarette products and potentially violates Meta's policy. Greater regulation and/or stronger enforcement of e-cigarette content on social media platforms such as Instagram is necessary to prevent the ongoing promotion of these harmful products.

Factors Influencing the Use of Control Measures to Reduce Occupational Exposure to Welding Fume in Australia: A Qualitative Study

Background

Exposure to welding fume is associated with adverse effects on worker health. The use of various control measures can reduce levels of exposure and the resulting health effects. However, little is known about the factors that may influence workers' use of control measures in the workplace and their perceived intervention needs. This study aimed to investigate workers' and other stakeholders' views on ways to improve the use of welding fume control measures in Australian workplaces.

Methods

We conducted a series of online focus group discussions and individual interviews with participants who have some occupational involvement in welding, whether as workers, employers or industry representatives, union representatives, or regulators. A semi-structured question guide was used, and all discussions and interviews were recorded and transcribed for analysis.

Results

Five focus group discussions and five individual interviews were conducted with a total of 21 participants. Three major themes emerged. The first addressed the current awareness of welding fume harms and concern about exposure; the second focussed on the current use of control measures, and barriers and facilitators to their use; and the last centred around intervention needs and the contents of a potential effective intervention.

Conclusion

Improving the use of control measures to prevent exposure to welding fume requires knowledge around the barriers and facilitators of control, use, and the intervention needs of stakeholders. This study has provided such knowledge, which will facilitate the design and implementation of an intervention to reduce welding fume exposure and ultimately protect the health of workers.

Promotion of E-Cigarettes on TikTok and Regulatory Considerations

E-cigarettes are promoted extensively on TikTok and other social media platforms. Platform policies to restrict e-cigarette promotion seem insufficient and are poorly enforced. This paper aims to understand how e-cigarettes are being promoted on TikTok and provide insights into the effectiveness of current TikTok policies. Seven popular hashtag-based keywords were used to identify TikTok accounts and associated videos related to e-cigarettes. Posts were independently coded by two trained coders. Collectively, the 264 videos received 2,470,373 views, 166,462 likes and 3426 comments. The overwhelming majority of videos (97.7%) portrayed e-cigarettes positively, and these posts received 98.7% of the total views and 98.2% of the total likes. A total of 69 posts (26.1%) clearly violated TikTok's own content policy. The findings of the current study suggest that a variety of predominantly pro-vaping content is available on TikTok. Current policies and moderation processes appear to be insufficient in restricting the spread of pro-e-cigarette content on TikTok, putting predominantly young users at potential risk of e-cigarette use.

Longitudinal measurements of per- and poly-fluoroalkyl substances (PFAS) in archived human serum samples between 1975 and 1995 in Australia

Per- and poly-fluoroalkyl substances (PFAS) are a group of manmade compounds produced since the 1950 s and used in a range of industrial processes and consumer products. In Australia, PFAS serum concentrations have been measured in the general population since 2002. However, few studies have retrospectively measured PFAS concentrations in serum samples representative of a general population prior to 2000, none of which have been conducted in Australia. To understand the general population's exposure to PFAS prior to 2002, longitudinal PFAS serum concentration measurements are required. In the current study, we accessed 'The Busselton Health Study Data Bank' to analyse archived serum samples for PFAS. Repeat serum samples collected in 1975, 1981 and 1995 were obtained from 17 participants. Of the 35 PFAS analysed, 13 PFAS were detected in the serum samples collected in 1975. Both the detection frequency and ∑PFAS serum concentrations increased between 1975 and 1995. Median ∑PFAS serum concentration increased over 7-fold; from 3.3 ng/mL in 1975-26 ng/mL in 1995. The increase in serum concentrations reflects the global production history of these PFAS during this period in time.

The future excess fraction of cancer due to lifestyle factors in Australia

BACKGROUND

Many cancers are caused by exposure to lifestyle, environmental, and occupational factors. Earlier studies have estimated the number of cancers occurring in a single year which are attributable to past exposures to these factors. However, there is now increasing appreciation that estimates of the future burden of cancer may be more useful for policy and prevention. We aimed to calculate the future number of cancers expected to arise as a result of exposure to 23 modifiable risk factors.

METHODS

We used the future excess fraction (FEF) method to estimate the lifetime burden of cancer (2016-2098) among Australian adults who were exposed to modifiable lifestyle, environmental, and occupational risk factors in 2016. Calculations were conducted for 26 cancer sites and 78 cancer-risk factor pairings.

RESULTS

The cohort of 18.8 million adult Australians in 2016 will develop an estimated 7.6 million cancers during their lifetime, of which 1.8 million (24%) will be attributable to exposure to modifiable risk factors. Cancer sites with the highest number of future attributable cancers were colon and rectum (n = 717,700), lung (n = 380,400), and liver (n = 103,200). The highest number of future cancers will be attributable to exposure to tobacco smoke (n = 583,500), followed by overweight/obesity (n = 333,100) and alcohol consumption (n = 249,700).

CONCLUSION

A significant proportion of future cancers will result from recent levels of exposure to modifiable risk factors. Our results provide direct, pertinent information to help determine where preventive measures could best be targeted.

Autoantibodies and cancer among asbestos-exposed cohorts in Western Australia

Asbestos exposure is associated with many adverse health conditions including malignant mesothelioma and lung cancer as well as production of autoantibodies. Autoantibodies may serve as biomarkers for asbestos exposure in patients with cancer, and autoimmune dysfunction has been linked to increased rates of various cancers. The aim of this study was to examine the hypothesis that autoantibodies are more frequent in asbestos-exposed individuals with either lung cancer or mesothelioma than those without these conditions. Asbestos-exposed individuals from Western Australia who had lung cancer (n = 24), malignant mesothelioma (n = 24), or no malignancy (n = 51) were tested for antinuclear autoantibodies (ANA) using indirect immunofluorescence and specific extractable nuclear autoantibodies (ENA) employing a multiplexed addressable laser bead immunoassay. Contrary to the hypothesis, data demonstrated that individuals without malignancy were more likely to be positive for ANA compared to those with cancer. However, autoantibodies to histone and Ro-60 were found to be associated with lung cancer. These results support a possible predictive value for specific autoantibodies in the early detection of lung cancer and/or in our understanding of the role of autoimmune processes in cancer. However, further studies are needed to identify specific target antigens for the antibodies.

Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia?

Disparities in exposure to workplace hazards exist between Māori and non-Māori workers in New Zealand, with Māori workers generally incurring poorer conditions. This study aimed to determine if these ethnic disparities are similar after migration to Australia. A national cross-sectional telephone survey asked participants what tasks they undertook in their job to assess exposure to carcinogens as well as whether they experienced ethnic discrimination, bullying, job precariousness, or job strain. A total of 389 New Zealand Caucasians and 152 Māori/Pasifika workers were recruited. After adjustment, 79% of Māori/Pasifika compared with 67% of New Zealand Caucasian workers were assessed as being exposed to at least one carcinogen at work (adjusted prevalence ratio [aPR] = 1.2, 95% confidence interval [CI] = 1.1-1.4). Māori/Pasifika workers were also more likely to report ethnic discrimination (aPR = 6.9, 95% CI = 2.6-18.3) and fair or poor current health (aPR = 1.9, 95% CI = 1.1-3.2) than New Zealand Caucasians. Some ethnic disparities in exposure to workplace hazards in New Zealand are apparent after migration to Australia.

Prevalence of exposure to multiple occupational carcinogens among exposed workers in Australia

OBJECTIVES

Workers can be exposed to a range of different carcinogenic agents in the workplace. However, previous studies have often focused on prevalence of exposure to a single carcinogen, resulting in substantial knowledge gaps regarding the extent of multiple exposures in the workplace. This study aims to investigate the current prevalence of occupational exposure to multiple carcinogens among exposed workers in Australia.

METHODS

The data for this study come from the Australian Work Exposures Study, a nationwide cross-sectional telephone survey of Australian workers aged between 18 and 65. Information was collected about the respondents' current employment and numerous demographic factors using a web-based application (Occupational Integrated Database Exposure Assessment System) to conduct the interview, with predefined algorithms used to automatically assign exposures to carcinogens based on the respondents' job tasks.

RESULTS

The majority (81%) of exposed respondents were assessed as being probably exposed to more than one carcinogen, and 26% reported exposure to five or more carcinogens. We found that after adjusting for occupation, exposure to multiple carcinogens was more likely among male respondents, while older workers (aged between 55 and 65) were less likely to be exposed to multiple carcinogens.

CONCLUSIONS

This study provides information on the prevalence of exposure to multiple carcinogens in the general population that has not previously been reported. This information could be useful for the intervention and control of occupational exposures to the prioritised carcinogens identified in this study.

The estimated prevalence of exposure to carcinogens, asthmagens, and ototoxic agents among healthcare workers in Australia

BACKGROUND

Healthcare workers are occupationally exposed to various hazardous chemicals and agents that can potentially result in long-term adverse health effects. These exposures have not been comprehensively examined at a population level. The aim of this study was to examine occupational exposures to a wide range of asthmagens, carcinogens, and ototoxic agents among healthcare workers in Australia.

METHODS

Data were collected as part of the Australian Work Exposures Studies, which were computer-assisted telephone surveys conducted in 2011, 2014, and 2016 to assess the prevalence of occupational exposures to carcinogens, asthmagens, and ototoxic agents, respectively, among Australian workers. Using data on healthcare workers, the prevalence of exposures to these agents was calculated and associations of demographic variables and occupation groups with exposure status were examined.

RESULTS

The prevalence of exposure to at least one asthmagen, carcinogen, and ototoxic agent was 92.3%, 50.7%, and 44.6%, respectively. The most common exposures were to (a) cleaning and sterilizing agents in the asthmagen group; (b) shift work in the carcinogen group; and (c) toluene and p-xylene among ototoxic agents. Exposure varied by occupation, with exposure to carcinogens and ototoxic agents highest among personal carers and exposure to carcinogens most likely among nursing professionals and health and welfare support workers.

CONCLUSION

The results demonstrate that a substantial proportion of Australian healthcare workers are occupationally exposed to asthmagens, carcinogens, and ototoxic agents. These exposures are more common among certain occupational groups. The information provided by this study will be useful in prioritizing and implementing control strategies.

Lifestyle and occupational factors associated with participation in breast mammography screening among Western Australian women

Objectives

Various lifestyle and occupational factors have been associated with an increased risk of breast cancer, but there is limited research investigating the relationship between these factors and participation in breast cancer screening. This study explores the associations between lifestyle and occupational factors and participation in breast mammography screening among women living in Western Australia.

Methods

This study involved 1705 women aged 40 and older who participated as controls in the Breast Cancer Environment and Employment Study conducted in Western Australia. Self-reported questionnaire data were collected on participation in mammography screening, demographic factors, and lifestyle and occupational variables (smoking, physical activity, alcohol consumption, body mass index, use of contraceptive pill and hormone replacement therapy, breastfeeding, occupation, and participation in shift work). Multivariate modified Poisson regression was used to identify variables associated with ever participation in breast mammography screening.

Results

Just over 88% of women reported having ever had a mammogram. Likelihood of having ever had a mammogram was higher among women who had ever used hormone replacement therapy (adjusted prevalence ratio (aPR) = 1.05, 95% CI 1.02–1.07). Women who worked in clerical occupations (aPR = 1.06, 95% CI 1.01–1.11) or home duties (aPR = 1.05, 95% CI 1.00–1.11) were also more likely to report having ever had a mammogram compared with those in professional or technical occupations.

Conclusions

Participation in mammography screening was found to differ by lifestyle and occupational factors. These results have important implications for public health strategies on improving screening participation.

Lifestyle and occupational factors associated with participation in colorectal cancer screening among men and women in Australia

This study explores the associations between lifestyle and occupational factors and participation in colorectal cancer (CRC) screening among men and women aged 50 and over and living in Australia. We used weighted data from the Australian National Health Survey 2014-15 to produce population estimates. Lifestyle variables investigated were smoking, physical activity, alcohol consumption, fruit and vegetable consumption, and body mass index, while the occupational variables were labour force status, occupation, and participation in shift work. Using weighted data, 1,990,287 men (55%) and 1,898,232 women (49%) reported ever-screening for CRC. Female current smokers were less likely to report ever-screening for CRC (adjusted RR = 0.78, 95% CI 0.64-0.96), as were men who were less physically active (aRR = 0.87, 95% CI 0.78-0.97), reported no alcohol consumption (aRR = 0.73, 95% CI 0.59-0.91), and reported eating more vegetables (aRR = 0.84, 95% CI 0.72-0.99). When lifestyle behaviours were combined into a healthy lifestyle index score, a significant trend was observed for both men and women, whereby those who reported engaging in more healthy behaviours were more likely to have ever-screened for CRC (p = .027 men; p < .001 women). No associations were observed between CRC screening and occupational variables. This is the first comprehensive assessment of the lifestyle and occupational factors associated with participation in CRC screening among men and women in Australia. Participation in CRC screening was greater among those engaging in more healthy behaviours, suggesting that an individual's pattern of lifestyle behaviours may be important in determining screening participation. These results have important implications for public health strategies on improving CRC screening participation.

Does the Size of a Company Make a Difference in the Prevalence of Exposure to Asthmagens and in the Use of Respiratory Protective Equipment?

Introduction

About half of all workers in high-income countries work in small companies. However, regulatory bodies and researchers predominantly work with large companies because they are more convenient to study and easier to reach. We aimed to estimate the prevalence of exposure to asthmagens and the use of respiratory protective equipment (RPE) by company size.

Methods

This analysis used data from the Australian Work Exposures Study-Asthma, a telephone survey which investigated exposure to 27 asthmagen groups.

Results

Among 4844 respondents, 18.8, 19.9, 31.9, and 29.4% of workers reported working in micro (<5 employees), small (5-19 employees), medium (20-200 employees), and large (>200 employees) companies, respectively. Compared to workers in large companies, workers in micro, small, or medium companies had higher prevalence of exposure to most asthmagens and lesser use of RPE.

Conclusion

Our results suggest that policy actions and regulatory measures should target micro/small companies in order to have the greatest effect.

Variations in exposure to carcinogens among shift workers and non-shift workers

BACKGROUND

There is limited information on whether the prevalence of exposure to workplace carcinogens varies among shift workers and non-shift workers.

METHODS

This analysis used data from the Australian Work Exposures Study-Cancer, a telephone survey which examined exposure to carcinogens in the workplace. Workers were classified as shift workers if they indicated that their usual roster ever included work between the hours of midnight and 5 am. Modified Poisson regression was used to estimate the adjusted prevalence ratios (aPRs) and 95% confidence internals (CIs).

RESULTS

Among the 5425 workers, 6.88% reported being exposed to shift work. Overall, shift workers were more likely to be exposed to any carcinogen (aPR = 1.16; 95% 1.06-1.26) and to specific carcinogens such as asbestos (aPR = 1.93; 95% 1.33-2.83) than non-shift workers.

CONCLUSIONS

Our study shows that there are differences in exposure to carcinogenic agents among shift and non-shift workers, and so there is a need for prevention programs in order to reduce these discrepancies.

Interventions to Reduce Future Cancer Incidence from Diesel Engine Exhaust: What Might Work?

Exposure to diesel engine exhaust (DEE) contributes appreciably to the burden of occupational cancer. This study aims to estimate the potential impact of a range of interventions on the future burden of cancer from occupational exposure to DEE in Australia. The future excess fraction method, a novel method based on the lifetime risk approach, was used to model changes in the future burden of cancer among the Australian working age population exposed to DEE at work in 2012 under various intervention strategies. The interventions modeled were based on the widely accepted hierarchy of control model. At baseline, 600 (0.4%) future bladder and 4,450 (0.6%) future lung cancer cases over the lifetime of the cohort were estimated to be attributable to occupational exposure to DEE in those exposed in 2012. Up to 2,000 of these cases were estimated to be avoidable through the use of various interventions. Exhaust hoses (engineering controls) were estimated to be particularly effective. This study provides an indication of which intervention strategies may be most useful in reducing the future burden of cancer associated with occupational DEE exposure. These results show the potential effect of changing current exposure, rather than focusing on past exposures, and thus provide relevant information for policy planning.

The prevalence of exposure to high molecular weight asthmagens derived from plants among workers in Australia

BACKGROUND

Limited information is available on exposure to high molecular weight (HMW) asthmagens derived from plants and on the main occupations and tasks that result in such exposure among workers.

METHODS

Data were collected as part of the Australian Work Exposures Study-Asthma. We estimated adjusted prevalence ratios (aPR) using modified Poisson regression models to determine which factors were associated with exposure.

RESULTS

A 12.8% of 4878 workers were exposed to HMW asthmagens derived from plants. The highest prevalence of exposure was found among farmers/animal workers, education workers, and food processing workers. The main circumstances of exposure were through handling flour, freesias, or through raising livestock. Exposure was more common among female workers (aPR = 1.26, 1.10-1.43) than males, while it was lower among workers born overseas (aPR = 0.70, 0.57-0.86) than those born in Australia.

CONCLUSION

Prevention of exposure to HMW asthmagens derived from plants requires a broad strategy targeting different tasks and occupations.

Workplace psychosocial stressors experienced by migrant workers in Australia: A cross-sectional study

OBJECTIVE

To explore work-related psychosocial stressors among people of Chinese, Vietnamese and Arabic-speaking backgrounds currently working in Australia.

METHODS

In 2015, a telephone survey of 585 Vietnamese, Chinese and Arabic-speaking workers asked about workplace bullying, ethnic discrimination, job complexity, degree of control, security and fairness of payment along with demographic and employment information. Estimates of job-related psychosocial stressors were derived and regression analyses used to identify significant associations.

RESULTS

At least one workplace stressor was reported by 83% of the workers in the study. Education was significantly associated with experiencing any psychosocial stressor and also with the total number of stressors. Workers aged 45 years and older were more likely to be bullied or experience racial discrimination compared with younger workers of any ethnicity. There was a greater likelihood of reporting low control over a job when the interview was conducted in a language other than English and the workers were either Chinese or Arabic. Workers on a fixed-term contract, independent of ethnicity were more likely to report a job with low security. Overall psychosocial job quality decreased with education and was associated with occupation type which interacted with ethnicity and gender.

CONCLUSIONS

The results suggest that job-related psychosocial stressors are widespread but not uniform across ethnic groups. Further research into what drives differences in work experience for migrant groups would provide information to guide both employers and migrants in ways to reduce workplace psychosocial stressors.

Latex glove use among healthcare workers in Australia

BACKGROUND

Exposure to natural rubber latex, primarily through the use of gloves, is a well-recognized cause of occupational asthma. We investigated latex glove use among Australian workers and estimated the resultant burden of occupational asthma among healthcare workers (HCWs).

METHODS

Data were collected in 2014 as part of the Australian Work Exposures Study-Asthma, a telephone survey investigating the prevalence of current occupational exposure to asthmagens, including latex. We estimated adjusted prevalence ratios (aPRs) to determine variables associated with the use of latex gloves among HCWs and calculated the asthma-related disability-adjusted life years due to latex exposure among HCWs.

RESULTS

Latex gloves were used by 22% of respondents. Almost two-thirds (63%) of HCWs reported wearing latex gloves, with 26% using powdered latex gloves. The use of latex gloves was more common among those employed in micro companies (less than 5 employees) than large companies (200+ employees) (aPR = 1.5, 95% confidence interval 1.1-2.0). Latex exposure in HCWs was estimated to contribute 3% of the total asthma-related burden.

DISCUSSION

Latex gloves are widely used by Australian workers and by HCWs in particular.

CONCLUSIONS

This is the first estimate of the burden of asthma attributable to occupational exposure to latex among HCWs. These results can be used to guide decisions regarding the control of occupational exposure to latex.

Prevalence of exposure to occupational carcinogens among farmers

INTRODUCTION

Farmers experience a range of carcinogenic exposures, including some pesticides, fuels, engine exhausts, metals, some organic solvents, silica, wood dusts and solar radiation. However many studies investigating the risk of cancer in farmers focus on pesticide exposure alone. The aim of this study was to determine which carcinogens Australian farmers are exposed to, the prevalence and circumstances of those exposures, and the use of protective equipment.

METHODS

The study used data from the Australian Work Exposures Study (AWES) a cross-sectional study conducted in 2012 that investigated the prevalence of carcinogen exposure among Australian workers. This was supplemented with data from AWES-Western Australia (WA), conducted in 2013, which followed the same methodology but in Western Australian workers only. A total of 5498 Australian workers were interviewed about the tasks they carry out in their workplace. The 166 participants who worked in farming (126 men and 40 women, with an age range of 18-65 years) are the focus of this article.

RESULTS

On average, farmers had been exposed to five different carcinogens. Highest numbers of exposures occurred among men and those working on mixed crop and livestock farms. Solar radiation, diesel engine exhaust and certain solvents were the most prevalent exposures, each with over 85% of farmers exposed. The main tasks leading to exposure were working outdoors, using and repairing farming equipment and burning waste. Sun protection and closed cabs on machinery were the most frequently used forms of protection.

CONCLUSIONS

Farmers are a high risk group in relation to carcinogen exposure. The variation in tasks that they undertake results in exposure to a wide variety of different carcinogens that require similarly varied control measures.

Association between shiftwork and the risk of colorectal cancer in females: a population-based case-control study

OBJECTIVE

Research indicates that shiftwork may be associated with increased risks of adverse health outcomes, including some cancers. However, the evidence of an association between shiftwork and colorectal cancer risk is limited and inconclusive. Further, while several possible pathways through which shiftwork might result in cancer have been proposed, few studies have taken these factors into account. We investigated the association between two types of shiftwork (graveyard shiftwork and early-morning shiftwork) and six mechanistic shiftwork variables (including light at night and phase shift) and the risk of colorectal cancer among females in an Australian population-based case-control study. Graveyard shiftwork was the primary exposure of interest.

METHODS

Participants (350 cases and 410 controls) completed a lifetime occupational history, and exposure to each of the eight shiftwork variables was assigned to participants through a job exposure matrix. We used logistic regression to calculate odds ratios (OR) and corresponding 95% confidence intervals (CI) for the association between different shiftwork variables and the risk of colorectal cancer, adjusting for potential demographic, lifestyle and medical confounders.

RESULTS

Working in an occupation involving long-term exposure (>7.5 years) to graveyard shiftwork was not associated with colorectal cancer risk (adjusted OR 0.95, 95% CI 0.57 to 1.58). Similarly, no increased risks of colorectal cancer were seen for any of the other seven shiftwork variables examined.

CONCLUSIONS

No evidence of an increased risk of colorectal cancer among females who had worked in occupations involving shiftwork was observed in this study.

Prevalence of occupational exposure to asthmagens derived from animals, fish and/or shellfish among Australian workers

OBJECTIVE

Several animal, fish and/or shellfish derived substances encountered in the workplace can initiate or exacerbate asthma. The aims of this study were: to produce a population-based estimate of the current prevalence of occupational exposure to animal, fish and/or shellfish derived asthmagens, to identify the main circumstances of exposures and to identify occupations with the highest proportions of exposed respondents.

METHODS

We used data from the Australian Work Exposure Study-Asthma, a national telephone survey that investigated the current prevalence of occupational exposure to asthmagens among Australian workers. A web-based tool was used to collect job task information and assign exposure to asthmagens, including animal, fish and/or shellfish derived asthmagens. Prevalence ratios to determine risk factors for exposure were estimated using modified Poisson regression.

RESULTS

Of the 4878 respondents, 12.4% were exposed to asthmagens derived from animals, fish and/or shellfish. Exposure to these asthmagens was significantly higher in workers residing in regional and remote areas, compared with major cities. The main circumstance of exposure to animal derived asthmagens was through cleaning up rat/mice infestations, while the main circumstance of exposure to fish and/or shellfish derived asthmagens was through preparing and cooking salmon. Occupational groups with the highest proportion of exposure to animal or fish and/or shellfish derived asthmagens were farmers/animal workers and food workers, respectively.

CONCLUSIONS

This is the first study investigating occupational exposure to animal, fish and/or shellfish derived asthmagens in a nationwide working population. The results of this study can be used to inform the direction of occupational interventions and policies to reduce work-related asthma.

Current and future risks of asbestos exposure in the Australian community

BACKGROUND

Australia mined asbestos for more than 100 years and manufactured and imported asbestos products. There is a legacy of in situ asbestos throughout the built environment.

METHODS

The aim of this study was to identify the possible sources of current and future asbestos exposure from the built environment. Telephone interviews with environmental health officers, asbestos removalists, and asbestos assessors in Australia sought information about common asbestos scenarios encountered.

RESULTS

There is a considerable amount of asbestos remaining in situ in the Australian built environment. Potential current and future sources of asbestos exposure to the public are from asbestos-containing roofs and fences, unsafe asbestos removal practices, do-it-yourself home renovations and illegal dumping.

CONCLUSION

This research has highlighted a need for consistent approaches in the regulation and enforcement of safe practices for the management and removal of asbestos to ensure that in situ asbestos in the built environment is managed appropriately.

Cancers in Australia in 2010 attributable to modifiable factors: introduction and overview

OBJECTIVE

To describe the approach underpinning a national project to estimate the numbers and proportions of cancers occurring in Australia in 2010 that are attributable to modifiable causal factors.

METHODS

We estimated the population attributable fraction (PAF) (or prevented fraction) of cancers associated with exposure to causal (or preventive) factors using standard formulae. Where possible, we also estimated the potential impact on cancer incidence resulting from changes in prevalence of exposure. Analyses were restricted to factors declared causal by international agencies: tobacco smoke; alcohol; solar radiation; infectious agents; obesity; insufficient physical activity; insufficient intakes of fruits, vegetables and fibre; red and processed meat; menopausal hormone therapy (MHT); oral contraceptive pill (OCP); and insufficient breast feeding. Separately, we estimated numbers of cancers prevented by: aspirin; sunscreen; MHT; and OCP use. We discuss assumptions pertaining to latent periods between exposure and cancer onset, choices of prevalence data and risk estimates, and approaches to sensitivity analyses.

RESULTS

Numbers and population attributable fractions of cancer are presented in accompanying papers.

CONCLUSIONS

This is the first systematic assessment of population attributable fractions of cancer in Australia.

Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions

OBJECTIVE

To estimate the numbers and proportions of cancers occurring in Australia in 2010 attributable to modifiable causal factors.

METHODS

We estimated the population attributable fraction (PAF) of cancers associated with exposure to 13 causal factors using standard formulae incorporating exposure prevalence and relative risk data. We also calculated the potential impact of changing exposure to some factors.

RESULTS

A total of 32% of all cancers diagnosed in Australia in 2010 (excluding keratinocyte cancers) were attributable to the 13 factors assessed (men 33%; women 31%). Leading factors were tobacco smoke (PAF all cancers: 13.4%), solar radiation (6.2%), inadequate diet (6.1%) and overweight/obesity (3.4%). Factors conferring highest PAFs differed by sex: highest PAFs for men were tobacco smoke (15.8%), solar radiation (7.1%) and alcohol (3.0%); while highest PAFs for women were tobacco smoke (10.1%), solar radiation (5.0%) and overweight/obesity (4.5%). Sites with the highest counts of potentially preventable cancers were lung (8,569), colorectal (7,404), melanoma of the skin (7,220) and breast (3,233).

CONCLUSIONS

At least one in three cancers in Australia is attributable to exposure to known modifiable factors.

IMPLICATIONS

Up to 37,000 cancers could be prevented in Australia each year if the population avoided exposure to 13 common factors known or strongly suspected to cause cancer.

The future excess fraction model for calculating burden of disease

BACKGROUND

Estimates of the burden of disease caused by a particular agent are used to assist in making policy and prioritizing actions. Most estimations have employed the attributable fraction approach, which estimates the proportion of disease cases or deaths in a specific year which are attributable to past exposure to a particular agent. While this approach has proven extremely useful in quantifying health effects, it requires historical data on exposures which are not always available.

METHODS

We present an alternative method, the future excess fraction method, which is based on the lifetime risk approach, and which requires current rather than historical exposure data. This method estimates the future number of exposure-related disease cases or deaths occurring in the subgroup of the population who were exposed to the particular agent in a specific year. We explain this method and use publically-available data on current asbestos exposure and mesothelioma incidence to demonstrate the use of the method.

CONCLUSIONS

Our approach to modelling burden of disease is useful when there are no historical measures of exposure and where future disease rates can be projected on person years at risk.

The estimated prevalence of exposure to asthmagens in the Australian workforce, 2014

Background

There is very little information available on a national level as to the number of people exposed to specific asthmagens in workplaces.

Methods

We conducted a national telephone survey in Australia to investigate the prevalence of current occupational exposure to 277 asthmagens, assembled into 27 groups. Demographic and current job information were obtained. A web-based tool, OccIDEAS, was used to collect job task information and assign exposure to each asthmagen group.

Results

In the Australian Workplace Exposure Study – Asthma (AWES- Asthma) we interviewed 4878 participants (2441 male and 2437 female). Exposure to at least one asthmagen was more common among men (47 %) than women (40 %). Extrapolated to the Australian population, approximately 2.8 million men and 1.7 million women were estimated to be exposed. Among men, the most common exposures were bioaerosols (29 %) and metals (27 %), whilst the most common exposures among women were latex (25 %) and industrial cleaning and sterilising agents (20 %).

Conclusions

This study provides information about the prevalence of exposure to asthmagens in Australian workplaces which will be useful in setting priorities for control and prevention of occupational asthma.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-016-0212-6) contains supplementary material, which is available to authorized users.

The Australian Work Exposures Study: Prevalence of Occupational Exposure to Formaldehyde

INTRODUCTION

The aims of this study were to produce a population-based estimate of the prevalence of work-related exposure to formaldehyde, to identify the main circumstances of exposure and to describe the use of workplace control measures designed to decrease those exposures.

METHODS

The analysis used data from the Australian Workplace Exposures Study, a nationwide telephone survey, which investigated the current prevalence and exposure circumstances of work-related exposure to 38 known or suspected carcinogens, including formaldehyde, among Australian workers aged 18-65 years. Using the web-based tool OccIDEAS, semi-quantitative information was collected about exposures in the current job held by the respondent. Questions were addressed primarily at tasks undertaken rather than about self-reported exposures.

RESULTS

Of the 4993 included respondents, 124 (2.5%) were identified as probably being exposed to formaldehyde in the course of their work [extrapolated to 2.6% of the Australian working population-265 000 (95% confidence interval 221 000-316 000) workers]. Most (87.1%) were male. About half worked in technical and trades occupations. In terms of industry, about half worked in the construction industry. The main circumstances of exposure were working with particle board or plywood typically through carpentry work, building maintenance, or sanding prior to painting; with the more common of other exposures circumstances being firefighters involved in fighting fires, fire overhaul, and clean-up or back-burning; and health workers using formaldehyde when sterilizing equipment or in a pathology laboratory setting. The use of control measures was inconsistent.

CONCLUSION

Workers are exposed to formaldehyde in many different occupational circumstances. Information on the exposure circumstances can be used to support decisions on appropriate priorities for intervention and control of occupational exposure to formaldehyde, and estimates of burden of cancer arising from occupational exposure to formaldehyde.

Prevalence of occupational exposure to carcinogens among workers of Arabic, Chinese and Vietnamese ancestry in Australia

BACKGROUND

Although job-related diseases result in more deaths per year than job-related injuries, most research concerning ethnic minority workers has concerned accidents and injuries rather than disease-causing exposures such as carcinogens.

METHODS

We conducted a telephone-based cross-sectional survey to estimate the prevalence of occupational exposure to carcinogens among a sample of ethnic minority workers in Australia, and compared their exposure prevalence to that of a sample of the general Australian-born working population ('Australian workers').

RESULTS

One-third of the ethnic minority workers were exposed to at least one carcinogen at work. The likelihood of exposure to carcinogens was not significantly different from that of Australian workers, although the likelihood of exposure to individual carcinogens varied by ethnicity.

CONCLUSION

Knowing the prevalence of exposure to carcinogens in the workplace in different ethnic groups will allow better targeted and informed occupational health and safety measures to be implemented where necessary.

The Australian Work Exposures Study: Occupational Exposure to Polycyclic Aromatic Hydrocarbons

INTRODUCTION

The aims of this study were to produce a population-based estimate of the prevalence of work-related exposure to polycyclic aromatic hydrocarbons (PAHs), to identify the main circumstances of exposure and to describe the use of workplace control measures designed to decrease those exposures.

METHODS

The analysis used data from the Australian Workplace Exposures Study, a nationwide telephone survey which investigated the current prevalence and exposure circumstances of work-related exposure to 38 known or suspected carcinogens, including PAHs, among Australian workers aged 18-65 years. Using the web-based tool OccIDEAS, semi-quantitative information was collected about exposures in the current job held by the respondent. Questions were addressed primarily at tasks undertaken rather than about self-reported exposures.

RESULTS

Of the 4,993 included respondents, 297 (5.9%) were identified as probably being exposed to PAHs in their current job [extrapolated to 6.7% of the Australian working population-677 000 (95% confidence interval 605 000-757 000) workers]. Most (81%) were male; about one-third were farmers and about one-quarter worked in technical and trades occupations. In the agriculture industry about half the workers were probably exposed to PAHs. The main exposure circumstances were exposure to smoke through burning, fighting fires or through maintaining mowers or other equipment; cleaning up ash after a fire; health workers exposed to diathermy smoke; cooking; and welding surfaces with a coating. Where information on control measures was available, their use was inconsistent.

CONCLUSION

Workers are exposed to PAHs in many different occupational circumstances. Information on the exposure circumstances can be used to support decisions on appropriate priorities for intervention and control of occupational exposure to PAHs, and estimates of burden of cancer arising from occupational exposure to PAHs.

The Australian Work Exposures Study: Occupational Exposure to Lead and Lead Compounds

INTRODUCTION

The aims of this study were to produce a population-based estimate of the prevalence of work-related exposure to lead and its compounds, to identify the main circumstances of exposures, and to collect information on the use of workplace control measures designed to decrease those exposures.

METHODS

Data came from the Australian Workplace Exposures Study, a nationwide telephone survey which investigated the current prevalence and circumstances of work-related exposure to 38 known or suspected carcinogens, including lead, among Australian workers aged 18-65 years. Using the web-based tool, OccIDEAS, semi-quantitative information was collected about exposures in the current job held by the respondent. Questions were addressed primarily at tasks undertaken rather than about self-reported exposures.

RESULTS

A total of 307 (6.1%) of the 4993 included respondents were identified as probably being exposed to lead in the course of their work. Of these, almost all (96%) were male; about half worked in trades and technician-related occupations, and about half worked in the construction industry. The main tasks associated with probable exposures were, in decreasing order: soldering; sanding and burning off paint while painting old houses, ships, or bridges; plumbing work; cleaning up or sifting through the remains of a fire; radiator-repair work; machining metals or alloys containing lead; mining; welding leaded steel; and working at or using indoor firing ranges. Where information on control measures was available, inconsistent use was reported. Applied to the Australian working population, approximately 6.3% [95% confidence interval (CI) = 5.6-7.0] of all workers (i.e. 631000, 95% CI 566000-704000 workers) were estimated to have probable occupational exposure to lead.

CONCLUSIONS

Lead remains an important exposure in many different occupational circumstances in Australia and probably other developed countries. This information can be used to support decisions on priorities for intervention and control of occupational exposure to lead and estimates of burden of cancer arising from occupational exposure to lead.

Occupational exposure to solar radiation in Australia: who is exposed and what protection do they use?

OBJECTIVE

Solar ultraviolet radiation (UVR) exposure is widely recognised as a leading cause of skin cancer, with outdoor workers being particularly at risk. Little is known on a national level about how many workers are exposed to solar radiation, the circumstances in which they are exposed, or their use of protective measures.

METHODS

The Australian Work Exposures Study (AWES) was a cross-sectional telephone survey of 5,023 Australian workers aged 18 to 65. A subset of 1,113 respondents who indicated they worked outdoors was asked about their exposure to solar radiation in terms of the amount of time they spent working outdoors, their working location and their use of sun protective measures.

RESULTS

A total of 1,100 respondents (22% overall) were assessed as being exposed to solar radiation at work. Exposure was more likely among males and those residing in lower socioeconomic and regional areas. Sun protection was used by 95% of the respondents, although the level of protection varied among workers, with only 8.7% classified as fully protected.

CONCLUSIONS

This study provides valuable information regarding solar exposure that has not previously been available.

IMPLICATIONS

The results of this study will inform strategies for risk reduction.

An advance letter did not increase the response rates in a telephone survey: a randomized trial

OBJECTIVE

To test the impact of an advance letter on response and cooperation rates in a nationwide telephone survey, given previous inconsistent results.

STUDY DESIGN AND SETTING

Within the context of a larger telephone survey, 1,000 Australian households were randomly selected to take part in this trial. Half were randomly allocated to receive an advance letter, whereas the remainder did not receive any advance communication. Response and cooperation rates were compared between the two groups.

RESULTS

A total of 244 interviews were completed, 134 of which were with households that had been sent an advance letter. Intention-to-treat analysis revealed no significant difference in response between those who had received a letter and those who had not (26.8% vs. 22.0%, respectively). In addition, there was no significant difference between the groups in terms of either cooperation (78.4% vs. 79.7%) or response rate (56.3% vs. 57.9%), and no clear differences emerged in terms of the demographic characteristics of the two groups.

CONCLUSION

An advance letter was not seen to be effective in increasing response or cooperation rates in a nationwide telephone survey. Researchers should consider alternative methods of increasing participation in telephone surveys.

‘What you look like is such a big factor’: Girls’ own reflections about the appearance culture in an all-girls’ school

High school is a key venue for the development and expression of body image concerns in adolescent girls. Researchers have begun to investigate the role of school-based ‘appearance cultures’ in magnifying the body image concerns of students. To date, however, no research has examined girls’ experience as participants within these cultures, and thus the opportunity to learn how girls account for the development and maintenance of these cultures has been missed. In interviews with nine girls attending an all-girls’ school, the existence of a strong ‘appearance culture’ in the school was identified as a major influence on the body image concerns of students. Girls talked about the ways in which appearance-focused conversations, dieting, and weight monitoring occurred as part of the everyday interaction with friends and peers at school. They also identified many ways in which their school attempted to address body image concerns, although these attempts were often portrayed as ineffective, if not counter-productive. These findings suggest that attempts to address the body image concerns of students will need to be sensitive to the lived reality of appearance cultures within schools.

Adult onset grape hypersensitivity causing life threatening anaphylaxis

BACKGROUND

Adverse reactions to foods are encountered much less frequently in adults than in the children. Adult onset hypersensitivity to grapes has not been previously reported.

OBJECTIVE

Evaluation of a case of anaphylaxis that occurred as a result of the consumption of white grapes (Vitis vinifera).

METHODS AND RESULTS

A 28-year-old woman experienced generalized urticaria, facial/oropharyngeal angioedema, and dizziness after eating a bunch of white grapes. She was treated in an emergency room for anaphylaxis. Previously, she had experienced two similar episodes after eating white grapes. The grape prick skin tests were strongly positive forming a pseudopod type reaction. The total serum IgE was 1918 ng/mL. The grape-specific serum IgE was weakly positive by the modified RAST and negative in the Pharmacia-Upjohn Cap System.

CONCLUSION

Hypersensitivity to a commonly consumed fruit such as grapes can develop late in life causing a near-fatal anaphylaxis.

Quality control for qualitative assays: quantitative QC procedure designed to assure analytical quality required for an ELISA of hepatitis B surface antigen

An assay for hepatitis B surface antigen (HBsAg) should reliably detect 0.2 microgram/L, the lowest reported concentration in an asymptomatic blood donor. The difference between this concentration and the assay cutoff defines the analytical quality requirement in a total error format. The design of a statistical QC procedure is critically dependent on the precision of the assay. The precision of a developmental ELISA of HBsAg under study ranged from 17.5% to 9.6% for controls containing 0.07 to 1.50 micrograms/L, respectively. Use of one positive control with the 1(3s), QC rule provided an 85% chance of detecting a critical loss of assay sensitivity; use of two positive controls increased the chance of detecting critical loss of assay sensitivity to nearly 100%. These rules are based on the precision of this developmental assay, and must be developed individually for other assays. The development of the proposed QC procedures illustrates how quantitative QC can be provided for qualitative assays.

A systems approach to assure optimal proficiency testing in the hematology laboratory

Although CLIA 88 has probably caused the laboratorian to place inordinate emphasis on proficiency testing, we believe that it will ultimately improve clinical laboratory practice. Due to the increased numbers of challenges within a mailing, the laboratorian has a greater ability to gauge magnitudes and types of any existing error. These magnitudes can be compared with previously established limits to determine the need for corrective action. Laboratories are encouraged to devise a system to guarantee accurate preanalytic, analytic, and postanalytic PT processing and reporting. Due to the relatively low imprecisions of today's hematology analyzers compared with the HCFA limits, most hematology laboratories should focus their attention on measures of and factors affecting long-term control and calibration. More attention should be paid to moving averages of indices and the analytic performance in regional or manufacturer control pools.

Multicentric reticulohistiocytosis and Sjögren's syndrome

A 66-year-old man with an 18-year history of cutaneous multicentric reticulohistiocytosis (MRH) developed a chronic destructive symmetrical arthritis and xerostomia. Biopsies of synovium and minor salivary glands established a diagnosis of MRH polyarthritis and lymphocytic infiltrative Sjögren's syndrome, respectively. Anti-Ro(SSA) antibody was present. Hypothyroidism was also identified. This report of Sjögren's syndrome in MRH may enlarge the spectrum of autoimmune diseases associated with MRH.

Clinical studies of a fast homoarginine-sensitive alkaline phosphatase in patients with cancer

The activity of an isoenzyme of alkaline phosphatase (FHAP) was measured in serum samples obtained from 1692 individual subjects. The median FHAP concentration in patients with untreated or recurrent cancer (2.73 IU/liter) was two-fold higher than in hospitalized control patients with illnesses other than cancer (1.17 IU/liter) and three-fold higher than in healthy control subjects (0.93 IU/liter). Among patients with either breast or colorectal cancer who were clinically disease free following their initial therapy, the median FHAP concentration (1.54 IU/liter) was intermediate between the median FHAP concentration in patients with untreated or recurrent cancer and that of healthy control subjects. In order to illustrate the potential clinical application of FHAP as a diagnostic cancer marker, we have selected a serum FHAP concentration of 2.22 IU/liter as a reference value above which only 3% of healthy control subjects would have a "positive" test. Utilizing this reference value, 58% of the patients in the present study with untreated or recurrent cancer would have a positive FHAP test, whereas only 11%, of hospitalized patients with illnesses other than cancer would have a positive test. These data suggest that FHAP may be equivalent to the carcinoembryonic antigen as a diagnostic cancer marker.