Leslie Elliott

University of Nebraska Medical Center, Omaha, Nebraska, United States

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Publications (21)110.21 Total impact

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    ABSTRACT: Animal data and physical models suggest that the carcinogenicity of asbestos fibres is related to their size and shape. To investigate the influence of fibre length and diameter on lung cancer risk in workers at asbestos textile mills in North Carolina and South Carolina, USA. Men and women (n=6136) who worked ≥30 days in production and were employed between 1940 and 1973 were enumerated and followed for vital status through 2003. A matrix of fibre size-specific exposure estimates was constructed using determinations of fibre numbers and dimensions through analysis of 160 historical dust samples by transmission electron microscopy. Associations of lung cancer mortality with metrics of fibre exposure were estimated by Poisson regression with adjustment for age, sex, race and calendar year. Exposure to fibres throughout the range of length and diameter was significantly associated with increased risk of lung cancer. Models for fibres >5 μm long and <0.25 μm in diameter provided the best fit to the data, while fibres 5-10 μm long and <0.25 μm in diameter were associated most strongly with lung cancer mortality (log rate about 4% per IQR, p<0.001). When indicators of mean fibre length and diameter were modelled simultaneously, lung cancer risk increased as fibre length increased and diameter decreased. The findings support the hypothesis that the occurrence of lung cancer is associated most strongly with exposure to long thin asbestos fibres. The relationship of cancer risk and fibre dimensions should be examined in cohorts exposed to other types of fibres.
    No preview · Article · May 2012 · Occupational and environmental medicine
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    ABSTRACT: Studies of workers in two US cohorts of asbestos textile workers exposed to chrysotile (North Carolina (NC) and South Carolina (SC)) found increasing risk of lung cancer mortality with cumulative fibre exposure. However, the risk appeared to increase more steeply in SC, possibly due to differences in study methods. The authors conducted pooled analyses of the cohorts and investigated the exposure-disease relationship using uniform cohort inclusion criteria and statistical methods. Workers were included after 30 days of employment in a production job during qualifying years, and vital status ascertained through 2003 (2001 for SC). Poisson regression was used to estimate the exposure-response relationship between asbestos and lung cancer, using both exponential and linear relative rate models adjusted for age, sex, race, birth cohort and decade of follow-up. The cohort included 6136 workers, contributing 218,631 person-years of observation and 3356 deaths. Cumulative exposures at the four study facilities varied considerably. The pooled relative rate for lung cancer, comparing 100 f-yr/ml to 0 f-yr/ml, was 1.11 (95% CI 1.06 to 1.16) for the combined cohort, with different effects in the NC cohort (RR=1.10, 95% CI 1.03 to 1.16) and the SC cohort (RR = 1.67, 95% CI 1.44 to 1.93). Increased rates of lung cancer were significantly associated with cumulative fibre exposure overall and in both the Carolina asbestos-textile cohorts. Previously reported differences in exposure-response between the cohorts do not appear to be related to inclusion criteria or analytical methods.
    Full-text · Article · Jan 2012 · Occupational and environmental medicine

  • No preview · Article · Oct 2011 · Occupational and Environmental Medicine
  • D. Loomis · J. Dement · L. Elliott · D. Richardson · E. Kuempel

    No preview · Article · Oct 2011 · Occupational and Environmental Medicine
  • Leslie Elliott

    No preview · Article · Jun 2010 · JAMA Pediatrics
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    ABSTRACT: To identify potential risk factors associated with a sudden increase in gastroschisis cases in northern Nevada. Case-control study. Medical centers and a pregnancy care center in Reno, Nevada. Participants (n = 14) were women who gave birth to infants with gastroschisis at either of the 2 medical centers in Reno, Nevada, from April 5, 2007, through April 4, 2008. Controls (n = 57) were selected from the same pregnancy center providing perinatal care to the cases and were matched 4:1 to the case mothers by maternal date of birth within 1 year. Environmental exposures and illnesses during pregnancy. Association of gastroschisis with illnesses, medications, or environmental exposures. Gastroschisis was associated with the use of methamphetamine (odds ratio [OR], 7.15; 95% confidence interval [CI], 1.35-37.99) or any vasoconstrictive recreational drug (methamphetamine, amphetamine, cocaine, ecstasy) (OR, 4.46; 95% CI, 1.21-16.44) before pregnancy. When we limited self-reported illnesses to those occurring during the first trimester of pregnancy, chest colds (OR, 16.77; 95% CI, 1.88-150.27) and sore throats (OR, 12.72; 95% CI, 1.32-122.52) were associated with gastroschisis. These findings add strength to the hypothesis that use of methamphetamine and related drugs is a risk factor for gastroschisis and raise questions about the risks associated with infections.
    No preview · Article · Nov 2009 · JAMA Pediatrics
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    ABSTRACT: Breast-feeding clearly protects against early wheezing, but recent data suggest that it might increase later risk of atopic disease and asthma. We sought to examine the relationship between breast-feeding and later asthma and allergy outcomes by using data from the Avon Longitudinal Study of Parents and Children, a large birth cohort in the United Kingdom. We used adjusted logistic regression models to evaluate the association between breast-feeding and atopy at age 7 years, bronchial responsiveness to methacholine at age 8 years, and wheeze at ages 3 and 7 1/2 years. Bayesian methods were used to assess the possibility of bias caused by an influence of early wheezing on the duration of breast-feeding, as well as selection bias. Breast-feeding was protective for wheeze in the first 3 years of life (odds ratio [OR] of 0.80 [95% CI, 0.70-0.90] for > or = 6 months relative to never) but not wheeze (OR, 0.98; 95% CI, 0.79-1.22), atopy (OR, 1.12; 95% CI, 0.92-1.35), or bronchial hyperresponsiveness (OR, 1.07; 95% CI, 0.82-1.40) at ages 7 to 8 years. Bayesian models adjusting for the longer duration of breast-feeding among children with wheezing in early infancy produced virtually identical results. We did not find consistent evidence for either a deleterious effect or a protective effect of breast-feeding on later risk of allergic disease in a large prospective birth cohort of children with objective outcome measures and extensive data on potential confounders and effect modifiers. Neither reverse causation nor loss to follow-up appears to have materially biased our results.
    Full-text · Article · Jul 2008 · The Journal of allergy and clinical immunology
  • Leslie Elliott · Dana Loomis

    No preview · Article · Feb 2008 · Epidemiology
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    ABSTRACT: Settled dust has been used in studies to assess exposures to allergens and other biologically active components, but it has not been considered in the aggregate in relation to respiratory health outcomes in the general population. We addressed whether total house dust weight, an index of total dust exposure, was associated with respiratory health outcomes in the National Survey of Lead and Allergens in Housing (1998-1999) (NSLAH). NSLAH was a cross-sectional survey designed to represent permanently occupied housing units in the United States. In each household, a questionnaire was administered and settled dust was vacuumed from five locations. Linear regression models were used to identify predictors of dust weight; logistic regression models were used to examine the relationship between dust weight and asthma and wheeze. Dust weight samples were available for 829 households, and survey information was available for 2,456 participants (children and adults). Lower income, older homes, household pets, having a smoker in the house, and less frequent cleaning predicted higher dust weight levels in U.S. households. Higher levels of dust weight were associated with greater odds of current asthma and wheeze. The strongest associations were seen for wheeze [adjusted odds ratio (OR) = 1.99; 95% confidence interval (CI), 1.21-3.28 for bedroom bed dust; OR = 2.81; 95% CI, 1.52-5.21 for upholstery dust). These associations persisted when adjusting for allergen and endotoxin exposures. Dust weight, an index of total dust exposure in the home, may contribute to respiratory outcomes independently of the exposure to specific components.
    Full-text · Article · Mar 2007 · Environmental Health Perspectives
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    ABSTRACT: Volatile organic compounds (VOCs) are present in much higher concentrations indoors, where people spend most of their time, than outdoors and may have adverse health effects. VOCs have been associated with respiratory symptoms, but few studies address objective respiratory end points such as pulmonary function. Blood levels of VOCs may be more indicative of personal exposures than are air concentrations; no studies have addressed their relationship with respiratory outcomes. We examined whether concentrations of 11 VOCs that were commonly identified in blood from a sample of the U.S. population were associated with pulmonary function. We used data from 953 adult participants (20-59 years of age) in the Third National Health and Nutrition Examination Survey (1988-1994) who had VOC blood measures as well as pulmonary function measures. Linear regression models were used to evaluate the relationship between 11 VOCs and measures of pulmonary function. After adjustment for smoking, only 1,4-dichlorobenzene (1,4-DCB) was associated with reduced pulmonary function. Participants in the highest decile of 1,4-DCB concentration had decrements of -153 mL [95% confidence interval (CI) , -297 to -8] in forced expiratory volume in 1 sec and -346 mL/sec (95% CI, -667 to -24) in maximum mid-expiratory flow rate, compared with participants in the lowest decile. Exposure to 1,4-DCB, a VOC related to the use of air fresheners, toilet bowl deodorants, and mothballs, at levels found in the U.S. general population, may result in reduced pulmonary function. This common exposure may have long-term adverse effects on respiratory health.
    Full-text · Article · Sep 2006 · Environmental Health Perspectives
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    L Elliott · D Heederik · S Marshall · D Peden · D Loomis
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    ABSTRACT: Few studies have described relations between exposure to laboratory animals and the incidence of laboratory animal allergy (LAA). Studies that have found exposure-response relations have been cross sectional in design or have focused on exposure to rats and mice. This study used longitudinal data collected over a 12 year period to describe the relations between indices of exposure to laboratory animals and the development of LAA and LAA symptoms. Data were obtained from questionnaires and serological laboratory results from a dynamic cohort of workers exposed to a variety of laboratory animals in a pharmaceutical manufacturing company. Poisson regression was used to model the incidence rate ratios of species specific and general LAA and LAA symptoms at different levels of exposure. The 12 year incidence rates of LAA symptoms and LAA for all workers were 2.26 (95% CI 1.61 to 2.91) and 1.32 (95% CI 0.76 to 1.87) per 100 person-years, respectively. Higher rate ratios were seen with increasing reported hours of exposure to tasks that required working with animal cages or with many animals at one time. The most common symptoms were related to rhinitis rather than to asthma. This study suggests that the risk of LAA increases with duration of exposure to animals and work in animal related tasks. Incidence might be reduced by limiting hours per week of exposure to laboratory animals.
    Full-text · Article · Dec 2005 · Occupational and environmental medicine
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    ABSTRACT: Allergy skin tests were administered in the second and third National Health and Nutrition Examination Surveys (NHANES II and III) conducted in the United States from 1976 through 1980 and 1988 through 1994, respectively. This study estimated positive skin test response rates in NHANES III and identified predictors of one or more positive test responses. Comparisons with NHANES II were also made. In NHANES III, 10 allergens and 2 controls were tested in all subjects aged 6 to 19 years and a random half-sample of subjects aged 20 to 59 years. A wheal-based definition of a positive test response was used. In NHANES III, 54.3% of the population had positive test responses to 1 or more allergens. Prevalences were 27.5% for dust mite, 26.9% for perennial rye, 26.2% for short ragweed, 26.1% for German cockroach, 18.1% for Bermuda grass, 17.0% for cat, 15.2% for Russian thistle, 13.2% for white oak, 12.9% for Alternaria alternata, and 8.6% for peanut. Among those with positive test responses, the median number of positive responses was 3.0. Adjusted odds of a positive test response were higher for the following variables: age of 20 to 29 years, male sex, minority race, western region, old homes, and lower serum cotinine levels. For the 6 allergens common to NHANES II and III, prevalences were 2.1 to 5.5 times higher in NHANES III. The majority of the US population represented in NHANES III was sensitized to 1 or more allergens. Whether the higher prevalences observed in NHANES III reflect true changes in prevalence or methodological differences between the surveys cannot be determined with certainty.
    No preview · Article · Sep 2005 · Journal of Allergy and Clinical Immunology
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    ABSTRACT: Laboratory animal allergy is a common illness among workers exposed to laboratory animals and can progress to symptoms of asthma. This study evaluates the continuum of disease from allergy symptoms to asthma symptoms in a dynamic cohort of workers exposed to animals in a pharmaceutical company. Data arose from annual questionnaires administered to workers in a surveillance program established to monitor exposure to animals and the development of allergy. The life-table method was used to compare asthma-free survival between workers with and without symptoms of allergy. A Cox proportional hazards model was used to examine the effects of covariates on the development of asthma. A total of 603 workers contributed 2527.4 person-years to the study over the 12.3-year period. The probabilities of experiencing asthma symptoms by the 11th year of follow-up were 0.367 for workers with allergy symptoms and 0.052 for those without allergy symptoms. The hazard ratio for asthma symptoms when comparing workers with and without allergy symptoms was 7.39 (95% CI, 3.29-16.60) after adjustment for sex and family history of allergy. Female subjects developed asthma at a rate 3.4 times that of male subjects. This study supports the hypothesis that laboratory animal allergy symptoms are a major risk factor for the development of asthma. It also suggests a heightened risk of asthma for women who work with laboratory animals, a finding that has not been previously reported.
    No preview · Article · Aug 2005 · Journal of Allergy and Clinical Immunology
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    D Loomis · D B Richardson · L Elliott
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    ABSTRACT: Poisson regression is routinely used for analysis of epidemiological data from studies of large occupational cohorts. It is typically implemented as a grouped method of data analysis in which all exposure and covariate information is categorised and person-time and events are tabulated. To describe an alternative approach to Poisson regression analysis using single units of person-time without grouping. Data for simulated and empirical cohorts were analysed by Poisson regression. In analyses of simulated data, effect estimates derived via Poisson regression without grouping were compared to those obtained under proportional hazards regression. Analyses of empirical data for a cohort of 138 900 electrical workers were used to illustrate how the ungrouped approach may be applied in analyses of actual occupational cohorts. Using simulated data, Poisson regression analyses of ungrouped person-time data yield results equivalent to those obtained via proportional hazards regression: the results of both methods gave unbiased estimates of the "true" association specified for the simulation. Analyses of empirical data confirm that grouped and ungrouped analyses provide identical results when the same models are specified. However, bias may arise when exposure-response trends are estimated via Poisson regression analyses in which exposure scores, such as category means or midpoints, are assigned to grouped data. Poisson regression analysis of ungrouped person-time data is a useful tool that can avoid bias associated with categorising exposure data and assigning exposure scores, and facilitate direct assessment of the consequences of exposure categorisation and score assignment on regression results.
    Full-text · Article · Jun 2005 · Occupational and environmental medicine
  • L. Elliott · S.J. Arbes · D.C. Zeldin

    No preview · Article · Feb 2005 · Journal of Allergy and Clinical Immunology
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    L Elliott · K Yeatts · D Loomis
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    ABSTRACT: Farming and exposure to livestock have been proposed as protective against the development of asthma in children. An ecological study was conducted to examine the support for these relationships in the USA. County-specific aggregate measures were used to examine the relationship between the prevalence of asthma and wheeze in 7th and 8th grade school children (aged 12-14 yrs) and selected measures of potential exposure to farming in the state of North Carolina. Binomial regression models were fitted to quantify these relationships, with adjustments for parental smoking, socioeconomic status, sex and race. Regression coefficients were reported for an increment of one interquartile range (IQR) in each indicator of exposure. The prevalence of asthma showed decreasing trends for most indicators of farm exposure. Regression results suggested that the largest decreases in asthma prevalence were associated with the number of farms (-5.0% per IQR increment), acreage of hay (-7.2% per IQR increment) and beef cattle (-7.8% per IQR increment). The pattern of results was similar for wheezing. In conclusion, the findings of this study are consistent with the hypothesis that certain farm exposures are protective against childhood asthma. Further research with individual-level data is needed to identify the specific protective exposures.
    Full-text · Article · Jan 2005 · European Respiratory Journal
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    L Elliott · V Mortimer · V Ringenburg · S Kercher · D O'Brien
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    ABSTRACT: From industrial hygiene surveys of 24 sterilization areas with exposure to ethylene oxide in 20 hospitals, on the basis of the existence of engineering controls and observations of work practices, it was shown that engineering controls and/or good work practices can effectively reduce exposure to ethylene oxide. Engineering controls are more effective than just good work practices in reducing exposure potential. Proper work practices, in the absence of good engineering controls, were also shown to effect a considerable reduction in ethylene-oxide exposure. Effective engineering controls in conjunction with proper practices afforded the best reduction in the ethylene-oxide exposure of hospital workers. The following engineering controls collectively reduced ethylene-oxide exposure: local ventilation above the sterilizer door, local ventilation at the sterilizer drain, good general area ventilation of the sterilizer room, and additional vacuum purges. Work practices which collectively aided in a reduction of ethylene-oxide exposure included vacating the sterilizer room area during the exhaust cycle, opening the door 2-5 cm at the end of the cycle and again vacating the area to allow the ethylene oxide in the air to decrease, and limiting the handling time of and close contact with the sterilized items.
    Preview · Article · Feb 1988 · Scandinavian Journal of Work, Environment & Health
  • L. Stayner · L. Elliott
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    ABSTRACT: A walk through survey was made to evaluate the facility for inclusion in an ongoing NIOSH mortality and industrial hygiene study of exposure of workers to ethylene oxide (EtO) during industrial sterilization processes. The facility manufactures disposable health-care products, many of which require sterilization with EtO as part of the process. Limited EtO exposure sampling data for distinct job titles exists for the facility. The authors conclude that the facility should be excluded from the larger study due to the inadequacy of the personnel records for identifying workers potentially exposed to EtO.
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  • J. N. Zey · L. Elliott · V. Mortimer
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    ABSTRACT: A request was received from Clark County Hospital located in Jeffersonville, Indiana to evaluate possible employee exposures to hazardous substances while working in the central-supply (CS) area. Symptoms expressed by workers included headaches, dizziness, mucous membrane irritation, vomiting, diarrhea, nose bleeds, fatigue, nervous problems, and respiratory difficulties. Workers had reported smelling a sweet odor at times. Air sampling yielded time-weighted average personal-exposure concentrations of 0.23 to 0.56 parts per million (ppm) for ethylene oxide with short-term exposures of 77 ppm in the cart-storage area. The OSHA standard was 1 ppm, and the NIOSH recommended criterion was 0.1 ppm of ethylene oxide. Hydrochloric acid concentrations in area air samples were less than 1.0 ppm; for chlorine gas, less than 0.2 ppm; for carbon monoxide, less than 5.0 ppm; and up to 700 ppm for carbon dioxide. The lack of a dedicated ethylene oxide exhaust and the existence of an overloaded exhaust system were noted. The authors conclude that a health hazard to workers from exposure to ethylene oxide existed. They recommend specific measures to reduce exposures to ethylene oxide, including design and installation of a proper ventilation system.
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  • K. Steenland · L. Stayner · L. Elliott · V. Ringenburg
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    ABSTRACT: A walk-through survey was conducted at Kendall Company, Augusta, Georgia in February, 1984. The purpose of the survey was to determine the feasibility of including the facility in a NIOSH industry wide mortality and industrial hygiene study of ethylene oxide. The company produces medical supplies such as gauze pads, sponges, cotton balls, and trays that ore sterilized with ethylene oxide.
    No preview · Article ·

Publication Stats

645 Citations
110.21 Total Impact Points


  • 2012
    • University of Nebraska Medical Center
      Omaha, Nebraska, United States
  • 2009-2010
    • University of Nevada, Reno
      Reno, Nevada, United States
  • 2006-2007
    • National Institutes of Health
      • Division of Intramural Research
      베서스다, Maryland, United States
  • 2005
    • National Institute of Environmental Health Sciences
      • Epidemiology Branch
      Durham, North Carolina, United States
    • University of North Carolina at Chapel Hill
      • Department of Epidemiology
      Chapel Hill, NC, United States
    • University of Wisconsin–Madison
      Madison, Wisconsin, United States
  • 1988
    • United States National Transportation Safety Board
      Washington, Washington, D.C., United States