Background There are an estimated 460,000 Armenians in the United States, and more than half live in California. Armenian-Americans are generally represented within the ‘White’ or ‘Some Other Race’ race categories in population-based research studies. While Armenians have been included in studies focused on Middle-Eastern populations, there are no studies focused exclusively on Armenians due to a lack of standardized collection of Armenian ethnicity in the United States or an Armenian surname list. To fill this research gap, we sought to construct and evaluate an Armenian Surname List (ASL) for use as an identification tool in public health and epidemiological research studies focused on Armenian populations. Methods Data sources for the ASL included the California Public Use Death Files (CPUDF) and the Middle Eastern Surname List (MESL). For evaluation of the ASL, the California Cancer Registry (CCR) database was queried for surnames with birthplace in Armenia and identified by the MESL. Results There are a total of 3,428 surnames in the ASL. Nearly half (1,678) of surnames in the ASL were not identified by the MESL. The ASL captured 310 additional Armenian surnames in the CCR than the MESL. Conclusions The ASL is the first surname list for identifying Armenians in major databases for epidemiological research.

ImportanceCalifornia’s tobacco control efforts have been associated with a decrease in cancer mortality, but these estimates are based on smoking prevalence of the general population. Patient-level tobacco use information allows for more precise estimates of the proportion of cancer deaths attributable to smoking.ObjectiveTo calculate the proportion (smoking-attributable fraction) and number (smoking-attributable cancer mortality) of cancer deaths attributable to tobacco use using patient-level data.Design, Setting, and ParticipantsThe smoking-attributable fraction and smoking-attributable cancer mortality were calculated for a retrospective cohort of patients whose cancer was diagnosed from 2014 to 2019 with at least 1 year of follow-up using relative risks from large US prospective studies and patient-level smoking information. Follow-up continued through April 2022. A population-based cohort was identified from the California Cancer Registry. Participants included adults aged 20 years and older with a diagnosis of 1 of the 12 tobacco-related cancers (oral cavity or pharynx, larynx, esophagus, lung, liver, stomach, pancreas, kidney, bladder, colon or rectum, cervix, and acute myeloid leukemia).ExposuresTobacco use defined as current, former, or never.Main Outcomes and MeasuresThe primary outcomes were the smoking-attributable fraction and smoking-attributable cancer mortality for each of the 12 tobacco-related cancers over 2 time periods (2014-2016 vs 2017-2019) and by sex.ResultsAmong 395 459 patients with a tobacco-related cancer, most (285 768 patients [72.3%]) were older than 60 years, the majority (228 054 patients [57.7%]) were non-Hispanic White, 229 188 patients were men (58.0%), and nearly one-half (184 415 patients [46.6%]) had lung or colorectal cancers. Nearly one-half of the deaths (93 764 patients [45.8%]) in the cohort were attributable to tobacco. More than one-half (227 660 patients [57.6%]) of patients had ever used tobacco, and 69 103 patients (17.5%) were current tobacco users, which was higher than the proportion in the general population (11.7%). The overall smoking-attributable fraction of cancer deaths decreased significantly from 47.7% (95% CI, 47.3%-48.0%) in 2014 to 2016 to 44.8% (95% CI, 44.5%-45.1%) in 2017 to 2019, and this decrease was seen for both men and women. The overall smoking-attributable cancer mortality decreased by 10.2%.Conclusions and RelevanceCalifornia still has a substantial burden of tobacco use and associated cancer. The proportion of cancer deaths associated with tobacco use was almost double what was previously estimated. There was a modest but significant decline in this proportion for overall tobacco-associated cancers, especially for women.

Background: While previous studies show the long-term and transgenerational effects of war on mental health, immediate effects on mental health are relatively understudied. The 44-day 2020 Artsakh War (September 27-November 10, 2020) resulted in an estimated 5,000 Armenian casualties, displacement of half the Artsakh population, and ongoing captivity of Armenian prisoners of war. This is the first study post-war to quantify depression, anxiety, and post-traumatic stress disorder (PTSD) levels among the Armenian population. Methods: We conducted a cross-sectional study from February 3-May 31, 2021. Using Google Forms, we implemented a 75-item survey, including depression (PHQ-9), anxiety (GAD-7), and PTSD (PCL-5) questionnaires. We used six binary (yes/no) questions to define direct-exposure (DE) and no direct exposure (NDE) groups. We used independent samples t-tests to compare mean scores between groups. Results: There were 825 participants from 32 countries, 48% from the United States and 33% from Armenia and Artsakh. All participants from Artsakh (100%), 89.2% from Armenia, and 46.6% from the United States were directly exposed to the war. The DE (n=529) group exhibited significantly higher PHQ-9 (p=0.0001), GAD-7 (p=<0.0001), and PCL-5 (p=0.0001) mean scores, than the NDE (n=296) group. Those who sustained a physical injury (n=20) had the highest average clinically relevant PTSD score (mean=39.5, SD=24). Conclusion: Our results suggest an association between direct exposure to war in Artsakh and increased depression, anxiety, and PTSD severity, suggesting an immediate need for mental health resources. Those who lost a loved one, had a loved one get injured, and had a loved one participate in the 2020 Artsakh War had higher PHQ-9, GAD-7, and PCL-5 mean scores relative to those who did not. Implications of this study include the development of targeted evidence-based psychotherapeutic methods based on specific direct exposure factors.