title: Analysis of primary risk factors for oral cancer from select US states with increasing rates.
abstract: OBJECTIVE
  To examine the primary risk factor for oral cancer in the US, smoking and tobacco use, among the specific US states that experienced short-term increases in oral cancer incidence and mortality.
  
  
  METHODS
  Population-based data on oral cancer morbidity and mortality in the US were obtained from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) database for analysis of recent trends. Data were also obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) to measure current and former trends of tobacco usage. To comprehensive measures of previous state tobacco use and tobacco-related policies, the Initial Outcomes Index (IOI, 1992-1993) and the Strength of Tobacco Control index (SoTC, 1999-2000) were also used for evaluation and comparison.
  
  
  RESULTS
  Analysis of the NCI-SEER data confirmed a previous report of geographic increases in oral cancer and demonstrated these were state-specific, were not regional, and were unrelated to previously observed increases among females and minorities. Analysis of the CDC-BRFSS data revealed these states had relatively higher percentages of smokers currently, as well as historically. In addition, analysis of the IOI and SoTC indexes suggest that many factors, including cigarette pricing, taxes and home or workplace bans, may have had significant influence on smoking prevalence in these areas. Trend analysis of these data uncovered a recent and significant reversal in smoking rates that suggest oral cancer incidence and mortality may also begin to decline in the near future.
  
  
  CONCLUSIONS
  Due to the rising costs of health care in the US and the limited resources available for health prevention efforts, it is essential to organize and direct more effective efforts by public health officials and epidemiologists, as well as funding from local, state and federal governments, to reduce and eliminate identified health disparities. This study provides evidence how these efforts may be directed to specific geographic areas, and towards the white males, previously thought to be unaffected by the increases in oral cancer among females and minorities.
authors.affiliation: Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, USA. karl.kingsley@unlv.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Bunnell
authors.forename: Nathan
authors.initials: N
authors.lastname: Pettit
authors.forename: Nicole
authors.initials: N
authors.lastname: Reddout
authors.forename: Kanika
authors.initials: K
authors.lastname: Sharma
authors.forename: Susan
authors.initials: S
authors.lastname: O'Malley
authors.forename: Michelle
authors.initials: M
authors.lastname: Chino
authors.forename: Karl
authors.initials: K
authors.lastname: Kingsley