Leslie K Dennis

Interests

Research

Skin cancer etiology and prevention (particularly melanoma), hepatocellular cancer, meta-analyses to summarize areas before moving forward with new research, risk factors for Prostate cancer

Teaching

Epidemiology Methods, Advanced Epidemiology Methods, Exposure Measurement, Cancer Epidemiology & Control, and Meta-analytic Methods

Courses

Scholarly Contributions

Chapters

• Dennis, L. K., Lynch, C. F., Brown, H. E., Laukaitis, C. M., Lashway, S. G., & Smith, E. M. (2022). Cancer. In Maxcy-Rosenau-Last Public Health and Preventive Medicine. New York: McGraw-Hill Medical.
• Langston, M. E., Lashway, S. G., & Dennis, L. K. (2015). Risk factors for sun exposure during spring break among college students. In Sun Exposure: Risk Factors, Protection Practices and Health Effects.. Nova Science Publishers, Inc.
• Dennis, L. K. (2008). Melanoma. In Encyclopedia of Aging and Public Health. New York: Springer.
• Dennis, L. K. (2008). Moles. In Encyclopedia of Aging and Public Health. New York: Springer.
• Dennis, L. K., Lynch, C. F., & Smith, E. (2008). Cancer. In Maxcy-Rosenau-Last Public Health and Preventive Medicine. New York: McGraw-Hill Medical.
• Dennis, L. K. (2004). Melanoma. In Encyclopedia of Women’s Health. New York: Kluwer Academic/Plenum Publishers.
• Dennis, L. K. (2004). Moles. In Encyclopedia of Women’s Health. New York: Kluwer Academic/Plenum Publishers.
• Dennis, L. K., & Pallota, S. L. (2001). Chronic disease in rural health. In Handbook of Rural Health. New York: Kluwer Academic.
• Dennis, L. K., & White, E. (1994). Risk factors for the prevalence of nevi: a review. In Epidemiologic Aspects of cutaneous malignant Melanoma. Boston: Kluwer Academic Publishers.

Journals/Publications

• Dennis, L. K., Brown, H. E., & Arrington, A. K. (2023). Comparison of Prognostic Factors for Merkel Cell Carcinoma, Mucosal Melanoma and Cutaneous Malignant Melanoma: Insights into Their Etiologies. Current oncology (Toronto, Ont.), 30(4), 3974-3988.
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  Little is known about the epidemiology of Merkel cell carcinoma (MCC) and mucosal melanoma (MM). Using the United States (US) National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program data, we compared MCC and MM with cutaneous malignant melanoma (CMM) with respect to incidence rates and prognostic factors to better understand disease etiologies. We describe the proportional incidences of the three cancers along with their survival rates based on 20 years of national data. The incidence rates in 2000-2019 were 203.7 per 1,000,000 people for CMM, 5.9 per 1,000,000 people for MCC and 0.1 per 1,000,000 people for MM. The rates of these cancers increased over time, with the rate of MM tripling between 2000-2009 and 2010-2019. The incidences of these cancers increased with age and rates were highest among non-Hispanic Whites. Fewer MCCs and MMS were diagnosed at the local stage compared with CMM. The cases in the 22 SEER registries in California were not proportional to the 2020 population census but instead were higher than expected for CMM and MCC and lower than expected for MM. Conversely, MM rates were higher than expected in Texas and New York. These analyses highlight similarities in the incidence rates of CMM and MCC-and differences between them and MM rates-by state. Understanding more about MCC and MM is important because of their higher potential for late diagnosis and metastasis, which lead to poor survival.
• Jung, A. M., Jahnke, S. A., Dennis, L. K., Bell, M. L., Burgess, J. L., & Farland, L. V. (2023). Firefighter occupational factors and the risk of preterm birth: results from a survey of women firefighters in the USA. Occupational and environmental medicine, 80(2), 77-85.
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  Previous research has suggested that women firefighters may have a greater risk of adverse reproductive outcomes compared with non-firefighting women. In this study, we investigated the association between firefighter occupational factors and risk of preterm birth.
• Lashway, S. G., Worthen, A. D., Abuasbeh, J. N., Harris, R. B., Farland, L. V., O'Rourke, M. K., & Dennis, L. K. (2023). A meta-analysis of sunburn and basal cell carcinoma risk. Cancer epidemiology, 85, 102379.
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  Basal cell carcinoma (BCC) is the most common cancer in the United States. Sunburn is a modifiable risk factor for BCC. The objective of this project was to synthesize research on BCC and sunburn to quantify the impact and severity of sunburn at different life stages on BCC risk in the general population. A systematic literature search of four electronic databases was conducted and data were extracted by two independent reviewers using standardized forms. Data from 38 studies were pooled using both dichotomous and dose-response meta-analytic methods. BCC risk increased with ever experiencing a sunburn in childhood (OR=1.43, 95% CI: 1.19, 1.72) and with ever experiencing a sunburn in life (OR= 1.40, 95% CI: 1.02, 1.45). Every five sunburns experienced per decade in childhood increased BCC risk by 1.86 (95% CI: 1.73, 2.00) times. Every five sunburns experienced per decade in adulthood increased BCC risk by 2.12 (95% CI: 1.75, 2.57) times and every five sunburns per decade of life increased BCC risk by 1.91 (95% CI: 1.42, 2.58) times. The data on sunburn exposure and BCC show that an increase in number of sunburns at any age increased the risk of BCC. This may inform future prevention efforts.
• Martin, M. K., Zaman, T., Okello, A. M., & Dennis, L. K. (2023). Validity of a Self-Assessment Skin Tone Palette Compared to a Colorimeter for Characterizing Skin Color for Skin Cancer Research. Current oncology (Toronto, Ont.), 30(3), 3189-3200.
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  Our goal is to determine whether our objective 9-point Self-Assessment Skin Tone Palette (SASTP) is correlated with a colorimeter's assessment of a melanin index, so that Hispanic and Black people can be included in skin cancer research where scales were developed for White populations. Subjects were asked to self-identify their skin tones using the SASTP. This study assessed the criterion validity of the SASTP by measuring a range of skin colors compared to a melanin index reported from a colorimeter for the upper-inner arm (non-sun-exposed skin color), and the outer forearm (sun-exposed). Among 188 non-artificial tanners, 50% were White, 30% were Hispanic or White-Hispanic, and 20% were other racial categories. Meanwhile, 70% were female (30% male) and 81% were age 18-29 (19% age 30+). The mean melanin of the upper-inner arm decreased with lighter skin color and stronger tendency to burn. The SASTP in comparison to melanin index values was correlated for both the upper-inner arm ( = 0.81, < 0.001) and the outer forearm ( = 0.77, < 0.001). The SASTP provides a 9-point scale that can be considered as an alternative, less expensive method that is comparable to the objective colorimeter melanin index, which may be useful in studies on skin cancer among White, non-White, and Hispanic peoples.
• Catalfamo, C. J., Brown, H. E., & Dennis, L. K. (2022). Evaluating the strength of association of human papillomavirus infection with penile carcinoma: a meta-analysis. Sexually transmitted diseases.
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  Human papillomavirus (HPV) is a common sexually transmitted infection that is strongly associated with cervical cancer. A link to penile cancers has been suggested by case series. We sought to assess the strength of the association between HPV infection and penile cancer by meta-analysis.
• Dennis, L. K. (2022). Cumulative Sun Exposure and Melanoma in a Population-Based Case-Control Study: Does Sun Sensitivity Matter?. Cancers, 14(4).
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  Cutaneous melanoma (CM) has consistently been associated with intermittent sun exposure, while the association with chronic sun exposure is debated. The goal of this research was to examine the complex relationship between CM, sun sensitivity and sun exposure based on theoretical concepts of how these factors may be associated. Detailed sun exposure histories across life periods and various measures of sun sensitivity were collected in a population-based case-control study of melanoma in Iowa, USA. Participants were asked about their hours of sun exposure per day between March and October each year over periods or decades of life to estimate cumulative lifetime hours of sun exposure. Increased odds ratios (ORs) for CM were seen for most standard measures of sun sensitivity except for the tendency to sunburn. Minimal associations were seen with total hours of sun exposure early in life. However, an interaction was seen between fair skin color and lifetime hours of sun exposure, where the strongest associations with CM were seen among medium-skinned and dark-skinned participants. This suggests that cumulative sun exposure at high levels may increase CM among non-sun-sensitive individuals typically at lower risk of CM. Such a finding has implications for the prevention effort for melanoma regarding time in the sun among darker-skinned individuals.
• Dennis, L. K., Hsu, C. H., & Arrington, A. K. (2021). Reduction in Standard Cancer Screening in 2020 throughout the U.S. Cancers, 13(23).
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  Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21-65), breast (ages 50-74), and colorectal cancer (ages 50-75) prior to the pandemic. Cancer screening percentages for 2020 (April-December excluding January-March) were compared to screening percentages for 2014-2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014-2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40-49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.
• Dennis, L. K., Jung, A. M., Reynolds, K. A., & Abrell, L. M. (2021). Stability of chemical UV filters in sunscreens exposed to vehicle cabin temperatures.. Am J Dermatol Research Reviews, 4(46). doi:10.28933/ajodrr-2021-06-0805
• Jung, A. M., Jahnke, S. A., Dennis, L. K., Bell, M. L., Burgess, J. L., Jitnarin, N., Kaipust, C. M., & Farland, L. V. (2021). Occupational factors and miscarriages in the US fire service: a cross-sectional analysis of women firefighters. Environmental health : a global access science source, 20(1), 116.
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  Evidence from previous studies suggests that women firefighters have greater risk of some adverse reproductive outcomes. The purpose of this study was to investigate whether women firefighters had greater risk of miscarriage compared to non-firefighters and whether there were occupational factors associated with risk of miscarriage among firefighters.
• Langston, M. E., Brown, H. E., Lynch, C. F., Roe, D. J., & Dennis, L. K. (2022). Ambient UVR and Environmental Arsenic Exposure in Relation to Cutaneous Melanoma in Iowa. International journal of environmental research and public health, 19(3).
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  Intermittent sun exposure is the major environmental risk factor for cutaneous melanoma (CM). Cumulative sun exposure and other environmental agents, such as environmental arsenic exposure, have not shown consistent associations. Ambient ultraviolet radiation (UVR) was used to measure individual total sun exposure as this is thought to be less prone to misclassification and recall bias. Data were analyzed from 1096 CM cases and 1033 controls in the Iowa Study of Skin Cancer and Its Causes, a population-based, case-control study. Self-reported residential histories were linked to satellite-derived ambient UVR, spatially derived environmental soil arsenic concentration, and drinking water arsenic concentrations. In men and women, ambient UVR during childhood and adolescence was not associated with CM but was positively associated during adulthood. Lifetime ambient UVR was positively associated with CM in men (OR for highest vs. lowest quartile: 6.09, 95% confidence interval (CI) 2.21-16.8), but this association was not as strong among women (OR for highest vs. lowest quartile: 2.15, 95% CI 0.84-5.54). No association was detected for environmental soil or drinking water arsenic concentrations and CM. Our findings suggest that lifetime and adulthood sun exposures may be important risk factors for CM.
• Lashway, S. G., Harris, R. B., Farland, L. V., O'Rourke, M. K., & Dennis, L. K. (2021). Age and Cohort Trends of Malignant Melanoma in the United States. Cancers, 13(15).
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  The incidence of malignant melanoma in the United States is increasing, possibly due to changes in ultraviolet radiation (UVR) exposure due to lifestyle or increased awareness and diagnosis of melanoma. To determine if more recent birth cohorts experience higher rates of melanoma as they age, we examined age and birth cohort trends in the United States stratified by anatomic site and cancer type (in situ vs. malignant) of the melanoma diagnosed from 1975-2017. Poisson regression of cutaneous melanoma cases per population for 1975-2017 from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was used to estimate age adjusted incidence for five-year birth cohorts restricted to Whites, ages 15-84. The rate of melanoma incidence across birth cohorts varies by anatomic site and sex. Melanomas at all anatomic sites continue to increase, except for head and neck melanomas in men. Much of the increase in malignant melanoma is driven by cases of thin (
• Miller, J. M., Dennis, L. K., Hsu, C. H., & Harvey, E. M. (2021). Objective Assessment of Spectacle Wear in Infants and Toddlers Using a Wearable Sensor. Translational vision science & technology, 10(9), 29.
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  To assess the feasibility of using a thermal microsensor to monitor spectacle wear in infants and toddlers, to determine the inter-method reliability of two methods of estimating spectacle wear from sensor data, and to validate sensor estimates of wear.
• Dennis, L. K., Martin, M. K., Zaman, T., & Okello, A. M. (2020). Reliability of a self-assessment of skin color using a color palette. Arc Clin Exp Dermatol, 2(1), 111.
• Li, J., Yu, T., Javed, I., Siddagunta, C., Pakpahan, R., Langston, M. E., Dennis, L. K., Kingfield, D. M., Moore, D. J., Andriole, G. L., Lai, H. H., Colditz, G. A., Sutcliffe, S., & , M. R. (2020). Does weather trigger urologic chronic pelvic pain syndrome flares? A case-crossover analysis in the multidisciplinary approach to the study of the chronic pelvic pain research network. Neurourology and urodynamics, 39(5), 1494-1504.
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  To investigate whether meteorological factors (temperature, barometric pressure, relative humidity, ultraviolet index [UVI], and seasons) trigger flares in male and female urologic chronic pelvic pain patients.
• Brown, H. E., Dennis, L. K., Lauro, P. L., Purve, J., Pelley, E., & Oren, E. (2019). Emerging evidence for infectious causes of cancer in the United States.. Epidemiologic Reviews.
• Brown, H. E., Dennis, L. K., Lauro, P., Jain, P., Pelley, E., & Oren, E. (2019). Emerging Evidence for Infectious Causes of Cancer in the United States. Epidemiologic reviews, 41(1), 82-96.
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  Worldwide, infectious agents currently contribute to an estimated 15% of new cancer cases. Most of these (92%, or 2 million new cancer cases) are attributable to 4 infectious agents: Helicobacter pylori, human papillomavirus, and hepatitis B and C viruses. A better understanding of how infectious agents relate to the US cancer burden may assist new diagnostic and treatment efforts. We review US-specific crude mortality rates from infection-associated cancers and describe temporal and spatial trends since 1999. We review the US-specific evidence for infection-cancer associations by reporting available estimates for attributable fractions for the infection-cancer associations. Death due to cancers with established infectious associations varies geographically, but estimates for the US attributable fraction are limited to a few observational studies. To describe the burden of infection-associated cancer in the United States, additional observational studies are necessary to estimate the prevalence of infection nationally and within subpopulations. As infectious associations emerge to explain cancer etiologies, new opportunities and challenges to reducing the burden arise. Improved estimates for the United States would help target interventions to higher-risk subpopulations.
• Dennis, L. K., Brown, H. E., & Farland, L. V. (2019). DSM II Colormeter for measuring skin color: its usefulness and reliability of its measurement of melanin. J Dermatol Cosmet Treat, 1(1), 1-5.
• Langston, M. E., Horn, M., Khan, S., Pakpahan, R., Doering, M., Dennis, L. K., & Sutcliffe, S. (2019). A Systematic Review and Meta-analysis of Associations between Clinical Prostatitis and Prostate Cancer: New Estimates Accounting for Detection Bias. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 28(10), 1594-1603.
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  Previous meta-analyses have estimated summary positive associations between clinical prostatitis and prostate cancer. However, none have accounted for detection bias, the possibility for increased prostate cancer screening and detection in men with clinical prostatitis, in their pooled estimates.
• Harvey, E. M., McGrath, E. R., Miller, J. M., Davis, A. L., Twelker, J. D., & Dennis, L. K. (2018). A preliminary study of astigmatism and early childhood development. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 22(4), 294-298.
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  To determine whether uncorrected astigmatism in toddlers is associated with poorer performance on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSITD-III).
• Harvey, E. M., Miller, J. M., Davis, A. L., Twelker, J. D., & Dennis, L. K. (2018). Spectacle Wear in Toddlers: Frequency of Wear and Impact of Treatment on the Child and Family. Translational vision science & technology, 7(6), 43.
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  We assessed the frequency of spectacle wear and impact of spectacle treatment in toddlers.
• Jung, A. M., Dennis, L. K., Jacobs, E. T., & Wondrak, G. T. (2018). Sun sensitivity and sun protective behaviors during sun exposure among indoor office workers in the American Midwest. Photodermatology, photoimmunology & photomedicine, 34(6), 393-399.
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  Sun sensitivity, a confounder between sun exposure and sun protection, is often overlooked. We examined how sun exposure and sun protection behaviors among indoor workers varied by sun sensitivity.
• Miller, J. M., Harvey, E. M., Hsu, C., & Dennis, L. K. (2018). Use of a wearable microsensor for monitoring duration of spectacle wear in young children.. In progress.
• Tsai, R. J., Dennis, L. K., Lynch, C. F., Snetselaar, L. G., Zamba, G. K., & Scott-Conner, C. (2018). Lymphedema following breast cancer: The importance of surgical methods and obesity. Frontiers in women's health, 3(2).
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  Breast cancer-related arm lymphedema is a serious complication that can adversely affect quality of life. Identifying risk factors that contribute to the development of lymphedema is vital for identifying avenues for prevention. The aim of this study was to examine the association between the development of arm lymphedema and both treatment and personal (e.g., obesity) risk factors.
• Harvey, E. M., Leonard-Green, T. K., Mohan, K. M., Kulp, M. T., Davis, A. L., Miller, J. M., Twelker, J. D., Campus, I., & Dennis, L. K. (2017). Interrater and Test-Retest Reliability of the Beery Visual-Motor Integration in Schoolchildren. Optometry and vision science : official publication of the American Academy of Optometry, 94(5), 598-605.
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  To assess interrater and test-retest reliability of the 6th Edition Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and test-retest reliability of the VMI Visual Perception Supplemental Test (VMIp) in school-age children.
• Harvey, E. M., Leonard-Green, T. K., Mohan, K., Kulp, M. T., Davis, A. L., Miller, J. M., Twelker, J. D., Campus, I., & Dennis, L. K. (2017). Interrater and Test-Retest Reliability of the Beery Visual-Motor Integration in Schoolchildren. Optometry and Vision Science, 94(5), 598-605.
• Langston, M. E., Dennis, L. K., Lynch, C. F., Roe, D., & Brown, H. (2017). Temporal Trends in Satellite-Derived Erythemal UVB and Implications for Ambient Sun Exposure Assessment. Int J Environ Res Public Health, 14(2), E176. doi:10.3390/ijerph14020176
• Langston, M., Dennis, L., Lynch, C., Roe, D., & Brown, H. (2017). Temporal Trends in Satellite-Derived Erythemal UVB and Implications for Ambient Sun Exposure Assessment. International journal of environmental research and public health, 14(2).
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  Ultraviolet radiation (UVR) has been associated with various health outcomes, including skin cancers, vitamin D insufficiency, and multiple sclerosis. Measurement of UVR has been difficult, traditionally relying on subject recall. We investigated trends in satellite-derived UVB from 1978 to 2014 within the continental United States (US) to inform UVR exposure assessment and determine the potential magnitude of misclassification bias created by ignoring these trends. Monthly UVB data remotely sensed from various NASA satellites were used to investigate changes over time in the United States using linear regression with a harmonic function. Linear regression models for local geographic areas were used to make inferences across the entire study area using a global field significance test. Temporal trends were investigated across all years and separately for each satellite type due to documented differences in UVB estimation. UVB increased from 1978 to 2014 in 48% of local tests. The largest UVB increase was found in Western Nevada (0.145 kJ/m2 per five-year increment), a total 30-year increase of 0.87 kJ/m2. This largest change only represented 17% of total ambient exposure for an average January and 2% of an average July in Western Nevada. The observed trends represent cumulative UVB changes of less than a month, which are not relevant when attempting to estimate human exposure. The observation of small trends should be interpreted with caution due to measurement of satellite parameter inputs (ozone and climatological factors) that may impact derived satellite UVR nearly 20% compared to ground level sources. If the observed trends hold, satellite-derived UVB data may reasonably estimate ambient UVB exposures even for outcomes with long latency phases that predate the satellite record.
• Hansen, V., Oren, E., Dennis, L. K., & Brown, H. E. (2016). Infectious Disease Mortality Trends in the United States, 1980-2014. JAMA, 316(20), 2149-2151.
• Mohan, K. M., Miller, J. M., Harvey, E. M., Gerhart, K. D., Apple, H. P., Apple, D., Smith, J. M., Davis, A. L., Leonard-Green, T., Campus, I., & Dennis, L. K. (2016). Assessment of Grating Acuity in Infants and Toddlers Using an Electronic Acuity Card: The Dobson Card. Journal of pediatric ophthalmology and strabismus, 53(1), 56-9.
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  To determine if testing binocular visual acuity in infants and toddlers using the Acuity Card Procedure (ACP) with electronic grating stimuli yields clinically useful data.
• Christensen, D. K., Dennis, L. K., Lynch, C. F., Smith, E. M., & Snetselaar, L. G. (2015). Sunless tanning product use among young adults as related to their prevention behaviors regarding ultraviolet radiation. Invest Dermatol Venereol Res, 1(2), 1-6.
• Dennis, L. K. (2015). Mean nevus counts by sun sensitivity factors, frequency of artificial tanning, and sunburns among sorority and fraternity-affiliated university students.. J Experimental Dermatology & Clinical Research.
• Dennis, L. K., Lashway, S. G., & Langston, M. E. (2015). Sun sensitivity and sunburns as related to cutaneous melanoma among populations of Spanish descent: a meta-analysis. J Dermatol Res Ther, 1(2), 1-5.
• Dennis, L. K., & Lowe, J. B. (2013). Does artificial UV use prior to spring break protect students from sunburns during spring break?. Photodermatology, photoimmunology & photomedicine.
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  Dark-skinned individuals are less likely than light-skinned individuals to become sunburned or develop skin cancer. Some have extrapolated this relationship and surmised that developing and maintaining a tan will reduce the risk of sunburns and melanoma. In order to examine whether this strategy indeed protects against sunburns, we surveyed college students about both their tanning habits prior to spring break and their spring break activities.
• Schweizer, M. L., Bossen, A., McDanel, J. S., & Dennis, L. K. (2012). Staphylococcus aureus colonization before infection is not associated with mortality among S. aureus-infected patients: a meta-analysis. Infection control and hospital epidemiology, 33(8).
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  The literature is conflicted as to whether people colonized with Staphylococcus aureus are at an increased risk of mortality. The aim of this meta-analysis was to review and analyze the current literature to determine whether prior history of S. aureus colonization is associated with mortality among S. aureus-infected patients.
• Askelson, N. M., Campo, S., Smith, S., Lowe, J. B., Dennis, L. K., & Andsager, J. (2011). The birds, the bees, and the HPVs: what drives mothers' intentions to use the HPV vaccination as a chance to talk about sex?. Journal of pediatric health care, 25(3), 162-70.
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  Parent-child communication about sex is a way to protect adolescents from engaging in risky behavior. The human papillomavirus vaccine provides mothers with a teachable moment to communicate about sex. This study examines mothers' intentions to talk about sex in conjunction with the vaccination of daughters ages 9 to 15 years, using the Theory of Planned Behavior as a framework. A random sample of mothers was surveyed (N=217). Findings indicated that mothers' intentions were driven by attitudes, subjective norms, and the age at which they intended to vaccinate. Efforts to encourage vaccination should concentrate on strengthening mothers' attitudes about the value of talking about sex and highlight referent persons who support communication about sex.
• Askelson, N. M., Campo, S., Lowe, J. B., Dennis, L. K., Smith, S., & Andsager, J. (2010). Factors related to physicians' willingness to vaccinate girls against HPV: the importance of subjective norms and perceived behavioral control. Women & health, 50(2), 144-58.
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  This study assessed factors related to physicians' intentions to vaccinate patients against human papillomavirus. A random sample of physicians was surveyed. The survey questions focused on the constructs of the Theory of Planned Behavior. Structural equation modeling was used to estimate the relationship of theoretical constructs to intention to vaccinate. Of the 207 physicians who responded, intentions to vaccinate were very high (86.5%). On a scale of 1 to 7 (strongly disagree to strongly agree) physicians had positive attitudes toward the vaccine. Physicians reported the vaccine was a good idea (M = 6.65, SD = 0.79), beneficial (M = 6.64, SD = 0.76), and protected against cervical cancer (M = 6.63, SD = 0.77). Intention to vaccinate was driven by subjective norms (provided by guidelines or standards of practice by important professional and general referent groups) (beta = 1.00, p < 0.05) and perceived behavioral control (beta = 0.39, p < 0.05). These findings indicate that public health efforts to encourage physicians to adopt the human papillomavirus vaccine should focus on subjective norms, such as those provided by professional organizations.
• Askelson, N. M., Campo, S., Lowe, J. B., Smith, S., Dennis, L. K., & Andsager, J. (2010). Using the theory of planned behavior to predict mothers' intentions to vaccinate their daughters against HPV. The Journal of school nursing, 26(3), 194-202.
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  This study assessed mothers' intentions to vaccinate their daughters against human papillomavirus (HPV) using the theory of planned behavior (TPB). Experience with sexually transmitted infections (STIs), beliefs about the vaccine encouraging sexual activity, and perception of daughters' risk for HPV were also examined for a relationship with intention. A random sample of mothers in a rural, Midwestern state were mailed a survey with questions pertaining to the intention to vaccinate. Attitudes were the strongest predictor of mothers' intentions to vaccinate, but intentions were not high. Subjective norms also influence intention. Mothers' risk perceptions, experience with STIs, and beliefs about the vaccine encouraging sexual activity were not related to intention. Mothers' perceptions of the daughters' risks for HPV were surprisingly low. This research provides a foundation for designing interventions to increase HPV vaccination rates. Further research should explore ways to influence mothers' attitudes and to uncover the referent groups mothers refer to for vaccination behavior.
• Askelson, N. M., Campo, S., Smith, S., Lowe, J. B., Dennis, L. K., & Andsager, J. (2011). Assessing physicians’ intentions to talk about sex when they vaccinate girls against HPV. Sexual Education, 11(4), 431-441.
• Dennis, L. K., Lynch, C. F., Sandler, D. P., & Alavanja, M. C. (2010). Pesticide use and cutaneous melanoma in pesticide applicators in the agricultural heath study. Environmental health perspectives, 118(6), 812-7.
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  Melanoma rates continue to increase; however, few risk factors other than sun sensitivity and ultraviolet radiation (including sun exposure) have been identified. Although studies of farmers have shown an excess risk of melanoma and other skin cancers, it is unclear how much of this is related to sun exposure compared with other agricultural exposures.
• Wells, T. S., Bukowinski, A. T., Smith, T. C., Smith, B., Dennis, L. K., Chu, L. K., Gray, G. C., & Ryan, M. A. (2010). Racial differences in prostate cancer risk remain among US servicemen with equal access to care. The Prostate, 70(7), 727-34.
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  Prostate cancer is the most common cancer among US men, however, the etiology remains unclear. Yet, one consistency is that black non-Hispanic men are at increased risk for prostate cancer compared to white, non-Hispanic men. The goal of this study was to assess relations between demographic and other potential prostate cancer risk factors in the context of the US military healthcare system, which provides equal access to all US servicemen.
• Dennis, L. K., Coughlin, J. A., McKinnon, B. C., Wells, T. S., Gaydos, C. A., Hamsikova, E., & Gray, G. C. (2009). Sexually transmitted infections and prostate cancer among men in the U.S. military. Cancer Epidemiology, Biomarkers & Prevention, 18(10), 2665-71.
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  Studies of self-reported sexually transmitted infections (STI) suggesting an association with prostate cancer may reflect underreporting of such infections among nondiseased subjects. To reduce such bias, we studied archived sera in a cohort of U.S. military personnel known to have high rates of both STIs and prostate cancer. Using a nested case-control design, serum samples from 534 men who served on active duty between September 1, 1993 and September 1, 2003 were examined. Controls were individually matched to cases based on date of serum collection, date of birth, branch of service, military rank, marital status, and race. Each of the 267 case-control pairs had two serum samples: a recent serum sample, taken approximately 1 year before the case's prostate cancer diagnosis, and an earlier serum sample, taken approximately 8 years before diagnosis. Each serum specimen was studied for antibodies against human papillomavirus, herpes simplex virus-2 (HSV-2), and Chlamydia trachomatis. Logistic regression accounted for matching and potential confounding factors. Study data indicated no association between prostate cancer and serologic evidence of infections just before the reference date. However, a statistically significant association between prostate cancer and serologic evidence of HSV-2 infection was detected in the earlier sample (odds ratio, 1.60; 95% confidence interval, 1.05-2.44). The strength of this association increased when analyses were restricted to sera collected at least 60 months before diagnosis (odds ratio, 2.04; 95% confidence interval, 1.26-3.29; 204 pairs). If this association is causal, then our findings would suggest a long latency period for prostate cancer development after HSV-2 infection.
• Dennis, L. K., Kancherla, V., & Snetselaar, L. G. (2009). Adolescent attitudes towards tanning: does age matter?. Pediatric health, 3(6), 565-578.
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  Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.
• Dennis, L. K., Lowe, J. B., & Snetselaar, L. G. (2009). Tanning behavior among young frequent tanners is related to attitudes and not lack of knowledge about the dangers. Health education journal, 68(3), 232-243.
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  OBJECTIVE: To examine the importance of tanning among students in relation to attitudes and knowledge regarding skin cancer prevention. DESIGN: A cross-sectional survey. SETTING: College students at a major Midwestern university METHODS: Students were recruited to complete a self-administered questionnaire that included information on sun-sensitivity, knowledge and tanning attitudes and behaviors. Survey sampling statistical techniques that account for clustering among the 163 students recruited were used. RESULTS: We found a high level of skin cancer prevention knowledge; however knowledge was not related to a reduction in the importance of tanning. In many cases, higher levels of knowledge corresponded to a greater emphasis on the importance of tanning. Sunscreen use was low among this population. Those who placed an importance on tanning more often checked that they believed that "sunless tanning creams are safer than the sun". CONCLUSIONS: This population's belief that they look healthier and feel better with a tan strongly influences the desire to tan. Therefore, future cancer information campaigns or other prevention efforts should directly address the desire to tan by encouraging the use of sunless tanning products as an alternative method of tanning.
• Rocheleau, C. M., Romitti, P. A., & Dennis, L. K. (2009). Pesticides and hypospadias: a meta-analysis. Journal of pediatric urology, 5(1), 17-24.
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  To use meta-analytic techniques to synthesize the findings of the current body of published literature regarding the risk of hypospadias resulting from parental exposure to pesticides.
• Tsai, R. J., Dennis, L. K., Lynch, C. F., Snetselaar, L. G., Zamba, G. K., & Scott-Conner, C. (2009). The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Annals of surgical oncology, 16(7), 1959-72.
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  As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent.
• Beining, R. M., Dennis, L. K., Smith, E. M., & Dokras, A. (2008). Meta-analysis of intrauterine device use and risk of endometrial cancer. Annals of epidemiology, 18(6), 492-9.
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  We sought to study the association between intrauterine device (IUD) use and endometrial cancer.
• Dennis, L. K., Kim, Y., & Lowe, J. B. (2008). Consistency of reported tanning behaviors and sunburn history among sorority and fraternity students. Photodermatology, photoimmunology & photomedicine, 24(4), 191-8.
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  Reliable measurements of behavior are crucial to evaluating health promotion efforts. The goal of this reliability study was to examine the consistency of recalled tanning behaviors in a population with a potentially high use.
• Dennis, L. K., Lowe, J. B., Lynch, C. F., & Alavanja, M. C. (2008). Cutaneous melanoma and obesity in the Agricultural Health Study. Annals of epidemiology, 18(3), 214-21.
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  To describe the risk of cutaneous melanoma in the Agricultural Health Study (AHS), a cohort of pesticide applicators and their spouses, according to baseline characteristics related to obesity along with sun exposure and sun sensitivity.
• Dennis, L. K., Vanbeek, M. J., Beane Freeman, L. E., Smith, B. J., Dawson, D. V., & Coughlin, J. A. (2008). Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Annals of epidemiology, 18(8), 614-27.
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  Sunburns are an important risk factor for melanoma and those occurring in childhood are often cited as posing the greatest risk. We conducted a meta-analysis to quantify the magnitude of association for melanoma and sunburns during childhood, adolescence, adulthood and over a lifetime.
• Lazovich, D., Stryker, J. E., Mayer, J. A., Hillhouse, J., Dennis, L. K., Pichon, L., Pagoto, S., Heckman, C., Olson, A., Cokkinides, V., & Thompson, K. (2008). Measuring nonsolar tanning behavior: indoor and sunless tanning. Archives of dermatology, 144(2), 225-30.
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  To develop items to measure indoor tanning and sunless tanning that can be used to monitor trends in population surveys or to assess changes in behavior in intervention studies.
• Nothwehr, F., Dennis, L., & Wu, H. (2007). Measurement of behavioral objectives for weight management. Health education & behavior : the official publication of the Society for Public Health Education, 34(5), 793-809.
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  Measurement of specific behaviors involved in weight management is essential to understanding the behavior change process. This study presents measures of common behavioral objectives for weight management interventions. The relationships between these measures and conventional outcomes of weight management are described. Data are from a survey of 407 adults in the rural Midwest ages 23 to 88. Analyses involved bivariate and multivariate statistical tests. Relationships were stronger when limited to diet or physical activity outcomes as opposed to body mass index or waist circumference. Diet-related strategies were more strongly correlated with diet-related outcomes than physical activity-related outcomes and vice versa. Measures of social interactions and self-monitoring for both diet and physical activity were consistently related to outcomes. The measures show promise as reliable and valid indicators of behavior that could be useful in the evaluation of interventions. Intervention studies are needed to further characterize their value and sensitivity to change over time.
• Romitti, P. A., Herring, A. M., Dennis, L. K., & Wong-Gibbons, D. L. (2007). Meta-analysis: pesticides and orofacial clefts. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 44(4), 358-65.
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  The risk of orofacial clefts associated with pesticide exposure was examined by conducting a meta-analysis of studies published from 1966 through 2005.
• Beane Freeman, L. E., Dennis, L. K., Lynch, C. F., Lowe, J. B., & Clarke, W. R. (2005). Test-retest of self-reported exposure to artificial tanning devices, self-tanning creams, and sun sensitivity showed consistency. Journal of clinical epidemiology, 58(4), 430-2.
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  Exposure to ultraviolet radiation has consistently been linked to an increased risk of melanoma. Epidemiologic studies are susceptible to measurement error, which can distort the magnitude of observed effects. Although the reliability of self-report of many sun exposure factors has been previously described in several studies, self-report of use of artificial tanning devices and self-tanning creams has been less well characterized.
• Dennis, L. K., Ritchie, J. M., & Resnick, M. I. (2005). Prostate cancer and consistency of reporting sexual histories in men over age 50. Prostate cancer and prostatic diseases, 8(3), 243-7.
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  We conducted an in-person interview to examine the reliability of reported sexual histories among men over age 50 y with and without prostate cancer. Marriage and cohabitation were used as memory cues to recall sexual activity. High correlations on test-retest for questions evaluating sexual histories suggest reliable answers for most factors, and specifically for age at first sexual activity, and lifetime number of sexual partners. Low correlations were seen for ill-defined and socially undesirable items. These data suggest that men consistently report most measures of sexual activity when using marriage and cohabitation as memory cues to recall sexual histories.
• Beane Freeman, L. E., Dennis, L. K., Lynch, C. F., Thorne, P. S., & Just, C. L. (2004). Toenail arsenic content and cutaneous melanoma in Iowa. American journal of epidemiology, 160(7), 679-87.
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  Cutaneous melanoma has the lowest survival rate of all forms of skin cancer. There has been little research investigating the link between arsenic and cutaneous melanoma, although arsenic has been associated with increased risk of nonmelanoma skin cancer. The authors performed a case-control study examining the association between cutaneous melanoma and environmental arsenic exposure among Iowans aged 40 years or older. Participants included 368 cutaneous melanoma cases and 373 colorectal cancer controls diagnosed in 1999 or 2000, frequency matched on gender and age. Participants completed a mailed survey and submitted toenail clippings for analysis of arsenic content by graphite furnace atomic absorption spectrophotometry. The authors found an increased risk of melanoma for participants with elevated toenail arsenic concentrations (odds ratio = 2.1, 95 percent confidence interval: 1.4, 3.3; p-trend = 0.001) and effect modification by prior skin cancer diagnosis (p-interaction = 0.03). The arsenic-melanoma findings in this study are not known to have been previously reported in observational epidemiologic studies involving incident cutaneous melanoma. Therefore, the findings warrant confirmation.
• Dennis, L. K., Snetselaar, L. G., Smith, B. J., Stewart, R. E., & Robbins, M. E. (2004). Problems with the assessment of dietary fat in prostate cancer studies. American journal of epidemiology, 160(5), 436-44.
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  The authors conducted a detailed review of studies on the association between prostate cancer and total dietary fat along with specific fatty acids. Overall, the 29 studies reporting actual dietary fat levels in grams of fat were heterogeneous, suggesting that pooling of the relative risks may be inappropriate. Heterogeneity was also seen by study design. More specifically, although the pooled estimate for prostate cancer and an increase of 45 g in total fat consumption per day was small (relative risk = 1.2), heterogeneity between studies was large, and the association was not supported by specific fatty acids. The strongest association was found among the five extremely inconsistent studies of alpha-linolenic fatty acid. The associations with advanced prostate cancer were more homogeneous and suggest a relation with total and saturated fat but none with specific fatty acids. This review highlights the inconsistent way in which total dietary fat and specific fatty acids have been measured and reported across epidemiologic studies of prostate cancer. The heterogeneity between studies was large, possibly because of the variation in the dietary instruments used and the corresponding databases (nondifferential misclassification), recall bias, differing case definitions, residual confounding, or potential selection bias in different studies.
• Dennis, L. K., Beane Freeman, L. E., & VanBeek, M. J. (2003). Sunscreen use and the risk for melanoma: a quantitative review. Annals of internal medicine, 139(12), 966-78.
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  Originally developed to protect against sunburn, sunscreen has been assumed to prevent skin cancer. However, conflicting reports include claims that sunscreen increases risk for melanoma.
• Dennis, L. K., Snetselaar, L. G., Nothwehr, F. K., & Stewart, R. E. (2003). Developing a scoring method for evaluating dietary methodology in reviews of epidemiologic studies. Journal of the American Dietetic Association, 103(4), 483-7.
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  We examined the quality of dietary assessment used by studies of prostate cancer and dietary fat in an attempt to explain the heterogeneity of their relative risk (RR) estimates. We reviewed the dietary assessment of 39 studies published in English that reported RRs for the association between prostate cancer and dietary fat intake derived from food frequency questionnaires (FFQs). We scored studies based on several objective measures of quality dietary assessment. Studies received no points for characteristics with unclear information. Studies scored 2 points for interviewer-completed FFQs, along with 2 points for quantitative assessments. They were scored 4 points for FFQs with more than 150 items, with an additional point for pretesting and 2 points for validated FFQs. Studies were given 1 point for describing each of the following characteristics: specifying the nutrient database used to convert foods to grams of fat, specifying quality control, attempting to measure dietary intake prior to diagnosis (recalled dietary period), and reporting the time needed to complete the FFQ. We then ranked studies based on their overall score: "high" for a score of 7 or greater out of 15 and "low" for lower scores. Two of the 39 studies that used quantitative methods other than a FFQ were excluded. Of the remaining 37 studies reviewed that used FFQs, only 16 were judged to have a high quality assessment of dietary fat. This review highlights the inconsistency of FFQ used in epidemiologic studies of dietary fat. Such variations in dietary measurement may be reflected in the variation in the magnitude of RRs reported for prostate cancer and dietary fat. The problems identified here include insufficient reporting of the details of dietary assessment, in addition to use of questionnaires with only a few food items to estimate a subject's dietary fat intake. It is imperative that journals include experts in the field of nutrition as reviewers of epidemiologic papers describing diet.
• Dennis, L. K., & Cohen, M. B. (2002). On the chemoprevention TRAIL. Cancer biology & therapy, 1(3), 291-2.
• Dennis, L. K., & Dawson, D. V. (2002). Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology (Cambridge, Mass.), 13(1), 72-9.
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  We conducted a meta-analysis of the association between prostate cancer and aspects of sexual activity. The data suggest an elevated relative risk (RR) of prostate cancer among men with a history of sexually transmitted infections. This was observed with both random- and fixed-effects models (RR = 1.4; 95% CI = 1.2-1.7; N = 17 studies; heterogeneity P = 0.14), especially for syphilis (RR = 2.3; 95% CI = 1.3-3.9; N = 6; heterogeneity P = 0.47). Risk of prostate cancer is also associated with increasing frequency of sexual activity (RR = 1.2 for an increase of three times per week; 95% CI = 1.1-1.3; N = 12). However, these studies are heterogeneous (P < 0.001). Increasing number of sexual partners is also associated with prostate cancer (RR = 1.2 for an increase of 20 partners; 95% CI = 1.1-1.3; N = 16; heterogeneity P = 0.11). The data do not support associations with multiple marriages, age at first intercourse, or age at first marriage. These results indicate an association between prostate cancer and sexually transmitted infections, suggesting that infections may represent one mechanism through which prostate cancer develops. The mechanism through which frequency of sexual activity may be related to prostate cancer is unclear.
• Dennis, L. K., Lynch, C. F., & Torner, J. C. (2002). Epidemiologic association between prostatitis and prostate cancer. Urology, 60(1), 78-83.
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  To quantify the relationship between prostatitis and prostate cancer by pooling previous epidemiologic studies of this association.
• McArtor, R. E., Iverson, D. C., Benken, D. E., Gilchrist, V. J., Dennis, L. K., & Broome, R. A. (2002). Physician assessment of patient motivation: influence on disposition for follow-up care. American journal of preventive medicine, 8(3), 147-9.
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  This study of 3,318 outpatient visits evaluated the influence of the physician-assessed level of patient motivation on the level of physician involvement in follow-up care. Data collected included patient demographics, health risk factors, physician-assessed level of patient motivation, and the disposition for follow-up care (return office visit or self-care). Physicians more frequently scheduled patients for a return office visit, regardless of assessed level of patient motivation, when they presented with a traditional biomedical problem. Patients with health promotion-disease prevention problems were more frequently relegated to self-care; patients physicians judged to be poorly motivated were four times as likely to be relegated to self-care. We discuss the implications of physician overuse of self-care strategies on the health status of poorly motivated patients. Factors influencing such physician behavior may include prior unrewarding experiences with poorly motivated patients, perceived lack of skill in affecting behavior change, time constraints, lack of reimbursement for preventive care services, and the actual process of physician education and professional socialization.
• Dennis, L. K., & Hayes, R. B. (2001). Alcohol and prostate cancer. Epidemiologic reviews, 23(1), 110-4.
• Cooper, G. S., Yuan, Z., Stange, K. C., Dennis, L. K., Amini, S. B., & Rimm, A. A. (2000). Agreement of Medicare claims and tumor registry data for assessment of cancer-related treatment. Medical care, 38(4), 411-21.
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  Although health claims data are increasingly used in evaluating variations in patterns of cancer care and outcomes, little is known about the comparability of these data with tumor registry information.
• Dennis, L. K. (2000). Meta-analysis for combining relative risks of alcohol consumption and prostate cancer. The Prostate, 42(1), 56-66.
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  Prostate cancer has become the most common cancer among men in the United States, but little is known about factors associated with prostate cancer incidence.
• Dennis, L. K., & Resnick, M. I. (2000). Analysis of recent trends in prostate cancer incidence and mortality. The Prostate, 42(4), 247-52.
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  There is debate over whether the recent increases seen in prostate cancer are due to lead-time bias from screening, or identification of clinically insignificant lesions.
• Cooper, G. S., Yuan, Z., Stange, K. C., Amini, S. B., Dennis, L. K., & Rimm, A. A. (1999). The utility of Medicare claims data for measuring cancer stage. Medical care, 37(7), 706-11.
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  The validity of using claims data for measuring tumor stage, one of the most important determinants of choice of therapy and long-term survival, is unknown.
• Cooper, G. S., Yuan, Z., Stange, K. C., Dennis, L. K., Amini, S. B., & Rimm, A. A. (1999). The sensitivity of Medicare claims data for case ascertainment of six common cancers. Medical care, 37(5), 436-44.
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  Although Medicare claims data have been used to identify cases of cancer in older Americans, there are few data about their relative sensitivity.
• Dennis, L. K. (1999). Analysis of the melanoma epidemic, both apparent and real: data from the 1973 through 1994 surveillance, epidemiology, and end results program registry. Archives of dermatology, 135(3), 275-80.
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  The incidence of melanoma has been increasing faster than that of any other cancer in the United States. It is unclear whether the increase is related to increased surveillance or other changes in the disease.
• Dennis, L. K. (1999). Increasing risk of melanoma with increasing age. JAMA, 282(11), 1037-8.
• Dennis, L. K. (1999). Melanoma incidence by body site: effects of birth-cohort adjustment. Archives of dermatology, 135(12), 1553-4.
• Stewart, R. E., Dennis, L. K., Dawson, D. V., & Resnick, M. I. (1999). A meta-analysis of risk estimates for prostate cancer related to tire and rubber manufacturing operations. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, 41(12), 1079-84.
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  Studies investigating the association between prostate cancer and exposure to the tire and rubber manufacturing environment have reported weak and inconsistent results. A meta-analysis of nine cohort studies that used standard mortality ratios and three case-control studies that used odds ratios was conducted. The pooled results from the nine cohort studies showed a standard mortality ratio of 101 (95% confidence interval [CI] = 93,110), whereas the pooled results from the three case-control studies showed on odds ratio of 1.10 (95% CI = 0.94, 1.29). The standard mortality ratios were converted to odds ratios by dividing by 100. The overall pooled risk estimate from all 12 studies was 1.03 (95% CI = 0.96, 1.11). The conclusion of this meta-analysis is that work exposure in a rubber and tire manufacturing environment does not result in an increased risk of prostate cancer.
• Cooper, G. S., Yuan, Z., Bowlin, S. J., Dennis, L. K., Kelly, R., Chen, H., & Rimm, A. A. (1998). An ecological study of the effectiveness of mammography in reducing breast cancer mortality. American journal of public health, 88(2), 281-4.
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  The purpose of this study was to determine the relation of screening mammography to breast cancer incidence and case fatality.
• Rahman, M. I., Dennis, L. K., & Gibson-Shreve, L. D. (1997). Selections from current literature: issues in genetic testing for cancer. Family practice, 14(6), 510-6.
• Dennis, L. K., White, E., Lee, J. A., Kristal, A., McKnight, B., & Odland, P. (1996). Constitutional factors and sun exposure in relation to nevi: a population-based cross-sectional study. American journal of epidemiology, 143(3), 248-56.
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  A survey of benign melanocytic nevi (moles), suspected precursors or markers for melanoma, was conducted in Washington State among 717 randomly selected 18- to 50-year-old white adults who participated in a telephone interview in 1990-1991. Participants were questioned about constitutional factors, time spent in the sun, and severe sunburns over three time periods and were asked to count the raised nevi on both their arms. Logistic regression was used to examine the risk for 2+ nevi compared with none. An odds ratio (OR) of 2.0 (95% confidence interval (CI) 1.3-3.1) was seen for current freckling. Skin color, tendency to burn, and inability to tan were important risk factors but were not independent of each other. Individuals with a history of severe sunburns had an increased risk of nevi: OR = 1.9 (95% CI 0.9-3.9) for 3+ severe sunburns compared with none in the last 5 years; OR = 2.0 (95% CI 1.2-3.1) for 4+ severe teenage sunburns; and OR = 3.1 (95% CI 1.7-5.3) for 4+ severe childhood sunburns. Furthermore, childhood sunburns were related to nevi independently of sun sensitivity and teenage and recent sunburns: OR = 2.0 (95% CI 1.0-4.0) for 4+ severe sunburns. These data suggest that childhood sunburns are important in the etiology of nevi. This study supports prior studies of the relation between melanoma and early sun exposure.
• Dennis, L. K., White, E., McKnight, B., Kristal, A., Lee, J. A., & Odland, P. (1996). Nevi and migration within the United States and Canada: a population-based cross-sectional study. Cancer causes & control : CCC, 7(4), 464-73.
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  A survey to ascertain factors associated with benign melanocytic nevi or moles was conducted among randomly-selected White adults (aged 18 to 50 years) in Washington State (United States). Participants of the telephone interview in 1990-91 were questioned about lifetime places of residence and constitutional factors. Subjects counted raised nevi on their arms at the end of the survey. Logistic regression was used to examine the risk for two or more nevi compared with no nevi. Individuals who resided in warmer areas and lower latitudes than Washington State were at higher risk of having multiple nevi. This association held for residence at birth, during childhood, adolescence, and over lifetime: an odds ratio (OR) of 2.3 (95 percent confidence interval = 1.2-4.3) for lifetime average daily maximum temperature of > or = 64 degrees F compared with 58.9 degrees F, and similar ORs of 2.1 for adolescence and 1.8 for childhood. These associations remained significant after adjusting for potential confounding effects of constitutional factors and for childhood sunburns as a potential mechanism. Risk of multiple nevi was reduced for both early age at migration and longer duration of stay in Washington. These data are consistent with the importance of childhood and adolescent sun exposure in the etiology of nevi, but also suggest an effect of lifetime sun exposure.
• Rahman, M. I., Campbell, J. W., Dennis, L. K., & Gibson-Shreve, L. D. (1996). Selections from current literature: abortion, breast cancer and causal inferences. Family practice, 13(2), 194-200.
• Goldberg, B. W., von Borstel, E. R., Dennis, L. K., & Wall, E. (1995). Firearm injury risk among primary care patients. The Journal of family practice, 41(2), 158-62.
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  Firearm injuries are the eighth leading cause of death in the United States. Evidence suggests that availability of guns in the home is associated with an increased risk of homicide, suicide, and unintentional injuries and fatalities. Our study examined five demographically diverse primary care practices in Oregon to determine the extent to which patients and members of their households might be at risk for firearm injuries.
• Wall, E. M., & Dennis, L. K. (1995). Will the real primary care provider please stand up?. The Journal of the American Board of Family Practice, 8(1), 73-5.
• Sugarman, J. R., Dennis, L. K., & White, E. (1994). Cancer survival among American Indians in western Washington State (United States). Cancer causes & control : CCC, 5(5), 440-8.
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  Cancer survival among American Indians is worse than among other races in some regions of the United States, but has not been studied among American Indians in Washington state. Our purpose was to evaluate cancer survival among American Indians included in the Seattle-Puget Sound Cancer Registry. We compared site-specific survival among American Indians (n = 551) and Whites (n = 110,899) diagnosed from 1974 to 1989 for five cancer sites. For all sites except prostate, the distribution of cancer stage at diagnosis for American Indians was not significantly different from the distribution for Whites, and a similar proportion of American Indians and Whites received cancer treatment. After adjustment for age differences between American Indians and Whites, American Indians experienced poorer survival from prostate, breast, cervical, and colorectal cancer. Poorer survival among American Indians persisted after adjustment for differences in cancer stage at diagnosis, lack of cancer treatment, and residence in a non-urban county. The survival experience among American Indians who were recorded as non-American Indians in the cancer registry but who were listed as American Indians in Indian Health Service records was more favorable than that among persons initially coded as American Indians in the cancer registry. We conclude that cancer survival among American Indians in western Washington is poorer than that among Whites in the same region, and that factors other than age, differences in stage at diagnosis, lack of cancer treatment, and residence in non-urban counties account for this.
• Dennis, L. K., White, E., & Lee, J. A. (1993). Recent cohort trends in malignant melanoma by anatomic site in the United States. Cancer causes & control : CCC, 4(2), 93-100.
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  The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18,787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974-86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920-44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920-44 cohorts. Recent birth cohorts, 1945-64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women.(ABSTRACT TRUNCATED AT 250 WORDS)
• Longstreth, W. T., Copass, M. K., Dennis, L. K., Rauch-Matthews, M. E., Stark, M. S., & Cobb, L. A. (1993). Intravenous glucose after out-of-hospital cardiopulmonary arrest: a community-based randomized trial. Neurology, 43(12), 2534-41.
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  Does the common practice of infusing small amounts of glucose after cardiopulmonary arrest worsen neurologic outcome?
• Longstreth, W. T., Dennis, L. K., McGuire, V. M., Drangsholt, M. T., & Koepsell, T. D. (1993). Epidemiology of intracranial meningioma. Cancer, 72(3), 639-48.
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  Intracranial meningiomas arise from the meninges and typically have benign histologic findings. They constitute approximately 20% of all intracranial tumors. Their incidence increases with age, and they affect women more commonly than men. The annual incidence per 100,000 people ranges from two to seven for women and from one to five for men. Since the first study was published in 1970, only eight major epidemiologic studies have been done that attempted to identify risk factors for meningioma. Ionizing radiation and head trauma have emerged as the most promising etiologic risk factors. In these studies, radiation doses as low as 1-2 Gy have been associated with increased risk. The role of dental radiographs has been suggested in some studies but not supported in others. An explanation for the apparent excess of meningiomas in women remains obscure. The potential effects of endogenous or exogenous sex hormones on tumor induction or growth remain unexplored in epidemiologic studies. More should be learned about the risk factors for meningioma in search of opportunities for prevention.
• McArtor, R. E., Iverson, D. C., Benken, D., & Dennis, L. K. (1992). Family practice residents' identification and management of obesity. International journal of obesity and related metabolic disorders, 16(5), 335-40.
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  This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.
• Calonge, B. N., Miller, R. S., Dennis, L. K., & Joffe, L. S. (1991). AIDS in primary care: a report from the Ambulatory Sentinel Practice Network. The Journal of family practice, 32(4), 369-72.
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  Despite the importance of the epidemic of acquired immune deficiency syndrome (AIDS), little is known about the incidence and prevalence of AIDS in the patient population of primary care physicians. This study was designed as an initial step in evaluating the impact of this disease on primary care practices.

Poster Presentations

• Divya, R., Miller, J. M., Romer McGrath, E. F., Martin, J. A., Marshall-Gonzales, M. S., Hsu, C., Gerhart, K., Enriquez, S., Davis, A. L., Dennis, L. K., Arthur, A. W., Harvey, E. M., & Twelker, J. D. (2023, April). Agreement between the Welch Allyn Spot Vision Screener and Cycloplegic Retinoscopy in Toddlers.. ARVO. New Orleans, LA: ARVO.
• Divya, R., Miller, J. M., Romer McGrath, E. F., Martin, J. A., Marshall-Gonzales, M. S., Hsu, C., Gerhart, K., Enriquez, S., Davis, A. L., Dennis, L. K., Arthur, A. W., Harvey, E. M., & Twelker, J. D. (2023, April). Agreement between the Welch Allyn Spot Vision Screener and Cycloplegic Retinoscopy in Toddlers.. Association for Research in Vision and Ophthalmology Annual Meeting. New Orleans, LA: ARVO.
• Foote, J. A., Roe, D., Harris, R. B., Dennis, L. K., & Celaya, M. P. (2019, November). Prediction of Attrition From a Medical Weight Loss Intervention With Community Hospital Employees. Obesity Week 2019 - TOS.
• Koch, S., Harris, R. B., Jacobs, E. T., Ernst, K. C., & Dennis, L. K. (2016, October). Sun protection behavior and sunburns among Arizona adults. Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon). Aurora, CO: International Dermato-Epidemiology Association.
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  Koch S, Harris RB, Jacobs ET, Ernst KC, Dennis LK. Sun protection behavior and sunburns among Arizona adults. Poster presentation at Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon) . Aurora CO, September 2016