Occupational patterns of opioid-related harms comparing a cohort of formerly injured workers to the general population in Ontario, Canada

OBJECTIVES

The role of work-related injuries as a risk factor for opioid-related harms has been hypothesized, but little data exist to support this relationship. The objective was to compare the incidence of opioid-related harms among a cohort of formerly injured workers to the general population in Ontario, Canada.

METHODS

Workers' compensation claimants (1983-2019) were linked to emergency department (ED) and hospitalization records (2006-2020). Incident rates of opioid-related poisonings and mental and behavioural disorders were estimated among 1.7 million workers and in the general population. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) were calculated, adjusting for age, sex, year, and region.

RESULTS

Compared to the general population, opioid-related poisonings among this group of formerly injured workers were elevated in both ED (SIR = 2.41, 95% CI = 2.37-2.45) and hospitalization records (SIR = 1.54, 95% CI = 1.50-1.59). Opioid-related mental and behavioural disorders were also elevated compared to the general population (ED visits: SIR = 1.86, 95% CI = 1.83-1.89; hospitalizations: SIR = 1.42, 95% CI = 1.38-1.47). Most occupations and industries had higher risks of harm compared to the general population, particularly construction, materials handling, processing (mineral, metal, chemical), and machining and related occupations. Teaching occupations displayed decreased risks of harm.

CONCLUSION

Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms. Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted.

Risk of chronic obstructive pulmonary disease in a large cohort of Ontario, Canada workers

Although several occupational exposures have been linked to the risk of COPD; limited data exists on sex-specific differences. This study aimed to identify at-risk occupations and sex differences for COPD risk. Cases were identified in a large surveillance system established through the linkage of former compensation claimants' data (non-COPD claims) to physician visits, ambulatory care data, and hospital inpatient data (1983-2020). Cox proportional hazard models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for occupation groups (occupation at time of claim), stratified by sex. HRs were indirectly adjusted for cigarette smoking using another population dataset. A total of 29,445 male and 14,693 female incident cases of COPD were identified. Increased risks were observed in both sexes for construction (HRmale 1.15, 95% CI 1.12-1.19; HRfemale 1.54, 95% CI 1.29-1.83) transport/equipment operating (HRmale 1.32, 95% CI 1.28-1.37; HRfemale 1.53, 95% CI 1.40-1.68) farming (HRmale 1.23, 95% CI 1.15-1.32; HRfemale 1.19, 95% CI 1.04-1.37) and janitors/cleaners (HRmale 1.31, 95% CI 1.24-1.37; HRfemale 1.40, 95% CI 1.31-1.49). Increased risks were observed for females employed as chefs and cooks (HR 1.44, 95% CI 1.31-1.58), bartenders (HR 1.38, 95% CI 1.05-1.81), and those working in food/beverage preparation (HR 1.34, 95% CI 1.24-1.45) among other occupations. This study demonstrates elevated risk of COPD among both male and female workers potentially exposed to vapours, gases, dusts, and fumes, highlighting the need for occupational surveillance of COPD.

Cancer Risks among Emergency Medical Services Workers in Ontario, Canada

OBJECTIVES

Emergency medical services workers, such as paramedics, provide important emergency care and may be exposed to potential carcinogens while working. Few studies have examined the risk of cancer among paramedics demonstrating an important knowledge gap in existing literature. This study aimed to investigate cancer risks among paramedics in a large cohort of Ontario workers.

METHODS

Paramedics were identified in the Occupational Disease Surveillance System (ODSS) from 1996 to 2019. The ODSS was established by linking lost-time worker's compensation claims to administrative health data, including the Ontario Cancer Registry to identify incident cases of cancer. Cox-proportional hazard models were used to calculate age and sex-adjusted hazard ratios and 95% confidence intervals to estimate the risk of cancer among paramedics compared to all other workers in the ODSS.

RESULTS

A total of 7240 paramedics were identified, with just over half of the paramedics identifying as male similar to the overall ODSS cohort. Paramedics had a statistically significant elevated risk of any cancer (HR 1.19, 95% CI 1.06-1.34), and elevated risks for melanoma (HR 2.18, 95% CI 1.46-3.26) and prostate cancer (HR 1.73, 95% CI 1.34-2.22). Paramedics had a statistically significant reduced risk for lung cancer (HR 0.48, 95% CI 0.28-0.83). Findings were similar to cancer risks identified in firefighters and police in the same cohort.

CONCLUSIONS

This study contributes valuable findings to understanding cancer risks among paramedics and further supports the existing evidence on the increased risk of cancer among emergency medical services workers. We have observed some similar results for firefighters and police, which may be explained by similar exposures, including vehicle exhaust, shiftwork, and intermittent solar radiation. This can lead to a better understanding of carcinogens and other exposures among paramedics and inform cancer prevention strategies.

Cancer risk among firefighters and police in the Ontario workforce

Objective

Firefighters and police often work in high-stress, complex environments with known and suspected carcinogenic exposures. We aimed to characterise cancer incidence among firefighters and police.

Methods

The Occupational Disease Surveillance System (ODSS) was used to identify workers employed as firefighters or police in Ontario. A cohort of workers were identified using lost-time workers’ compensation claims data and followed for cancer in the Ontario Cancer Registry (1983–2020). Cox proportional hazard models were used to estimate HRs and 95% CIs for primary site-specific cancer diagnoses adjusted for age at start of follow-up, birth year and sex.

Results

A total of 13 642 firefighters and 22 595 police were identified in the cohort. Compared with all other workers in the ODSS, firefighters and police had increased risk of prostate cancer (firefighters: HR=1.43, 95% CI 1.31 to 1.57; police: HR=1.47, 95% CI 1.35 to 1.59), colon cancer (firefighters: HR=1.39, 95% CI 1.19 to 1.63; police: HR=1.39, 95% CI 1.21 to 1.60) and skin melanoma (firefighters: HR=2.38, 95% CI 1.99 to 2.84; police: HR=2.27, 95% CI 1.96 to 2.62). Firefighters also had increased risk of cancer of the pancreas, testis and kidney, as well as non-Hodgkin’s lymphoma and leukaemia. Police had increased risk of thyroid, bladder and female breast cancer. When compared directly with the police, firefighters had an elevated risk of mesothelioma and testicular cancer.

Conclusions

Firefighters and police demonstrated some similar as well as some unique cancer risks. Findings from this larger worker population may have important implications for workplace and policy-level changes to improve preventative measures and reduce potential exposures to known carcinogenic hazards.

Mental Health Concerns of Frontline Workers During the COVID-19 Pandemic: A Scoping Review

OBJECTIVES: The current COVID-19 pandemic continues to have a significant impact on the mental health of frontline workers worldwide. Currently there are limited published studies addressing mental health issues in frontline workers. The objective of this scoping review is to examine the range of existing global literature on mental health issues reported in frontline workers during the COVID-19 pandemic and to understand what mitigating factors exist. METHODS: The scoping review was guided by the Levac Colquhoun and O’Brien’s adapted version of Arkey and O’Malley’s framework. We performed a comprehensive search of three databases, Pubmed, APA PsychINFO, and CINAHL, identifying 684 studies. In total, 16 original studies and 4 letters to editors were included in this review. RESULTS: Of the original studies, 13 were published in China, and the remaining 3 in Italy, Turkey, and Iraq; all letters to editors were published in China. Sources of stress reported in frontline workers across studies included direct contact with COVID-19 patients, isolation, putting loved ones at risk, facing life and death decision making with COVID-19 patients, uncertainty with COVID-19 disease control, limited personal protective equipment, time spent thinking about COVID-19, limited staff/resources/pay, burnout, and stigma. Mental health symptoms and outcomes reported in frontline workers were fear, stress, anxiety, depression, insomnia, burnout, and psychological distress. CONCLUSION: Findings demonstrate the immediate need to increase mental health awareness and resources at an individual and system wide level. Mental health programs need to be catered towards each unique workplace to provide the necessary resources for frontline workers.

Trends in participation rates in case–control studies of occupational risk factors 1991–2017

Objective

Declining participation has been observed in previous epidemiological studies, could occupational risk factor epidemiology be particularly vulnerable to this trend? The objective of this study was to assess trends of participation rates in occupational case-control studies.

Methods

Five prominent occupational and epidemiological journals were pre-selected and all articles published between 1991 and 2017 were screened for case-control studies of occupational risk factors for chronic disease outcomes. The primary independent variable was median year of data collection, while the primary outcome variable was reported participation rate. We conducted linear regression, adjusting for study characteristics that included study gender mix, location of recruitment, disease outcome, and data collection method.

Results

A total of 180 studies published in the five journals were included in the final analysis. The mean participation was higher for cases (78.9%) than for controls (71.5%). In linear regression, a significant trend of decreasing participation was observed for both cases with a percent change of −0.50 per year (95% CI −0.75 to −0.25) for cases and a percent change of −0.95 per year (95% CI −1.23 to −0.67) for controls. After adjustment for study gender mix, location, disease outcome, and data collection method, the trend remained statistically significant for both case and control groups.

Conclusion

Declining participation rates in case-control studies of occupational risk factors may reflect an overall decline of participation in population-based samples. Lower participation rates introduce the potential for bias and may deter future population-based studies of occupational risk factors.

Prostate cancer risk by occupation in the Occupational Disease Surveillance System (ODSS) in Ontario, Canada

INTRODUCTION

Previous Canadian epidemiologic studies have identified associations between occupations and prostate cancer risk, though evidence is limited. However, there are no well-established preventable risk factors for prostate cancer, which warrants the need for further investigation into occupational factors to strengthen existing evidence. This study uses occupation and prostate cancer information from a large surveillance cohort in Ontario that linked workers' compensation claim data to administrative health databases.

METHODS

Occupations were examined using the Occupational Disease Surveillance System (ODSS). ODSS included 1 231 177 male workers for the 1983 to 2015 period, whose records were linked to the Ontario Cancer Registry (OCR) in order to identify and follow up on prostate cancer diagnoses. Cox proportional hazard models were used to calculate age-adjusted hazard ratios and 95% CI to estimate the risk of prostate cancer by occupation group.

RESULTS

A total of 34 997 prostate cancer cases were diagnosed among workers in ODSS. Overall, elevated prostate cancer risk was observed for men employed in management/ administration (HR 2.17, 95% CI = 1.98-2.38), teaching (HR 1.99, 95% CI = 1.79-2.21), transportation (HR 1.20, 95% CI = 1.16-1.24), construction (HR 1.09, 95% CI = 1.06-1.12), firefighting (HR 1.62, 95% CI = 1.47-1.78), and police work (HR 1.20, 95% CI = 1.10-1.32). Inconsistent findings were observed for clerical and farming occupations.

CONCLUSION

Associations observed in white collar, construction, transportation, and protective services occupations were consistent with previous Canadian studies. Findings emphasize the need to assess job-specific exposures, sedentary behaviour, psychological stress, and shift work. Understanding specific occupational risk factors can lead to better understanding of prostate cancer etiology and improve prevention strategies.

Breast cancer risk by occupation and industry in women and men: Results from the Occupational Disease Surveillance System (ODSS)

BACKGROUND

The recently established Occupational Disease Surveillance System (ODSS) was used to examine breast cancer risk in women and men by occupation and industry.

METHODS

Ontario workers in the ODSS cohort (1983-2016) were followed up for breast cancer diagnosis through the Ontario Cancer Registry. Cox-proportional hazard models were used to calculate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

A total of 17 865 and 492 cases were identified in working women (W) and men (M), respectively. Elevated risks were observed in management (W: HR = 1.54, 95% CI = 1.40-1.70; M: HR = 2.79, 95% CI = 1.44-5.39), administrative/clerical (W: HR = 1.16, 95% CI = 1.11-1.21; M: HR = 1.45, 95% CI = 1.06-1.99), and teaching (W: HR = 1.54, 95% CI = 1.44-1.63; M: HR = 3.00, 95% CI = 1.49-6.03). Other elevated risks were observed in nursing/health, social sciences, and janitor/cleaning services for both genders.

CONCLUSIONS

Common occupational associations in both genders warrant investigation into job-related risk factors, such as sedentary behavior, shift work, ionizing radiation, and chemical exposures.

Prostate cancer surveillance by occupation and industry: the Canadian Census Health and Environment Cohort (CanCHEC)

As there are no well-established modifiable risk factors for prostate cancer, further evidence is needed on possible factors such as occupation. Our study uses one of the largest Canadian worker cohorts to examine occupation, industry, and prostate cancer and to assess patterns of prostate cancer rates. The Canadian Census Health and Environment Cohort (CanCHEC) was established by linking the 1991 Canadian Census Cohort to the Canadian Cancer Database (1969-2010), Canadian Mortality Database (1991-2011), and Tax Summary Files (1981-2011). A total of 37,695 prostate cancer cases were identified in men aged 25-74 based on age at diagnosis. Cox proportional hazards models were used to estimate hazards ratios and 95% confidence intervals. In men aged 25-74 years, elevated risks were observed in the following occupations: senior management (HR = 1.12, 95% CI: 1.04-1.20); office and administration (HR = 1.19, 95% CI: 1.11-1.27); finance services (HR = 1.09, 95% CI: 1.04-1.14); education (HR = 1.05, 95% CI: 1.00-1.11); agriculture and farm management (HR = 1.12, 95% CI: 1.06-1.17); farm work (HR = 1.11, 95% CI: 1.01-1.21); construction managers (HR = 1.07, 95% CI: 1.01-1.14); firefighting (HR = 1.17, 95% CI: 1.01-1.36); and police work (HR = 1.22, 95% CI: 1.09-1.36). Decreased risks were observed across other construction and transportation occupations. Results by industry were consistent with occupation results. Associations were identified for white-collar, agriculture, protective services, construction, and transportation occupations. These findings emphasize the need for further study of job-related exposures and the potential influence of nonoccupational factors such as screening practices.

Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies

OBJECTIVES

We conducted a systematic review and meta-analysis to evaluate potential associations between firefighting and police occupations, and prostate cancer incidence and mortality.

METHODS

Original epidemiological studies published from 1980 to 2017 were identified through PubMed and Web of Science. Studies were included if they contained specific job titles for ever/never firefighting and police work and associated prostate cancer risk estimates with 95% confidence intervals (CI). Study quality was assessed using a 20-point checklist. Prostate cancer meta-risk estimates (mRE) and corresponding 95% CIs were calculated for firefighting and police work separately and by various study characteristics using random effects models. Between-study heterogeneity was evaluated using the I² score. Publication bias was assessed using Begg's and Egger's tests.

RESULTS

A total of 26 firefighter and 12 police studies were included in the meta-analysis, with quality assessment scores ranging from 7 to 19 points. For firefighter studies, the prostate cancer incidence mRE was 1.17 (95% CI = 1.08-1.28, I² = 72%) and the mortality mRE was 1.12 (95% CI = 0.92-1.36, I² = 50%). The mRE for police incidence studies was 1.14 (95% CI = 1.02-1.28; I² = 33%); for mortality studies, the mRE was 1.08 (95% CI = 0.80-1.45; I² = 0%). By study design, mREs for both firefighter and police studies were similar to estimates of incidence and mortality.

CONCLUSION

Small excess risks of prostate cancer were observed from firefighter studies with moderate to substantial heterogeneity and a relatively small number of police studies, respectively. There is a need for further studies to examine police occupations and to assess unique and shared exposures in firefighting and police work.

Occupation and risk of prostate cancer in Canadian men: A case-control study across eight Canadian provinces

BACKGROUND

The etiology of prostate cancer continues to be poorly understood, including the role of occupation. Past Canadian studies have not been able to thoroughly examine prostate cancer by occupation with detailed information on individual level factors.

METHODS

Occupation, industry and prostate cancer were examined using data from the National Enhanced Cancer Surveillance System, a large population-based case-control study conducted across eight Canadian provinces from 1994 to 1997. This analysis included 1737 incident cases and 1803 controls aged 50 to 79 years. Lifetime occupational histories were used to group individuals by occupation and industry employment. Odds ratios and 95% confidence intervals were calculated and adjustments were made for known and possible risk factors.

RESULTS

By occupation, elevated risks were observed in farming and farm management (OR=1.37, 95% CI 1.02-1.84), armed forces (OR=1.33, 95% CI 1.06-1.65) and legal work (OR=2.58, 95% CI 1.05-6.35). Elevated risks were also observed in office work (OR=1.20, 95% CI 1.00-1.43) and plumbing (OR=1.77, 95% CI 1.07-2.93) and with ≥10 years duration of employment. Decreased risks were observed in senior management (OR=0.65, 95% CI 0.46-0.91), construction management (OR=0.69, 95% CI 0.50-0.94) and travel work (OR=0.37, 95% CI 0.16-0.88). Industry results were similar to occupation results, except for an elevated risk in forestry/logging (OR=1.54, 95% CI 1.06-2.25) and a decreased risk in primary metal products (OR=0.70, 95% CI 0.51-0.96).

CONCLUSION

This study presents associations between occupation, industry and prostate cancer, while accounting for individual level factors. Further research is needed on potential job-specific exposures and screening behaviours.

Natural resource-based industries and prostate cancer risk in Northeastern Ontario: a case-control study

OBJECTIVE

Prostate cancer continues to be the most commonly diagnosed cancer in men, and there is limited knowledge on its preventable risk factors. A number of occupational exposures in natural resource-based industries are suspected to be related to prostate cancer risk. This study investigates associations between employment in these industries and prostate cancer.

METHODS

Data were from a population-based, case-control study previously conducted in Northeastern Ontario. Incident cases (N=760) aged 45-85 years and diagnosed with prostate cancer between 1995 and 1998 were identified from the Ontario Cancer Registry. Controls (N=1632) were recruited using telephone listings, and were frequency matched to cases by age. Lifetime occupational history was collected for all participants. Logistic regression was used to estimate ORs and their associated 95% CIs.

RESULTS

Elevated risks were observed for employment in forestry and logging industries (OR=1.87, 95% CI 1.32 to 2.73) and occupations (OR=1.71, 95% CI 1.24 to 2.35), and these risks increased with duration of employment for ≥10 years. Elevated risks were also found for employment in wood products industries (OR=1.45, 95% CI 1.07 to 1.97), and paper and allied products industries (OR=1.43, 95% CI 1.03 to 2.00), and when duration of employment was ≥10 years. There were also elevated risks in agriculture and mining-related work; however, these findings were not consistent across industry and occupation categories.

CONCLUSIONS

Prostate cancer risk may be associated with work in several natural resource industries, primarily in the forest industries. To further evaluate observed associations, studies should focus on natural resource-based exposures in larger populations with improved exposure assessment.

Environmental factors in an Ontario community with disparities in colorectal cancer incidence

Objective:

In Ontario, there are significant geographical disparities in colorectal cancer incidence. In particular, the northern region of Timiskaming has the highest incidence of colorectal cancer in Ontario while the southern region of Peel displays the lowest. We aimed to identify non-nutritional modifiable environmental factors in Timiskaming that may be associated with its diverging colorectal cancer incidence rates when compared to Peel.

Methods:

We performed a systematic review to identify established and proposed environmental factors associated with colorectal cancer incidence, created an assessment questionnaire tool regarding these environmental exposures, and applied this questionnaire among 114 participants from the communities of Timiskaming and Peel.

Results:

We found that tobacco smoking, alcohol consumption, residential use of organochlorine pesticides, and potential exposure to toxic metals were dominant factors among Timiskaming respondents. We found significant differences regarding active smoking, chronic alcohol use, reported indoor and outdoor household pesticide use, and gold and silver mining in the Timiskaming region.

Conclusions:

This study, the first to assess environmental factors in the Timiskaming community, identified higher reported exposures to tobacco, alcohol, pesticides, and mining in Timiskaming when compared with Peel. These significant findings highlight the need for specific public health assessments and interventions regarding community environmental exposures.

Abstract 4819: Assessing the environmental factors in two Ontario communities with diverging colorectal cancer incidence rates

Colorectal cancer is the third most diagnosed cancer and second leading cause of cancer related deaths in Canada. As Ontario has the largest population in Canada, it also has great disparities in colorectal cancer incidence. The region of Timiskaming has the highest incidence for colorectal cancer, while the region of Peel has the lowest incidence for colorectal cancer in Ontario. There are no previously published studies regarding cancer or environmental risk factors performed in the Timiskaming region. The purpose of this study was to identify the dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming compared to the reference region of Peel that may be associated with diverging colorectal cancer incidence rates. After reviewing the available published literature, a questionnaire assessment tool regarding environmental exposures was created. This questionnaire tool was created by combining standardized questionnaire tools available in the published literature that assessed environmental exposures. The questionnaire assessment tool was then utilized within a pilot study group followed by the Timiskaming and Peel participant communities. The tool assessed the exposures of tobacco smoking, alcohol use, pesticides/organochlorines, metal toxins, occupational exposures, and medical ionizing radiation. A total of 53 participants completed the questionnaire tool in Timiskaming, and a total of 61 participants completed the questionnaire tool in Peel. Findings indicate that there are dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming that may be associated with colorectal cancer when compared to the region of Peel. The significant dominant environmental factors identified by Timiskaming participants were tobacco smoking, alcohol use, pesticides/organochlorines, and metal toxins. The findings also indicate that the Peel community may have important community health initiatives that can be used in the Timiskaming community to reduce the present colorectal cancer disparities. Following this study, it is imperative that recommendations are directed at a community level and relate to the assessment of potential non-nutritional modifiable environmental risk factors. While colorectal cancer disparities are evident, future research should help to understand the relationship between cancer disparities and environmental risk factors.

Citation Format: Jeavana Sritharan, Rishikesan Kamaleswaran, Ken McFarlan, Manon Lemonde, Clemon George, Otto Sanchez. Assessing the environmental factors in two Ontario communities with diverging colorectal cancer incidence rates . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4819. doi:10.1158/1538-7445.AM2013-4819

Abstract A36: The relationship between modifiable environmental risk factors and colorectal cancer: A systematic review

Colorectal cancer is the second leading cause of cancer death in Canada with an estimated 8, 900 deaths per year. The province of Ontario currently has the highest estimated number of deaths from colorectal cancer. Within Ontario, there are prevalent disparities of cancer incidence between communities. Colorectal cancer incidence rates range between >65 new cases per 100, 000 people in communities with higher incidence rates and 45 new cases per 100, 000 people in communities with lower incidence rates. These diverging rates of colorectal cancer have not been studied in relation to modifiable environmental risk factors. As an initial step in assessing these types of risk factors, we are undertaking a systematic review in order to examine current epidemiological evidence on the effects of modifiable environmental risk factors in colorectal cancer incidence. A community based participatory study, as a second step following the systematic review, is currently underway as a case control study among the community groups that present the highest and lowest colorectal cancer incidence rates. The aim of this study is to conduct a synthesis of all primary studies that examine any modifiable environmental risk factors and colorectal cancer using systematic review methodology. We hypothesize that modifiable environmental risk factors are partially responsible for regional colorectal cancer incidence disparities. Seven categories pre-determined for the case control study are also being used for the systematic review as they were found to be the most common modifiable environmental risk factors associated with colorectal cancer in the literature. The categories are air pollution, alcohol, ionizing radiation, metal toxins, occupational exposure, pesticides/organochlorines, and smoking/tobacco. A screening inclusion tool was created in order to identify the articles that would be included in the systematic review. Any original research study, published in English, examining only human participants that discussed any modifiable environmental risk factor and the measurable outcome of colorectal cancer were eligible for inclusion. Studies that examine non human participants, cell lines or DNA components, languages other than English, nutritional components, and examine outcomes other than colorectal cancer were excluded. A comprehensive search of the PubMed database between 1960 and April 2011 was performed using the key words “colorectal neoplasms,” “ethanol,” “alcoholism,” “alcoholic beverages,” “alcoholic drinking,” “smoking,” “tobacco,” “air pollution,” “adverse effects ionizing radiation,” “metals,” “heavy/adverse effects,” “light/adverse effects,” and “occupational exposure,” “pesticides,” and “organochlorine products.” All articles are being reviewed by two researchers utilizing the screening inclusion tool and data extraction form. The articles that pass the inclusion criteria tool are then being categorized further into sub categories in the seven risk factor categories, based on type of study and specific risk factor studied. Initial search yielded 537 citations which are being categorized into the seven different types of risk factors using the inclusion criteria. The strongest evidence will be demonstrated in various categories highlighting characteristics of research methodology, risk factor, and measured outcomes. This evidence will be presented to not only benefit communities with cancer disparities but to benefit the second step of our study regarding a community based case control study. Identification and understanding of the best evidence is imperative to utilize robust methodology and assess research gaps for further community research.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A36.