Research Topics
Species | JULIE ANN ROSSSummaryAffiliation: University of Minnesota Country: USA Publications
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Publications
Genetic variants modify susceptibility to leukemia in infants: a Children's Oncology Group reportJulie A Ross
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Pediatr Blood Cancer 60:31-4. 2013..Genetic determinants of susceptibility to IL are unknown. Recent genome-wide association studies for childhood acute lymphoblastic leukemia (ALL) have identified susceptibility loci at IKZF1, ARID5B, and CEBPE...
Similar DNA methylation levels in specific imprinting control regions in children conceived with and without assisted reproductive technology: a cross-sectional studySusan E Puumala
Center for Health Outcomes and Prevention Research, Sanford Research, Sioux Falls, SD, USA
BMC Pediatr 12:33. 2012..Results from previous studies have been mixed, but some methylation differences have been observed...
Parental and infant characteristics and childhood leukemia in MinnesotaKimberly J Johnson
Division of Epidemiology Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
BMC Pediatr 8:7. 2008..Translocations present in neonatal blood spots and the young age peak of diagnosis suggest that early-life factors are involved in childhood leukemia etiology...
Nonsteroidal anti-inflammatory drug and acetaminophen use and risk of adult myeloid leukemiaJulie A Ross
Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 20:1741-50. 2011..Little is known about the causes of adult leukemia. A few small studies have reported a reduced risk associated with regular use of nonsteroidal anti-inflammatory drugs (NSAID)...
Dietary flavonoids: bioavailability, metabolic effects, and safetyJulie A Ross
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
Annu Rev Nutr 22:19-34. 2002..Because there are many biological activities attributed to the flavonoids, some of which could be beneficial or detrimental depending on specific circumstances, further studies in both the laboratory and with populations are warranted...
Etiology of childhood cancer: recent reportsJulie A Ross
Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
Pediatr Blood Cancer 45:239-41. 2005
Maternal diet and infant leukemia: the DNA topoisomerase II inhibitor hypothesis: a report from the children's oncology groupLogan G Spector
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 14:651-5. 2005..We hypothesized that maternal consumption of dietary DNAt2 inhibitors during pregnancy would increase the risk of infant leukemia, particularly AML(MLL+)...
Body mass index and risk of leukemia in older womenJulie A Ross
University of Minnesota Cancer Center, 420 Delaware Street Southeast, MMC 422, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 13:1810-3. 2004..6). Given the prevalence of overweight and obesity in the United States, the population attributable risk of AML due to obesity could approach 30%...
Genetics and childhood cancer. Commentary on: inherited cancer in children: practical/ethical problems and challengesJulie A Ross
Department of Pediatrics, Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, 420 Delaware St. S.E, MMC 422, Minneapolis, MN 55455, USA
Eur J Cancer 40:2471-2. 2004
Genetic susceptibility and body mass in childhood cancer survivorsJulie A Ross
Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota 55455, USA
Pediatr Blood Cancer 48:731-5. 2007..The new Childhood Cancer Research Network in the Children's Oncology Group, when fully implemented, should make it less difficult in the future to recruit the large numbers of patients needed for such studies...
Periconceptional vitamin useand leukemia risk in children with Down syndrome: a Children's Oncology Group studyJulie A Ross
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
Cancer 104:405-10. 2005..Because children with Down syndrome (DS) experience a 20-fold higher risk of leukemia than the general population, the authors evaluated whether periconceptional vitamin supplementation reduced the risk of leukemia in children with DS...
Hormone replacement therapy is not associated with an increased risk of leukemia (United States)Julie A Ross
Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
Cancer Causes Control 16:483-8. 2005..Since estrogen receptors are expressed on certain hematopoietic cells, it is possible that HRT use may also increase the risk of leukemia...
Childhood cancer following neonatal oxygen supplementationLogan G Spector
Department of Pediatrics, University of Minnesota, Minneapolis, MN 54555, USA
J Pediatr 147:27-31. 2005..To evaluate the relationship between neonatal oxygen supplementation (O2) and childhood cancer in the Collaborative Perinatal Project (CPP)...
Detection of cotinine in newborn dried blood spotsLogan G Spector
Division of Epidemiology Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware Street, Southeast, MMC 715, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 16:1902-5. 2007..These results suggest that DBS analysis may identify infants of women who smoke throughout pregnancy...
Looking for leukemia clues in of all places....meconium!Julie A Ross
Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota, USA
Pediatr Blood Cancer 49:607-8. 2007
Feasibility of nationwide birth registry control selection in the United StatesLogan G Spector
Division of Epidemiology Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
Am J Epidemiol 166:852-6. 2007..These results suggest that birth registries may be used to select controls for studies of rare childhood diseases on a national scale...
Birth characteristics, maternal reproductive history, and the risk of infant leukemia: a report from the Children's Oncology GroupLogan G Spector
Division of Epidemiology Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware Street Southeast, MMC 715, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 16:128-34. 2007..Other variables of interest were not notably associated with infant leukemia regardless of MLL status. This investigation further supports the contention that molecularly defined subtypes of infant leukemia have separate etiologies...
Host factors and consequence of chemotherapy in pediatric cancer patientsL aurelle A Johnson
Department of Pediatrics, Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA
Pediatr Blood Cancer 51:320-6. 2008..This review will focus on these factors in the treatment of childhood ALL...
Epidemiology of leukemia in children with Down syndromeJulie A Ross
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
Pediatr Blood Cancer 44:8-12. 2005....
Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor StudyJulie A Ross
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
J Clin Oncol 22:3558-62. 2004....
Glutathione S-transferase genotypes, genetic susceptibility, and outcome of therapy in childhood acute lymphoblastic leukemiaStella M Davies
Children s Oncology Group, Arcadia, CA 91066 6012, USA
Blood 100:67-71. 2002..These data, representing a larger series than any reported previously, suggest that GST genotype does not affect etiology or outcome of childhood ALL...
Prevalence of cigarette smoking in pregnant women participating in the special supplemental nutrition programme for Women, Infants and Children (WIC) in Minneapolis and Saint Paul, Minnesota, USAJulie A Ross
Division of Pediatric Epidemiology and Clinical Research, University of Minnesota Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455, USA
Paediatr Perinat Epidemiol 16:246-8. 2002..These data suggest that some participants in WIC make a concerted effort to quit smoking when they find out they are pregnant, and are generally truthful when reporting their smoking habits during pregnancy...
Diet and risk of leukemia in the Iowa Women's Health StudyJulie A Ross
Division of Pediatric Epidemiology and Clinical Research, University of Minnesota Department of Pediatrics, Minneapolis, Minnesota 55455, USA
Cancer Epidemiol Biomarkers Prev 11:777-81. 2002..However, given that our study focused on older women from a defined geographical area, analyses of prospective studies in other populations are needed to confirm or refute these results...
Childhood cancer etiology: recent reportsStella M Davies
Division of Epidemiology/Clinical Research, University of Minnesota, Minneapolis 55455, USA
Med Pediatr Oncol 40:35-8. 2003
Cancer in the Minnesota Hmong populationJulie A Ross
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 5455, USA
Cancer 97:3076-9. 2003..The objective of this study was to examine cancer incidence in this population, because it may indicate areas for targeted surveillance and intervention...
Prescription medication use during pregnancy and risk of infant leukemia (United States)Julie A Ross
Department of Pediatrics, University of Minnesota, USA
Cancer Causes Control 14:447-51. 2003..We explored whether maternal medication use during pregnancy may be an important etiologic area for investigation in studies of infant leukemia...
Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006Jenny N Poynter
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
Cancer 116:4882-91. 2010..To the authors' knowledge, few studies to date have evaluated trends in pediatric GCTs. Results from these analyses may provide clues to the etiology of GCTs...
Estrogen replacement therapy and ovarian cancerAaron R Folsom
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota55454 1015, USA
Epidemiology 15:100-4. 2004..However, several subsequent studies have suggested that long-term ERT could increase ovarian cancer risk...
Maternal health conditions during pregnancy and acute leukemia in children with Down syndrome: A Children's Oncology Group studySimona Ognjanovic
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
Pediatr Blood Cancer 52:602-8. 2009..We examined whether maternal infections and health conditions during pregnancy were associated with acute leukemia in children with DS...
Invited commentary: Birth certificates--a best control scenario?Julie A Ross
Division of Epidemiology and Clinical Research, Department of Pediatrics, and Cancer Center, University of Minnesota, Minneapolis, 55455, USA
Am J Epidemiol 159:922-4; discussion 925. 2004
Trends in childhood rhabdomyosarcoma incidence and survival in the United States, 1975-2005Simona Ognjanovic
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Masonic Cancer Center, Minneapolis, Minnesota 55455, USA
Cancer 115:4218-26. 2009..The authors of this report evaluated incidence and survival trends by RMS demographic subgroups to inform future etiologic hypotheses...
Recent report in the etiology of childhood cancer: 'greatest hits'Julie A Ross
Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota 55455, USA
Pediatr Blood Cancer 42:3-7. 2004
Family history of cancer and malignant germ cell tumors in children: a report from the Children's Oncology GroupJenny N Poynter
Department of Pediatrics, Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA
Cancer Causes Control 21:181-9. 2010..46, 95% CI 0.22-0.96). These sex and cancer site specific associations should be confirmed in additional studies as they may provide clues to the etiology of pediatric GCT...
History of allergy and reduced incidence of colorectal cancer, Iowa Women's Health StudyAnna E Prizment
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 16:2357-62. 2007..63 to 0.78 across these end points). Allergy history, which may reflect enhanced immunosurveillance, is associated with a reduced risk of colorectal cancer...
Height, body mass index, and ovarian cancer: a pooled analysis of 12 cohort studiesLeo J Schouten
Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
Cancer Epidemiol Biomarkers Prev 17:902-12. 2008..Although many studies have investigated the association between anthropometry and ovarian cancer risk, results have been inconsistent...
Trends in childhood cancer incidence in the U.S. (1992-2004)Amy M Linabery
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
Cancer 112:416-32. 2008..S. overall and among demographic subgroups, including Asian/Pacific Islanders and Hispanics, for whom to the authors' knowledge trends have not been previously examined...
Reproductive history, infertility treatment, and the risk of acute leukemia in children with down syndrome: a report from the Children's Oncology GroupSusan E Puumala
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
Cancer 110:2067-74. 2007..There is mixed evidence for associations between reproductive history or infertility and acute leukemia among children without DS...
Secular trends in response rates for controls selected by random digit dialing in childhood cancer studies: a report from the Children's Oncology GroupGreta R Bunin
Division of Oncology, Children s Hospital of Philadelphia, Philadelphia, PA 19104, USA
Am J Epidemiol 166:109-16. 2007..4% per year (95% CI: -2.7, -2.0; p < 0.001). The current low response rates for RDD indicate a substantial potential for selection bias and a need to seek alternative sources of controls...
Household pesticides and the risk of Wilms tumorMaureen A Cooney
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599 7435, USA
Environ Health Perspect 115:134-7. 2007..Previous epidemiologic studies have suggested that exposure to pesticides in utero and during early childhood may increase the risk for development of childhood cancer, including Wilms tumor, a childhood kidney tumor...
Vitamin supplement use among children with Down's syndrome and risk of leukaemia: a Children's Oncology Group (COG) studyCindy K Blair
University of Minnesota Cancer Center, Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
Paediatr Perinat Epidemiol 22:288-95. 2008..Future research should include larger sample sizes as well as a full assessment of diet including vitamin supplementation to adequately examine the relation between nutritional status and childhood leukaemia...
XPD Lys751Gln polymorphism in the etiology and outcome of childhood acute myeloid leukemia: a Children's Oncology Group reportParinda A Mehta
Cincinnati Children s Hospital and Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
Blood 107:39-45. 2006..These data, representing the only data in pediatric AML, suggest that XPD genotype does not affect the etiology or outcome of childhood AML...
Pediatric cancer in the United States: the Children's Oncology Group Epidemiology Research ProgramJulie A Ross
Cancer Epidemiol Biomarkers Prev 13:1552-4. 2004
Breast cancer and body mass: when is it ok to be too little, too big, or just right?Julie A Ross
Cancer Epidemiol Biomarkers Prev 14:560-1. 2005
Anthropometric characteristics and risk of multiple myelomaCindy K Blair
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Epidemiology 16:691-4. 2005..5 (0.92-2.6); for weight, 1.9 (1.1-3.4); for waist circumference, 2.0 (1.1-3.5); and for hip circumference, 1.8 (1.0-3.0). CONCLUSION: Greater adiposity may increase the risk of multiple myeloma...
BERing the burden of riskJulie A Ross
Cancer Epidemiol Biomarkers Prev 14:2064-5. 2005
Positive association of farm or rural residence with acute myeloid leukemia incidence in a cohort of older womenPenny J Sinner
University of Minnesota Cancer Center, MMC 422, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
Cancer Epidemiol Biomarkers Prev 14:2446-8. 2005..33-4.26) to develop AML compared with women who lived in a city with a population of >10,000 people. These results provide evidence that women who live on farms or rural areas are at an increased risk of AML...
Dietary flavonoid intake and risk of cancer in postmenopausal women: the Iowa Women's Health StudyGretchen J Cutler
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
Int J Cancer 123:664-71. 2008..93, 95% CI: 0.86-1.00). This study provides further support for a beneficial effect of flavonoid intake on lung cancer risk, especially among current and past smokers...
Parental marijuana use and risk of childhood acute myeloid leukaemia: a report from the Children's Cancer Group (United States and Canada)Katrina F Trivers
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 7435, USA
Paediatr Perinat Epidemiol 20:110-8. 2006..The decreased ORs observed in this study may be due to recall bias assuming plausibly low values of sensitivity...
A pooled analysis of 12 cohort studies of dietary fat, cholesterol and egg intake and ovarian cancerJeanine M Genkinger
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
Cancer Causes Control 17:273-85. 2006..Results for histologic subtypes were similar. Overall, fat, cholesterol and egg intakes were not associated with ovarian cancer risk. The positive association for saturated fat intake at very high intakes merits further investigation...
Anthropometric variables, physical activity, and incidence of ovarian cancer: The Iowa Women's Health StudyJeffrey P Anderson
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA
Cancer 100:1515-21. 2004....
Genetic polymorphisms in the Hmong population: implications for cancer etiology and survivalWilliam R Kiffmeyer
Department of Pediatrics, University of Minnesota Cancer Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
Cancer 100:411-7. 2004..The authors compared frequencies of common genetic polymorphisms believed to influence risk of malignancy to determine whether frequencies in the Hmong are different from those in other Asian populations and in white Minnesotans...
Breast-feeding and Wilms tumor: a report from the Children's Oncology GroupStephanie Saddlemire
Department of Epidemiology, University of North Carolina, CB 7435, Chapel Hill, NC, 27599 7435, USA
Cancer Causes Control 17:687-93. 2006..We investigated the association between breast-feeding and Wilms tumor, a childhood kidney tumor...
Child and maternal household chemical exposure and the risk of acute leukemia in children with Down's syndrome: a report from the Children's Oncology GroupLucy E Alderton
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, 55455, USA
Am J Epidemiol 164:212-21. 2006..0. This exploratory study suggests that household chemical exposure may play a role in the development of acute lymphoblastic leukemia in children with Down's syndrome...
Bias in studies of parental self-reported occupational exposure and childhood cancerJoachim Schüz
Institute for Medical Biostatistics, Epidemiology, and Informatics IMBEI, University of Mainz, Mainz, Germany
Am J Epidemiol 158:710-6. 2003..However, because future case-control studies will at least partially rely on questionnaire data, improvements including probing questions, better interview techniques, and validation studies are indicated...
Parental exposure to medications and hydrocarbons and ras mutations in children with acute lymphoblastic leukemia: a report from the Children's Oncology GroupXiao Ou Shu
Vanderbilt Ingram Cancer Center and Vanderbilt Center for Health Services Research, Vanderbilt University, Nashville, Tennessee, USA
Cancer Epidemiol Biomarkers Prev 13:1230-5. 2004..8, 95% CI 1.0-1.3) were associated with N-ras mutations. This study suggests that parental exposure to specific chemicals may be associated with distinct ras mutations in children who develop ALL...
Hepatoblastoma and low birth weightLogan G Spector
Pediatr Blood Cancer 43:706. 2004
Non-steroidal anti-inflammatory drug use and risk of adult leukemiaChristine M Kasum
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota 55454, USA
Cancer Epidemiol Biomarkers Prev 12:534-7. 2003..Although preliminary, the notable differences observed in leukemia risk between aspirin and nonaspirin NSAID use warrant further investigation...
Trends in leukemia incidence and survival in the United States (1973-1998)Yang Xie
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
Cancer 97:2229-35. 2003..CONCLUSIONS: Although the current study confirmed some of the results noted in other populations, the observed overall decline in leukemia survival for blacks is surprising and warrants further investigation...
High birthweight and cancer: evidence and implicationsJulie A Ross
Cancer Epidemiol Biomarkers Prev 15:1-2. 2006
Ontogeny of gene expression: a changing environment for malignancyLogan G Spector
Cancer Epidemiol Biomarkers Prev 17:1021-3. 2008
Childhood cancer research network: a North American Pediatric Cancer RegistryJeanne R Steele
Cancer Epidemiol Biomarkers Prev 15:1241-2. 2006
Childhood cancer and birthmarks in the Collaborative Perinatal ProjectKimberly J Johnson
Department of Pediatrics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
Pediatrics 119:e1088-93. 2007....
Ethnicity and survival in childhood acute myeloid leukemia: a report from the Children's Oncology GroupRichard Aplenc
Pediatric Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
Blood 108:74-80. 2006..Fewer black children than expected had an available family marrow donor...
Intake of the major carotenoids and the risk of epithelial ovarian cancer in a pooled analysis of 10 cohort studiesAnita Koushik
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
Int J Cancer 119:2148-54. 2006..These results suggest that consumption of the major carotenoids during adulthood does not play a major role in the incidence of ovarian cancer...
Infant leukemia: finding the needle in the haystackLogan G Spector
Cancer Epidemiol Biomarkers Prev 15:2331. 2006
Exposure to medical test irradiation and acute leukemia among children with Down syndrome: a report from the Children's Oncology GroupAmy M Linabery
Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
Pediatrics 118:e1499-508. 2006..The absence of an association should be encouraging for concerned parents of children with Down syndrome who undergo a series of diagnostic radiographs in the course of their standard care...
Mutational spectrum of beta-catenin, AXIN1, and AXIN2 in hepatocellular carcinomas and hepatoblastomasKen Taniguchi
Division of Experimental Pathology, Mayo Clinic, Rochester, Minnesota, MN 55905, USA
Oncogene 21:4863-71. 2002....
Research Grants
- EPIDEMIOLOGY OF INFANT LEUKEMIAJulie Ross; Fiscal Year: 2007..This study will utilize the unique resources available through the Children's Oncology Group, and include ascertainment of cases over a four-year period (Jan 1, 2003-Dec 31, 2006). ..
- Pediatric Cancer Epidemiology Training GrantJulie Ross; Fiscal Year: 2007..abstract_text> ..
- Predictors of Adult LeukemiaJulie Ross; Fiscal Year: 2009..The significance of this proposal, specifically with respect-to the identification of possible prevention strategies for adult AML, has important public health implications. ..
- EPIDEMIOLOGY OF DOWN SYNDROME--LEUKEMIA & DOWN SYNDROMEJulie Ross; Fiscal Year: 2001..It is claimed that each case-control study has adequate statistical power to address the hypotheses being explored. ..
- EPIDEMIOLOGY OF INFANT LEUKEMIAJulie Ross; Fiscal Year: 2002..The overall sample size includes 250 matched sets (2 controls per case), which will provide sufficient statistical power to address the hypothesis being investigated. ..
- Predictors of myelodysplastic syndrome in MinnesotaJULIE ANN ROSS; Fiscal Year: 2010..We are proposing one of the largest epidemiological studies of MDS ever conducted, with the goal of being able to identify risk factors that could lead to prevention. ..
