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Background: The laundry and dry cleaning industries are critical for maintaining cleanliness and hygiene in our daily lives. However, they have also been identified as sources of hazardous chemical exposure for workers, leading to potentially severe health implications. Despite mounting evidence that solvents like perchloroethylene and trichloroethylene are carcinogenic, they remain commonly used in the industry. Additionally, while alternative solvents are increasingly being utilized in response to indications of adverse health and environmental effects, there remains a significant gap in our understanding of the potential risks associated with exposure to these new agents. Methods: This study aims to identify gaps in the literature concerning worker exposure to contemporary toxic chemicals in the laundry and dry cleaning industry and their associated carcinogenic risks. A scoping review of peer-reviewed publications from 2012 to 2022 was conducted to achieve this objective, focusing on studies that detailed chemical exposures, sampling methods, and workers within the laundry and dry cleaning sector. Results: In this scoping review, 12 relevant papers were assessed. A majority (66%) examined perchloroethylene exposure, with one notable finding revealing that biomarkers from dry cleaners had significant micronuclei frequency and DNA damage, even when exposed to PCE at levels below occupational exposure limits. Similarly, another study supported these results, finding an increase in early DNA damage among exposed workers. Separate studies on TCE and benzene presented varied exposure levels and health risks, raising concern due to their IARC Group 1 carcinogen classification. Information on alternative solvents was limited, highlighting gaps in health outcome data, exposure guidelines, and carcinogenic classifications. Conclusion: Research on health outcomes, specifically carcinogenicity from solvent exposure in dry cleaning, is limited, with 66% of studies not monitoring health implications, particularly for emerging solvents. Further, findings indicated potential DNA damage from perchloroethylene, even below set occupational limits, emphasizing the need to reevaluate safety limits. As alternative solvents like butylal and high-flashpoint hydrocarbons become more prevalent, investigations into the effects of their exposure are necessary to safeguard workers’ health. This scoping review is registered with the Open Science Framework, registration DOI: . [ABSTRACT FROM AUTHOR]

Background: Over one-third of cancer cases are attributable to modifiable risk factors. Because health-related behaviors are often established at adolescence, it is important that adolescents understand the risks and lifestyle decisions that may reduce their chances of developing cancer. This study aims to identify the levels of cancer awareness of adolescents in Australia. Methods: Paper questionnaires were used to collect information about baseline levels of cancer awareness. These questionnaires included socio-demographic questions and the Cancer Awareness Measure (CAM) with slight modifications to ensure their suitability for the Australian adolescent population. Students aged 11 to 19 years were recruited from 13 Australian high schools between 2016 and 2019. Results: A total of 766 adolescents (58% female, mean age = 14.5 years) completed the questionnaires. Adolescents' cancer awareness was low. Adolescents who knew someone with cancer recognized significantly more cancer risk factors and cancer warning signs than those who did not know someone with cancer (t (756) = 2.35, p =.019; t (747) = 5.57, p =.001). Those from high Index of Community Socio-Educational Advantage (ICSEA) schools significantly recognized more cancer risk factors than those from low ICSEA schools (t (764) = 2.42, p =.016). Females recognized significantly more warning signs than males (t (583) = 3.11, p =.002) and students from senior high school grades recognized more warning signs than those from junior grades (t (754) = 2.24, p =.02). Most adolescents (78%) were aware of skin cancer as one of the most common cancers in Australia, however half or less were aware of other common cancers. Although most adolescents would seek medical help in the presence of possible cancer symptoms as soon as possible, approximately 20% of them would not see a doctor promptly. Emotional barriers were the most common reasons to delay seeing a doctor (56%), for example "being worried about hearing bad news" (27%). Conclusions: Australian adolescents show poor awareness of cancer risk factors and cancer warning signs. A number of demographic and experience factors were found to be related to lower cancer awareness. Education is essential to raise cancer awareness, promote healthy lifestyles from adolescence and avoid a preventable cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: The prevalence of smoking among cervical cancer survivors is high and evidence-based smoking cessation interventions are critically needed. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial (RCT) designed to evaluate the efficacy of a novel, personally tailored SMS-delivered text-based digital treatment adjuvant designed to enhance the long-term efficacy of a "Motivation And Problem-Solving" (MAPS) approach for smoking cessation among individuals with a history of cervical intraepithelial neoplasia (CIN) or cervical cancer. MAPS is a phone counseling approach designed to facilitate long-term abstinence that comprises 6 counseling calls over 12 months. The current trial is evaluating the efficacy of MAPS+, which comprises all MAPS components plus a 24-month digital treatment adjuvant. This trial represents a logical extension of our previous RCT, which compared the efficacy of MAPS to a quitline control condition and found that MAPS resulted in greater than a 2-fold increase in smoking abstinence at 12 months (i.e., 26.4% vs. 11.9%). This treatment effect was no longer significant at 18 months, suggesting that efficacy dissipated as time from the end of treatment increased. The primary aim of the current trial is to compare the efficacy of MAPS + and ST in facilitating long-term abstinence. Methods: Individuals who smoke and have a history of cervical cancer or CIN (N = 340) are recruited throughout Florida and randomly assigned to Standard Treatment [ST] or MAPS+. ST participants are electronically connected with the Florida Quitline. MAPS + consists of 6 proactive MAPS-based counseling calls over 12 months plus the novel, personally tailored, text message-based treatment adjuvant delivered over 24 months. All participants receive 12 weeks of combination nicotine replacement therapy (patch and lozenge) and are followed for 24 months. Participant recruitment commenced in December 2022 and is ongoing. Discussion: This study builds on promising results from our recent trial which found that MAPS was associated with substantially higher abstinence from smoking at the end of the 12-month treatment period. Finding that this low-burden, personally tailored digital treatment adjuvant improves the long-term efficacy of MAPS would have important clinical and public health implications. Trial registration: Clinical Trials Registry NCT05645146; https://clinicaltrials.gov/ct2/show/NCT05645146; Registered on December 9, 2022. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic disease that contributes to additional comorbidities including diabetes, kidney disease and several cancers. Change4Campbelltown implemented a 'whole of system' approach to address childhood overweight and obesity. We present methods to track implementation and stakeholder engagement in Change4Campbelltown.Methods: Change4Campbelltown aimed to build capacity among key leaders and the broader community to apply techniques from systems thinking to develop community-led actions that address childhood obesity. Change4Campbelltown comprised development of a stakeholder-informed Causal Loop Diagram (CLD) and locally-tailored action plan, formation of key stakeholder and community working groups to prioritise and implement actions, and continuous monitoring of intervention actions. Implementation data included an action register, stakeholder engagement database and key engagement activities and were collected quarterly by the project management team over 2 years of reporting.Results: Engagement activities increased level of community engagement amongst key leaders, the school-sector and community members. Community-led action increased as engagement increased and this action is mapped directly to the primary point of influence on the CLD. As action spread diversified across the CLD, the geographical spread of action within the community increased.Conclusions: This paper provides a pragmatic example of the methods used to track implementation of complex interventions that are addressing childhood overweight and obesity. [ABSTRACT FROM AUTHOR]

Background: Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program.Methods: We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program.Results: Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials.Conclusions: Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos. [ABSTRACT FROM AUTHOR]

Background: Alcohol is a Class-1 carcinogen but public awareness of the link between alcohol and cancer is low. The news media is a popular, readily-accessible source of health information and plays a key role in shaping public opinion and influencing policy-makers. Examination of how the link between alcohol and cancer is presented in Australian print media could inform public health advocacy efforts to raise awareness of this modifiable cancer risk factor.Method: This study provides a summative qualitative content analysis of 1502 articles that included information about a link between alcohol and cancer, as reported within Australian newspaper media (2005-2013). We use descriptive statistics to examine the prominence of reports, the nature and content of claims regarding the link between alcohol and cancer, and the source of information noted in each article.Results: Articles were distributed throughout newspapers, most appearing within the main (first) section. The link between alcohol and cancer tended not to appear early in articles, and rarely featured in headlines. 95% of articles included a claim that alcohol causes cancer, 5% that alcohol prevented or did not cause cancer, 1% included both. Generally, the amount of alcohol that would cause or prevent cancer was unspecified or open to subjective interpretation. Coverage increased over time, primarily within community/free papers. The claim that alcohol causes cancer often named a specific cancer, did not name a specific alcohol, was infrequently the focus of articles (typically subsumed within an article on general health issues), and cited various health-promoting (including advocacy) organisations as information sources. Articles that included the converse also tended not to focus on that point, often named a specific type of alcohol, and most cited research institutions or generic 'research' as sources. Half of all articles involved repetition of materials, and most confirmed that alcohol caused cancer.Conclusions: Information about a link between alcohol and cancer is available in the Australian newsprint media, but may be hidden within and thus overshadowed by other health-related stories. Strategic collaboration between health promoting organisations, and exploitation of 'churnalism' and journalists' preferences for ready-made 'copy' may facilitate increased presence and accuracy of the alcohol-cancer message. [ABSTRACT FROM AUTHOR]

Background: A large volume of research has been published on both the socio economic and demographic determinants of cancer and on the health of immigrants and minority groups. Yet because of data limitations, little research examines differences in the occurrence of cancer incidence between immigrants and non-immigrants and among immigrants defined by region of birth and time in the host country. In particular it is not known whether a healthy immigrant effect is present for cancer and if so, whether this advantage is lost with additional years of residence in the host country.Methods: This paper uses a large data file from Statistics Canada that links Census information on immigrant status, socioeconomic status including educational attainment, and other person-level information with administrative data on cancer and mortality over a continuous 13 year period of observation. It estimates discrete and continuous time duration models to identify differences in cancer diagnosis by immigrant subgroup after controlling for a variety of potential confounders. Differences in historical smoking behavior are not observable at the individual level in the dataset but are accounted for indirectly using various methods.Results: Results in general confirm the existence of a healthy immigrant effect for cancer in that, overall, recent immigrants to Canada are significantly less likely than otherwise comparable non-immigrant Canadians to be diagnosed with any cancer and the most common forms of cancer by site. As well, this gap appears to decline with additional years in Canada for immigrant men and women, eventually converging to Canadian-born levels. Differentiating among immigrant subgroups by period of arrival and country of birth reveals significant variation across immigrant subgroups, with immigrant men and women from developing countries typically having a lower likelihood of being diagnosed with cancer than immigrants from the US, UK and continental Europe. As well, controlling for immigrant heterogeneity this way weakens the conclusion that the gap narrows with years in Canada. Immigrant men overall continue to exhibit convergence to Canadian-born levels for diagnosis of any cancer and for prostate cancer, while immigrant women exhibit narrowing over time only for breast cancer. Although smoking behavior is not directly observed, controlling for subgroup-specific lifetime smoking behavior using survey data has only a relatively minor effect on the estimated differences.Conclusions: The specificity of the results by cancer type, gender, immigrant status and ethnicity provides useful guidance for future research by helping to narrow the possible channels through which social and economic characteristics may be affecting cancer incidence. [ABSTRACT FROM AUTHOR]

Background: Ample studies have observed an adverse association between individual socioeconomic position (SEP) and lung cancer mortality. Moreover, the presence of a partner has shown to be a crucial determinant of health. Yet, few studies have assessed whether partner's SEP affects health in addition to individual SEP. This paper will study whether own SEP (education), partner's SEP (partner's education) and own and partner's SEP combined (housing conditions), are associated with lung cancer mortality in Belgium.Methods: Data consist of the Belgian 2001 census linked to register data on cause-specific mortality for 2001-2011. The study population includes all married or cohabiting Belgian inhabitants aged 40-84 years. Age-standardized lung cancer mortality rates (direct standardization) and mortality rate ratios (Poisson regression) were computed for the different SEP groups.Results: In men, we observed a clear inverse association between all SEP indicators (own and partner's education, and housing conditions) and lung cancer mortality. Men benefit from having a higher educated partner in terms of lower lung cancer mortality rates. These observations hold for both middle-aged and older men. For women, the picture is less uniform. In middle-aged and older women, housing conditions is inversely associated with lung cancer mortality. As for partner's education, for middle-aged women, the association is rather weak whereas for older women, there is no such association. Whereas the educational level of middle-aged women is inversely associated with lung cancer mortality, in older women this association disappears in the fully adjusted model.Conclusions: Both men and women benefit from being in a relationship with a high-educated partner. It seems that for men, the educational level of their partner is of great importance while for women the housing conditions is more substantial. Both research and policy interventions should allow for the family level as well. [ABSTRACT FROM AUTHOR]

Background Indigenous Australians have poorer outcomes from cancer for a variety of reasons including poorer participation in screening programs, later diagnosis, higher rates of cancer with poor prognosis and poorer uptake and completion of treatment. Cancer prevention and support for people with cancer is part of the core business of the State and Territory Cancer Councils. To support sharing of lessons learned, this paper reports an environmental scan undertaken in 2010 in cancer councils (CCs) nationwide that aimed to support Indigenous cancer control. Methods The methods replicated the approach used in a 2006 environmental scan of Indigenous related activity in CCs. The Chief Executive Officer of each CC nominated individuals for interview. Interviews explored staffing, projects, programs and activities to progress cancer control issues for Indigenous Australians, through phone or face-to-face interviews. Reported initiatives were tabulated using predetermined categories of activity and summaries were returned to interviewees, the Aboriginal and Torres Strait Islander Subcommittee and Chief Executive Officers for verification. Results All CCs participated and modest increases in activity had occurred in most states since 2006 through different means. Indigenous staff numbers were low and no Indigenous person had yet been employed in smaller CCs; no CC had an Indigenous Board member and efforts at capacity building were often directed outside of the organisation. Developing partnerships with Indigenous organisations were ongoing. Acknowledgement and specific mention of Indigenous people in policy was increasing. Momentum increased following the establishment of a national subcommittee which increased the profile of Indigenous issues and provided collegial and practical support for those committed to reducing Indigenous cancer disparities. Government funding of "Closing the Gap" and research in the larger CCs have been other avenues for increasing knowledge and activity in Indigenous cancer control. Conclusions This environmental scan measured progress, allowed sharing of information and provided critical assessment of progress across areas of importance for increasing Indigenous cancer control. Structured examination of policies, institutional support systems, programs and interventions is a useful means of highlighting opportunities for progress with minority groups relevant for many organisations. Progress has occurred with momentum likely to increase in the future and benefit from commitment to long-term monitoring and sharing of achievements. [ABSTRACT FROM AUTHOR]

Background: The repertoire of statistical methods dealing with the descriptive analysis of the burden of a disease has been expanded and implemented in statistical software packages during the last years. The purpose of this paper is to present a web-based tool, REGSTATTOOLS http://regstattools.net intended to provide analysis for the burden of cancer, or other group of disease registry data. Three software applications are included in REGSTATTOOLS: SART (analysis of disease's rates and its time trends), RiskDiff (analysis of percent changes in the rates due to demographic factors and risk of developing or dying from a disease) and WAERS (relative survival analysis). Results: We show a real-data application through the assessment of the burden of tobacco-related cancer incidence in two Spanish regions in the period 1995-2004. Making use of SART we show that lung cancer is the most common cancer among those cancers, with rising trends in incidence among women. We compared 2000- 2004 data with that of 1995-1999 to assess percent changes in the number of cases as well as relative survival using RiskDiff and WAERS, respectively. We show that the net change increase in lung cancer cases among women was mainly attributable to an increased risk of developing lung cancer, whereas in men it is attributable to the increase in population size. Among men, lung cancer relative survival was higher in 2000-2004 than in 1995-1999, whereas it was similar among women when these time periods were compared. Conclusions: Unlike other similar applications, REGSTATTOOLS does not require local software installation and it is simple to use, fast and easy to interpret. It is a set of web-based statistical tools intended for automated calculation of population indicators that any professional in health or social sciences may require. [ABSTRACT FROM AUTHOR]

Background: The Dutch government recently added universal Human Papilloma Virus (HPV) vaccination for 12-year-old girls to the existing national immunization program. The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower (47%) than expected (70%). To inform future HPV information campaigns, this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009. Methods: A random sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate (n = 5,998 mothers and daughters). In addition, a random sample was recruited via an online panel by a marketing research company (n = 650 mothers; n = 350 daughters). Both groups were asked to complete a web-based questionnaire with questions on social demographic characteristics, social-psychological factors and HPV vaccination intention. Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention. Results: Data from 952 mothers (14%) and 642 daughters (10%) were available for the intended analyses. The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers (ΔR² = .01; p = .007), but not significant for daughters (ΔR² = .02; p = .17) after controlling for HPV vaccination uptake and the sample. In addition, social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers (ΔR² = .35; p < .001) and daughters (ΔR² = .34; p < .001). Attitudes, beliefs, subjective norms and habit strength were significantly associated with participants' HPV vaccination intentions. Conclusions: Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters, future communication strategies targeting HPV vaccination uptake should address attitudes, beliefs, subjective norms and habit strength. There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study. [ABSTRACT FROM AUTHOR]

Background: Little is known about adolescents' cancer awareness and help-seeking behaviour in Britain. This study assessed adolescents': awareness of cancer symptoms, common cancers, and the relationship between cancer and age; anticipated delay and perceived barriers to seeking medical advice; and examined variation by age, gender, ethnicity and whether individuals knew someone with cancer. Methods: A survey was conducted using a modified paper version of the Cancer Awareness Measure (CAM). The sample included 478 adolescents (male: n = 250, 52.3%) aged 11-17 years old (mean = 13.8, SD = 1.24) recruited from four British schools between August and October 2011. Results: Adolescents' cancer awareness was low. Half of all adolescents did not know the most common childhood (51%) or teenage (49%) cancers and most (69%) believed cancer was unrelated to age. Awareness of cancer symptoms was significantly higher among older adolescents (aged 13-17 years) (p = 0.003) and those who knew someone with cancer (p<0.001). Three-quarters (74%) of adolescents indicated they would seek help for a symptom they thought might be cancer within 3 days, and half (48%) within 24 hours. The most endorsed barriers to help-seeking were 'worry about what the doctor might find' (72%), being 'too embarrassed' (56%), 'too scared' (54%) and 'not feeling confident to talk about symptoms' (53%). Endorsement of these emotional barriers was significantly higher among females (p ≤ 0.001). Conclusion: There are certain groups of adolescents with poor cancer awareness. Cancer messages need to be targeted and tailored to particular groups to prevent the emergence of health inequalities in adulthood. Interventions to raise adolescents' cancer awareness have the potential for a life-long impact on encouraging early diagnosis and survival. [ABSTRACT FROM AUTHOR]

Background: A family history, reflecting genetic susceptibility as well as shared environmental and behavioral factors, is an important risk factor for common chronic multifactorial diseases such as cardiovascular diseases, type 2 diabetes and many cancers.Discussion: The purpose of the present paper is to discuss the evidence for the use of family history as a tool for primary prevention of common chronic diseases, in particular for tailored interventions aimed at promoting healthy lifestyles. The following questions are addressed: (1) What is the value of family history information as a determinant of personal disease risk?; (2)How can family history information be used to motivate at-risk individuals to adopt and maintain healthy lifestyles in order to prevent disease?; and (3) What additional studies are needed to assess the potential value of family history information as a tool to promote a healthy lifestyle?Summary: In addition to risk assessment, family history information can be used to personalize health messages, which are potentially more effective in promoting healthy lifestyles than standardized health messages. More research is needed on the evidence for the effectiveness of such a tool. [ABSTRACT FROM AUTHOR]

Background: The negative impact of cervical and breast cancers in low and lower-middle income countries are worsening, and, along with other non-communicable diseases, occur disproportionately in these resource-limited economies. Most preventive approaches to these cancers require government funding, but few countries with the most at-risk population can afford government-sponsored universal vaccination, screening, diagnostic and treatment programmes, which, along with socioeconomic issues, contribute to the poor outcomes in these mostly developing countries. An urgent need exists, therefore, to find an effective, affordable, cost-effective, culturally-acceptable and sustainable way of reducing these cancers. This paper advocates a re-thinking in the current preventive campaigns.Main Body: Using evidence provided by recently-published papers, a case is made for enlightenment campaigns to primarily target teenagers (boys and girls) in high schools of developing countries. Inclusions into the schools' academic curricula are the recommended approach, given that both cancers take hold on populations within that age bracket. This approach, if adopted, may be the only accessible, affordable and realistic approach that gives millions of women in low and lower-middle income countries the chance at survival. Empowering them early instils the self-awareness and confidence necessary for young adults to take charge of their own health. The acquired knowledge, in turn, helps them adopt positive attitudes and preventive behaviours that will, ultimately, prolong their lives.Conclusion: The recommended approach offers governments and concerned stakeholders an evidence-based option that allows them to deliver cost-effective and sustainable life-saving interventions, while hoping to get around the bottlenecks that limit the large scale implementation of other effective but capital-intensive strategies. [ABSTRACT FROM AUTHOR]

Background: In Australia, 40% of people diagnosed with cancer will be of working age (25-64 years). A cancer diagnosis may lead to temporary or permanent changes in a person's labour force participation, which has an economic impact on both the individual and the economy. However, little is known about this economic impact of cancer due to lost productivity in Australia. This paper aims to determine the labour force participation characteristics of people with cancer, to estimate the indirect cost due to lost productivity, and to identify any inequality in the distribution of labour force absence in Australia.Methods: This study used national cross-sectional data from the 2015 Survey of Disability, Ageing and Carers, conducted by the Australian Bureau of Statistics (ABS). The ABS weighted each component of the survey to ensure the sample represented the population distribution of Australia. The analysis was limited to people aged 25-64 years. Participants were assigned to one of three health condition groups: 'no health condition', 'cancer', and 'any other long-term health condition'. A series of logistic regression models were constructed to determine the association between health condition and labour force participation.Results: A total of 34,393 participants surveyed were aged 25-64 years, representing approximately 12,387,800 Australians. Almost half (46%) of people with cancer were not in the labour force, resulting in a reduction of $1.7 billion to the Australian gross domestic product (GDP). Amongst those in the labour force, people with no health condition were 3.00 times more likely to be employed full-time compared to people with cancer (95% CI 1.96-4.57), after adjusting for age, sex, educational attainment and rurality. Amongst those with cancer, people without a tertiary qualification were 3.73 times more likely to be out of the labour force (95% CI 1.97-7.07).Conclusions: This paper is the first in Australia to estimate the national labour force participation rates of people with cancer. People with cancer were less likely to be in the labour force, resulting in a reduction in Australia's GDP. Cancer survivors, especially those without a tertiary qualification may benefit from support to return to work after a diagnosis. [ABSTRACT FROM AUTHOR]

Background: When studying the influence of socioeconomic position (SEP) on health from data where individual-level SEP measures may be missing, ecological measures of SEP may prove helpful. In this paper, we illustrate the best use of ecological-level measures of SEP to deal with incomplete individual level data. To do this we have taken the example of a study examining the relationship between SEP and breast cancer (BC) stage at diagnosis.Methods: Using population based-registry data, all women over 18 years newly diagnosed with a primary BC in 2007 were included. We compared the association between advanced stage at diagnosis and individual SEP containing missing data with an ecological level SEP measure without missing data. We used three modelling strategies, 1/ based on patients with complete data for individual-SEP (n = 1218), or 2/ on all patients (n = 1644) using an ecological-level SEP as proxy for individual SEP and 3/ individual-SEP after imputation of missing data using an ecological-level SEP.Results: The results obtained from these models demonstrate that selection bias was introduced in the sample where only patients with complete individual SEP were included. This bias is redressed by using ecological-level SEP to impute missing data for individual SEP on all patients. Such a strategy helps to avoid an ecological bias due to the use of aggregated data to infer to individual level.Conclusion: When individual data are incomplete, we demonstrate the usefulness of an ecological index to assess and redress potential selection bias by using it to impute missing individual SEP. [ABSTRACT FROM AUTHOR]