Interventions in high-risk occupational cohorts: a cross-sectional demonstration project

Our plain-English summary of Interventions in high-risk occupational cohorts: a cross-sectional demonstration project, by S. Tillett, K. Ringen, P. Schulte, et al (Journal of Occupational Medicine., 1986).

The study

• Authors: S. Tillett, K. Ringen, P. Schulte, V. McDougall, K. Miller, S. Samuels
• Journal: Journal of Occupational Medicine.
• Published: 1986;28(8):719-27
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In 1980, the Workers' Institute for Safety and Health began a demonstration project designed to develop a model program of community-based intervention in three cohorts with different workplace exposures and target cancer sites. Program components included identification, notification, medical surveillance, education, social support services (eg, psychosocial, legal, financial, etc), and evaluation. The three cohorts included the Augusta cohort, a group at risk for bladder cancer due to workplace exposure to beta-naphthylamine; the Port Allegany cohort, a group at high risk of cancer associated with a workplace exposure to asbestos; and the Pattern Makers cohort, a group shown to be at increased risk of colorectal cancer. Together, these three projects give a cross-sectional view of possible approaches to educational and medical intervention strategies in diverse situations.

In plain English

This article described three worker notification and intervention demonstration projects, not trials, run by the Workers' Institute for Safety and Health from 1980 to 1984. One project involved about 1,200 workers, mostly Flint Glass Workers' Union members, potentially exposed to asbestos from 1964 to 1972 at a glass and insulation plant in Port Allegany, Pennsylvania. Of 854 cohort members located and notified, 80% of those living near the town and 46% of those living elsewhere took part in medical screening, or 70% overall. In 1979, 35% of 355 workers examined said they were current smokers. When 179 workers were reexamined in 1982 to 1983, 30% still smoked. In a 1984 survey, 30% of participants smoked, compared with 47% of nonparticipants. The program detected its first lung cancer in 1983. Among Augusta, Georgia, chemical workers exposed to beta-naphthylamine, 88% of the 849 located and notified took part, and 245 of 1,094 assumed eligible were lost to follow-up. Among pattern makers, average participation at selected screening locations was 48%. The authors concluded such programs are feasible, noting high losses to follow-up and self-reported data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive report of three community-based worker notification and intervention demonstration projects (not trials), with process indicators such as participation and compliance rates and preliminary medical findings
• Who was studied: Three occupational cohorts. (1) Port Allegany, Pennsylvania: about 1,200 workers, most of them members of the Flint Glass Workers' Union; 1,186 in the cohort per Table 5. (2) Augusta, Georgia: 1,094 living, predominantly black, male chemical workers. (3) Pattern makers: members of the Pattern Makers' League of North America (approximately 12,000 active and retired workers). The projects ran from 1980 to 1984.
• Exposure: Port Allegany: workplace exposure to asbestos at a glass and insulation plant; white males potentially exposed from 1964 to 1972. The fiber type is not stated. Augusta: beta-naphthylamine (bladder cancer). Pattern makers: an increased risk of colorectal cancer, with the cause not identified.
• Main results:
  • Port Allegany: 854 cohort members were located and notified. Of those, 80% of those living in the Port Allegany catchment area (within 30 miles of the town) participated.
  • Port Allegany: 46% of notified cohort members outside the catchment area participated.
  • Port Allegany: the overall participation rate among those notified was 70% (594 of 854 per Table 5).
  • Port Allegany: of 355 workers examined in 1979, 35% said they were current smokers and 43% said they were ex-smokers (self-reported).
  • Port Allegany: at reexamination of 179 workers by local physicians in 1982 to 1983, 30% of participants continued to smoke.
  • Port Allegany: in a 1984 telephone survey, smoking prevalence was 30% among randomly selected participants (N = 206) and 47% among nonparticipating cohort members (n = 92).
  • Port Allegany: the first case of lung cancer detected through the program was found in 1983. The authors noted that with a 20-year latency period, the earliest cancer cases were just beginning to appear.
  • Augusta: overall participation was 88% of the 849 cohort members located and notified (93% in the local area, 77% out of town). The authors defined participation rate as a percentage of those located and notified.
  • Augusta: of the assumed eligible population of 1,094, a total of 245 (22.5%) were lost to follow-up.
  • Augusta: by 1984, 273 of the 374 workers referred for follow-up cystoscopy had completed it, a compliance rate of 73%.
  • Augusta: 15 cases of bladder cancer were confirmed in the cohort.
  • Augusta: five of the 15 bladder cancer cases were identified as a result of the screening program.
  • Pattern makers: in data from select locations where the first baseline screenings were performed (Table 4), the average participation rate was 48% (1,513 participants of 3,131 eligible).
  • Pattern makers: 12 cases of malignant disease of the large bowel and rectum were confirmed among the 1,513 subjects who completed the examination.
  • Pattern makers: 219 pattern makers were found to have colorectal polyps.
  • Pattern makers: participants self-reported an overall compliance rate of 94% with the 7-day special diet before screening.
• The authors' conclusion: The authors concluded that the three programs show that notification and intervention programs for high-risk occupational cohorts are feasible within existing labor-management, medical care, community and social structures. They added that much remains to be learned about responding to low-probability risks and long-latency chronic diseases.
• Limitations the authors state:
  • The high rate of cohort members lost to follow-up in Augusta and Port Allegany needs further investigation.
  • The Port Allegany smoking data were self-reported and were being reexamined.
  • It is unknown how far earlier publicity about asbestos hazards at the plant influenced the smoking rates recorded in 1979.
  • There were no data on the effect of physicians' personal counseling about stopping smoking.
  • The pattern makers' self-reported diet compliance results need further confirmation and cast doubt on that indicator as a measure of compliance.

Topics

Medical terms in this study, explained in our Lexicon: Colorectal Cancer.

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