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Using the Watters et al. article “Alcoholic Beverages and Prostate Cancer in a Prospective US
Cohort Study,” answer the following questions. Answers should be submitted in Canvas
Webcourses by April 6, 2015 at 12:00 pm (noon) by following the submission link under
the Module called “Required Assignment 2: Article Critique.” No paper submissions will be
graded. Answers will be submitted just like the study design required assignment. You may
enter the answer submission quiz up to THREE times prior to the due date. I recommend
recording your answers on this assignment first, and then transferring them to Webcourses.
Since we are discussing this assignment in class later on the day it is due, no late assignments
will be accepted unless you miss class on April 6 for an emergency with acceptable
documentation. All other late assignments will receive a score of zero. All questions are worth
one (1) point unless otherwise noted.
1. Which of the following is not part of the initial background or rationale provided by the
authors to justify the need for their study?
a. Although there have been more than 60 studies of this association, the results are
inconsistent, and several critical gaps remain to be addressed using prospective data
with sample sizes sufficient to detect small to modest associations, including whether the
effect of alcohol differs by prostate cancer stage, how patterns of alcohol consumption
influence risk, and alcohol’s role in fatal prostate cancers.
b. One case-control study reported a protective association between prostate cancer
incidence and red wine….
c. Alcoholic beverages have been identified as known human carcinogens, with several
biologically plausible mechanisms that may influence prostate cancer risk.
d. The report by the World Cancer Research Fund on nutrition, physical activity, and cancer
concluded that the data were too limited to determine an association between alcohol
and prostate cancer. 2. Who comprised the study population for the current study?
a. Participants in the NIH-AARP Diet and Health Study
b. Patients in the Social Security Administration Death Master File in the United States
c. Patients in 11 state cancer registry databases
d. None of the above 3. What study design was used?
a. Case-control
b. Cross-sectional
c. Ecological d. Cohort 4. What is the primary dependent variable?
a. Wine consumption
b. Prostate cancer
c. Beer consumption
d. Liquor consumption
5. How did the authors determine whether or not participants had prostate cancer at
baseline?
a. Laboratory exam
b. Self-report via questionnaire
c. Medical record review
d. They did not determine whether or not participants had prostate cancer at baseline 6. Type in the major categories for the prostate cancer variable. (3 points) 7. Which of the following citations was used to categorize portion sizes and nutrients?
a. Platz, ES, Leitzmann MF, Michaud DS, et al. Interrelation of energy intake, body
size, and physicial activity with prostate cancer in a large prospective cohort study.
Cancer Res. 2003; 63(23):8542-8548.
b. Velicer CM, Kristal A, White E. Alcohol use and the risk of prostate cancer: results
from the VITAL Cohort Study. Nutr Cancer. 2006;56(1):50-56.
c. Dennis LK, Hayes RB. Alcohol and prostate cancer. Epidemiol Rev. 2001;23(1):110114.
d. Tippett KS, Cypel YS. Design and Operation: The Continuing Survey of Food Intakes
by Individuals and Diet and Health Knowledge Survey, 1994-96. Continuing Survey
of Food Intakes by Individuals, Nationwide Food Surveys. Washington, DC:
Agricultural Research Service, US Department of Agriculture; 1997. 8. Type in the first five (5) confounders/covariates (i.e. risk factors) that were included in the
final multiple regression model? (5 points) 9. Go to Table 1. Type in the correct numbers into a shortened version of the table below.
Reproduce the numbers exactly as they are in the article table. (12 points) Table 1. Selected Characteristics According to Alcohol Consumption Among Men in the
NIH-AARP Diet and Health Study, 1995-2003 (n=294,707). Characteristic 0
(n=61,431) Alcohol (Drinks/Day)
<1
1-3
(n = 146,027)
(n=55,438) >3
(n=31,811) Median age,
years
Married, %
History of
diabetes, % Using the abridged version of Table 1, answer the following questions. 10. There is a statistically significant difference in median age between the four exposure
categories.
a. Yes
b. No
c. Cannot determine
11. Marital status is likely to be a confounder of the association between alcohol
consumption and prostate cancer.
a. Probably
b. Probably not
c. Cannot determine 12. Heavier drinkers were less likely to report a history of diabetes than lighter or nondrinkers.
a. Yes
b. No
c. Cannot determine 13. Go to Table 2. Fill in the numbers from the article in the abridged version of the table
below. Reproduce the numbers that should go in place of the red X exactly as they
appear in the article table. (8 points) Table 2. Relative Risk of Prostate Cancer in Relation to Daily Alcohol
Consumption Among Men in the NIH-AARP Diet and Health Study,
1995-2003.
Alcohol
(Drinks/Day)
Non-advanced cases
0
<1
1-3
>3-<6
?6
Fatal Cases
0
<1
1-3
>3-<6
?6 Multivariate HRa 95% CI 1.
X
1.06
X
1.25 1.01, 1.11
X , 1.12
1.11, 1.29
1.13, X 1.
0.86
X
X
0.45 X , 1.08
0.72, 1.26
0.53, X
0.25, 0.81 a Adjusted for age, race, education, marital status, height, body mass index, physical
activity, family history of prostate cancer, diabetes, self-reported health status,
cigarette smoking, prostate-specific antigen screening and digital rectal examination,
total energy excluding alcohol, ?-tocopherol, calcium, red meat, fish, tomato, ?linolenic acid, and selenium. Use the data from the abridged Table 2 to answer the questions below. Thus, all questions
refer to results from the fully adjusted model. 14. How many covariates were included in the fully adjusted regression model? Assume
PSA screening and DRE were included as one summary variable. 15. What alpha (?) level was used in this study? 16. The HR for 0 drinks per day is 1. What does this mean?
a. There is no association between not drinking and prostate cancer
b. Zero drinks per day was used as the reference or comparison group
c. It is an error
d. Cannot determine 17. There is evidence of a dose-response trend associated with increasing drinks per day
among both non-advanced and fatal cases.
a. Yes
b. No
c. Cannot determine 18. Overall, the risk of prostate cancer increased as the number of alcoholic drinks
consumed per day increased among non-advanced cases.
a. Yes
b. No
c. Cannot determine 19. Look at the HR for non-advanced cases who drank >3-<6 alcoholic drinks per day. This
result is statistically significant.
a. Yes
b. No
c. Cannot determine 20. Overall, the risk of prostate cancer increased as the number of alcoholic drinks
consumed per day increased among fatal cases.
a. Yes
b. No
c. Cannot determine 21. Look at the HR for fatal cases who drank >3-<6 alcoholic drinks per day. This result is
statistically significant.
d. Yes
e. No
f. Cannot determine 22. As briefly as possible, explain why you think we observe a different pattern of results for
non-advanced cases compared to fatal cases. When making an overall conclusion
about this study (does alcohol consumption impact risk of prostate cancer?), which
group’s results would you feel most comfortable using (non-advanced, advanced, or fatal
prostate cancer)? Explain.
(5 points)

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