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D M Winn

Publications and source records attributed to D M Winn.

At least 19 recordsLinked to original sources
PubMed1996

An overview of the oral health component of the 1988-1991 National Health and Nutrition Examination Survey (NHANES III-Phase 1).

As part of a Federal consortium, the National Institute of Dental Research's (NIDR) Division of Epidemiology and Oral Disease Prevention (DEODP) staff and consultants collaborated with the National Center for Health Statistics (NCHS) to conduct a national oral health examination as a component of the 1988-94 National Health and Nutrition Examination Survey (NHANES III). The Phase 1 took place between October 18, 1988, and October 24, 1991, at 44 survey locations; Phase 2, between September 20, 1991, and October 15, 1994, at 45 sites. This article provides general background information on the NHANES III and its oral health examination component which pertains to all six years of the full survey. It also focuses on particular aspects of the first three years of the survey (NHANES III-Phase 1)--the database for the articles in this peer-reviewed Special Issue--and provides the essential context for the substantively oriented analyses of the Phase 1 database which are presented in the articles which follow this overview.

Adolescent↗
PubMed1996

Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991.

The Third National Health and Nutrition Examination Survey-Phase 1, conducted from 1988 to 1991 in the United States, included an assessment of dental caries in US children and adolescents and provided the opportunity for differences in dental caries status to be viewed by a ge, sex, race, and race-ethnicity. The measurement of dental caries in children and adolescents from 2-17 years of age included the number of decayed, missing, and filled permanent tooth surfaces and teeth, and the number of decayed, and filled primary tooth surfaces and teeth. Additionally, a brief visual inspection for the presence or absence of early childhood caries in the maxillary incisors was conducted for children 12-23 months of age. The survey yielded weighted estimates for 1988-1991 for over 58 million US children and adolescents 1 to 17 years of age. For infants aged 12-23 months, 0.8% were scored positive for early childhood caries. Over 60% (62.1%) of the children aged 2-9 years were caries-free in their primary dentition. Over half (54.7%) of the children 5-17 years were caries-free in their permanent dentition. The occurrence of caries in the permanent dentition is clustered: A quarter of the children and adolescents ages 5 to 17 with at least one permanent tooth accounted for about 80% of the caries experienced in permanent teeth. Differences in caries experience were found among race and race-ethnicity subpopulations, and caries patterns for the primary and permanent dentition were dissimilar. Further analyses are needed to explore other potential determinants of caries in children.

Adolescent↗
PubMed1996

Coronal and root caries in the dentition of adults in the United States, 1988-1991.

Dental public health policy planning requires accurate and current information about the extent of caries in the United States population. These data are available from the caries examination from Phase 1 of the Third National Health and Nutrition Examination Survey, which found that 94% of adults in the United States show evidence of past or present coronal caries. Among the dentate, the mean number of decayed and filled coronal surfaces per person was 21.5. Dentate females had a lower number of untreated coronal tooth surfaces with caries (1.5), but a higher mean number of treated and untreated surfaces per person (22.7) than males, with scores of 2.1 and 20.2, respectively. Estimates for race-ethnicity groups were standarized by age and gender to control for population differences among them. Dentate non-Hispanic blacks (11.9) and Mexican-Americans (14.1) had half the number of decayed and filled coronal surfaces as non-Hispanic whites (24.3), but more untreated surfaces (non-Hispanic whites, 1.5; non-Hispanic blacks, 3.4; Mexican-Americans, 2.8). Mexican-Americans were most likely to be dentate, had the highest average number of teeth, and had 25% fewer decayed, missing, and filled coronal surfaces (37.6) than non-Hispanic blacks (49.2) and non-Hispanic whites (51.0). Root caries affected 22.5% of the dentate population. Blacks had the most treated and untreated root surfaces with caries (1.6), close to the value for Mexican-Americans (1.4). The score for non-Hispanic whites was 1.1. Untreated root caries is most common in dentate non-Hispanic blacks (1.5), followed by Mexican-Americans (1.2), with non-Hispanic whites (0.6) having the fewest untreated carious root surfaces. Race-ethnicity groups were disparate with respect to dental caries; effort is needed to treat active caries common in some population subgroups.

Adolescent↗
PubMed1996

The prevalence of dental sealants in the US population: findings from NHANES III, 1988-1991.

Over the past decade, dental sealants have become recognized as an important adjunct to the use of fluorides in the prevention of dental caries. The most recent national survey of oral health in children conducted in 1986-1987 found that only 7.6% of children had any sealed teeth. As part of the oral health component of the 1988-1991 Third National Health and Examination Survey (NHANES III-Phase 1), the prevalence of dental sealants in children, adolescents, and adults was determined. The presence of dental sealants on posterior teeth (excluding third molars) and maxillary lateral incisors was recorded by visual and tactile methods during the dental caries examination. Findings in this paper are based on those examined persons having at least one sealable primary tooth for children aged 2-11 years (n=3,792); at least one sealable premanent tooth for persons aged 18 years and over (n=7,146). During 1988-1991, about 18.5% of US children and youth ages 5-17 had one or more sealed permanent teeth. A significantly higher percentage of non-Hispanic whites had sealants in comparison with their non-Hispanic black and Mexican-American counterparts (for all contrasts, p<0.001). As expected, molar teeth were the most frequently sealed tooth type. Only 1.4% of US children ages 2-11 had at least one sealed primary tooth. The prevalence of dental sealants decreased in the US adult population with increasing age; 5.5% of adults ages 18-24 had at least one sealed permanent tooth. Data collected from NHANES III-Phase 2 (1991-1994) will be analyzed to determine if the upward trend in sealant use continues.

Adolescent↗
PubMed1995

Diet and nutrition in the etiology of oral cancer.

Epidemiological studies worldwide have implicated dietary and nutritional factors in the development of oral and pharyngeal cancer. Dietary information in these case-control studies generally was collected through food-frequency questionnaires. Consistently, these studies observed a protective effect of a diet high in fruit intake, reflected in a 20-80% reduction in oral cancer risk. A high intake of foods considered to be dietary staples in particular cultural groups, possibly indicating a generally impoverished diet, has been linked to excess risk. Indigenous dietary practices that in single studies were found to increase risk include a high intake of chili powder and wood stove cooking. Supplementation with various vitamins has been protective in a few studies. Chemoprevention trials generally have found that chemopreventive agents reduce the size of oral leukoplakia lesions or the frequency of second primary oral cancers. The most consistent dietary findings across multiple cultural settings are a protective effect of high fruit consumption and the carcinogenic effect of high alcohol intake.

Case-Control Studies↗
PubMed1994

Familial risk in oral and pharyngeal cancer.

We examined the relationship between a family history of cancer and risk of oral and pharyngeal cancer using epidemiological data from a large case-control investigation of these tumours. 487 (45.7%) of the cases and 485 (41.0%) of the controls reported cancer in a parent or a sibling. After controlling for age, race, sex, study location, respondent status and smoking and alcohol use, the OR associated with any cancer in the family was 1.1 [95% confidence interval (CI) 0.9-1.3]. Risks were non-significantly elevated among those with a history of cancers arising from the oral cavity/pharynx (OR = 1.2, 95% CI 0.7-2.3), oesophagus/larynx (OR = 1.6, 95% CI 0.7-3.8) and lung (OR = 1.2, 95% CI 0.8-1.8), with the excess risk primarily among those for whom a male relative, particularly a brother, was affected with these smoking-related cancers. In addition, an elevated risk of oral/pharynx cancer was found among those whose sisters developed other cancers (OR = 1.6, 95% CI 1.1-2.2). Subsite analyses revealed stronger elevated risks of smoking-related cancers in relatives of pharyngeal cancer cases (OR = 1.7, 95% CI 1.1-2.8) than of oral cancer patients. The data indicate that there is at most a weak familial aggregation of oral/pharynx cancers. Furthermore, since the excess familial risk of oral/pharynx cancer was associated with smoking-related cancers among male but not female relatives, it seems likely that environmental factors (notably smoking and drinking) contribute to the familial tendency observed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1993

Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants.

BACKGROUND: In the United States, Blacks have increasingly higher rates of oral and pharyngeal cancer (oral cancer) than Whites, but determinants of the racial disparity have not been clear. PURPOSE: The purpose of this study was to explore reasons for the higher incidence of oral cancer among Blacks than Whites. METHODS: We used data from a large, population-based case-control study of oral cancer risk factors conducted in four areas of the United States. On the basis of interviews that ascertained characteristics of 1065 oral cancer patients (871 Whites and 194 Blacks) and 1182 controls (979 Whites and 203 Blacks), we examined racial differences in exposure prevalences and relative risks for a number of known etiologic factors, including tobacco and alcohol consumption, diet, and socioeconomic and other variables. To evaluate the extent to which the major risk factors explained the excess risk of oral cancer among Blacks, population-attributable risks were calculated. RESULTS: Differences with respect to alcohol consumption, especially among current smokers, emerged as the most important explanatory variables. After adjusting for smoking, heavy drinking (> or = 30 drinks/week) resulted in a 17-fold increased risk among Blacks and a ninefold increase among Whites. Among drinkers, Blacks tended to drink more than Whites. Also, a higher (P = .01) percentage of Blacks (37%) than Whites (28%) were current smokers, although there were little or no racial differences in relative risks or patterns of use for other smoking variables, including number of cigarettes smoked per day, years of smoking, and age started smoking. From population-attributable risk calculations, we estimated that differences in alcohol and tobacco use account for the bulk of the higher incidence of oral cancer among Blacks in the United States and that, in the absence of alcohol and tobacco, the rates of this cancer according to race (Black, White) and gender would be nearly equal. With regard to other potential etiologic factors, protective effects provided by higher dietary intake of fruits and vitamin C were more pronounced for Whites, while Blacks more often tended to be in sociodemographic and medical or dental health categories associated with increased risk. CONCLUSIONS: These analyses provide evidence that various environmental or lifestyle determinants of oral cancer may contribute to the higher oral cancer rates in Blacks than in Whites in the United States, but that patterns and risks associated with alcohol consumption, particularly among current smokers, are the most important contributors to the excess risk in Blacks. IMPLICATIONS: These findings suggest that the key to prevention of oral and pharyngeal cancers among both Blacks and Whites is reduced intake of alcoholic beverages and, because of strong interactive effects, the cessation of smoking.

Adult↗
PubMed1993

Health conditions among the currently employed.

This report presents national estimates of the prevalence and incidence of selected health conditions and their work-related consequences among currently employed persons 18 years of age and over. The major health conditions presented include back pain; hand discomfort; dermatitis; eye, nose, and throat irritation; and work injuries. Also presented are estimates of the distribution of workers on selected physical activities and exposures at work. Data are presented by age, sex, race, ethnicity, education, and broad occupational category.

Accidents, Occupational↗
PubMed1991

Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer.

Interviews with 866 patients with cancer of the oral cavity and pharynx and 1249 controls of similar age and sex from the general population in four areas of the United States revealed increased risks associated with the regular use of mouthwash. Risks of oral cancer were elevated by 40% among male and 60% among female mouthwash users, after adjusting for tobacco and alcohol consumption. Risks among both sexes generally increased in proportion to duration and frequency of mouthwash use. The increased risks were confined to users of mouthwash high in alcohol content, consistent with the elevated risks associated with drinking alcoholic beverages. Except for a higher prevalence of leukoplakia among cases, little relationship was found with oral or dental conditions, although denture wearing was reported more often by patients with cancer of the gums. These findings, together with other studies, provide further incentive for clarifying the association between mouthwash use and oral cancer.

Adult↗
PubMed1991

The relation of socioeconomic status to oral and pharyngeal cancer.

We assessed the relation between socioeconomic status and risk of oropharyngeal cancer in a population-based interview study of 762 male cases and 837 male controls in four areas of the United States. Three primary indicators of socioeconomic status were evaluated: education, occupational status, and percentage of potential working life spent in employment. With adjustment for the effects of established risk factors, such as use of tobacco products, alcohol consumption, and poor dentition, a relatively low percentage of years worked was also a risk factor. Educational attainment and occupational status were not independently related to risk of oropharyngeal cancer. These results are consistent with the hypothesis that behaviors that lead to social instability, and/or social instability itself, are linked to an increased risk of oral and pharyngeal cancers.

Adult↗
PubMed1991

Knowledge about AIDS and HIV in the US adult population: influence of the local incidence of AIDS.

BACKGROUND: Accurate information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study determined whether AIDS knowledge varied among populations residing in areas with a low, medium, or high incidence of AIDS. METHODS: Respondents to the 1988 National Health Interview Survey of AIDS Knowledge and Attitudes, which is based on a nationally representative sample of 29,659 adults, were rated on their knowledge about modes of HIV transmission, general knowledge about AIDS, and misperceptions about HIV transmission through casual contact. RESULTS: Persons 50 years of age or older, Blacks, Hispanics, and persons with less than a high school education had lower knowledge scores and higher misperception scores. Residents of the high-incidence area had more misperceptions than those who lived in the medium- or low-incidence areas. Sociodemographic determinants of scores were important factors overall and within each AIDS incidence area. CONCLUSIONS: These data suggest that the ability of educational messages to reach and be absorbed by individuals nationwide is less dependent on whether they live in an area with a high incidence of AIDS and more dependent on other demographic variables. New and continued efforts are needed to improve knowledge in older persons, minorities, and the less educated in all parts of the country.

Adolescent↗
PubMed1990

Diet and oral and pharyngeal cancer among blacks.

Data from a population-based multicenter case-control study were examined to assess for the first time the relationship between diet and oral and pharyngeal cancer among blacks. An increased intake of fruits and vegetables was associated with a decreased risk for oral cancer among both men and women, although the protective effect was stronger among men. Risk also declined in both sexes with an increase in the consumption of vitamin C and fiber and in men only for carotene and vitamin E. In both sexes, no associations were found with an intake of smoked, pickled, or charcoal-grilled meats or of hot beverages. However, the consumption of nitrite-containing meats was linked to increased risk among men. The dietary patterns of risk for blacks were generally similar to those previously reported for whites; however, a lower consumption of fruits and vegetables among blacks in this study may contribute to their higher rates of oral and pharyngeal cancer.

Adult↗
PubMed1989

Smokeless tobacco: association with increased cancer risk.

Smokeless tobacco (chewing tobacco and snuff) contains known carcinogens shown to increase the risk for oral cancer. The effect of snuff has been more fully documented than other forms of smokeless tobacco, although the carcinogenic potential of all such products is acknowledged. Risk increases with increasing length of exposure, with risks greatest for anatomic sites where the product has been held in contact the longest time. In some studies, other organs, such as the esophagus, larynx, and stomach, have been shown to be at increased risk for cancer from the use of smokeless tobacco, although at present the data are insufficient to substantiate fully a causal association. Numerous reports have shown an association between snuff use and leukoplakia, with less evidence at present linking chewing tobacco use with leukoplakia. The documented early onset of the smokeless tobacco habit and reports of increases in certain oral cancers among young men raise serious concerns of an impending oral cancer epidemic in this population. In addition, synergistic interactions with other oral cancer risk factors, e.g., smoking and alcohol, and a high rate for second primaries observed for these cancers add to the concern. Unless the tide of its use is stemmed, long-term use can be expected to produce an increase in oral cancers, and perhaps cancers of other sites, as youthful users mature and accumulate exposure to this carcinogenic agent.

Carcinogens↗
PubMed1988

Dietary factors in oral and pharyngeal cancer.

A population-based case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on a number of risk factors, including diet. Interviews were obtained from 871 oral cancer patients and 979 controls among whites, frequency matched for age and sex. Consumption frequency of 61 food items was assessed in the questionnaire; attention was given to foods that are sources of vitamins A and C and carotene. The major finding was an inverse relationship between fruit intake and risk of oral and pharyngeal cancer; individuals in the highest quartile of intake had about half the risk of those in the lowest quartile. Vitamin C, carotene, or fiber in fruit did not appear to account completely for this relationship, since these nutrients in vegetables did not provide similar protection. This finding suggests the influence of other constituents in fruits, although it is possible that cooking vegetables may have a nutrient-diminishing effect. Dietary intake of other nutrients, such as the B vitamins, vitamin E, folate, and iron, showed no consistent relationship to risk of oral and pharyngeal cancer. Coffee or other hot beverage consumption did not increase risk; intake of nitrite-containing meats or cooking practices, such as smoking, pickling, or charcoal grilling, also did not increase risk. All analyses were adjusted for the effects of tobacco and alcohol, strong risk factors for oral and pharyngeal cancer. Dietary findings among the few subjects who did not use tobacco or alcohol were similar to those for all subjects.

Adult↗