Measurement of lifetime exposure to passive smoke

This study describes the passive smoking histories of 380 never smokers who participated in a study on the respiratory health effects of tobacco smoke exposure conducted at a cancer screening clinic in Buffalo, New York, in 1986. Subjects were asked to report on their exposure to tobacco smoke during childhood years at home, as an adult at home, and as an adult at work. A total of 73 and 67% of subjects reported at least one year of continuous exposure to tobacco smoke at home as a child and as an adult, respectively. A total of 87% of subjects reported exposure to tobacco smoke at work. Subjects under age 40 years were more likely to report exposure to tobacco smoke at home as a child than were subjects aged 40 and older. Males and females differed in their reported exposure to tobacco smoke at home during adult years, with females reporting nearly twice as much exposure. Adult exposure at home also varied with age, with female subjects over age 55 years more likely to report having lived with other smokers. Age-adjusted correlations between childhood, adult home, and workplace exposure measures revealed little association between reports of exposure during different life stages. This study also evaluated concordance between subjects' exposure reports and those of surrogates who were asked to report on the subject's exposure at home, at work, and during childhood. Results showed good agreement between subjects and surrogates on most exposure measures. The results of this study underscore the need to obtain a complete exposure history from subjects when attempting to represent lifelong passive smoke exposure.

Cancer surveillance in a northeastern native American population

This study compares cancer incidence among the Seneca Nation of Indians (SNI) between 1955 and 1984 with cancer incidence patterns exhibited by the general population of New York State (NYS), exclusive of New York City. The cohort for this study consisted of all members of the SNI enrolled on January 1, 1955 and residing in NYS (N = 3262). Cancer incidence among the SNI is compared with cancer incidence patterns in NYS using age and sex standardized incidence ratios (SIR). Decreased cancer incidence was observed for all sites combined with SNI males exhibiting 64% of expected incidence and females exhibiting 53% of expected incidence. Although incidence deficits were observed for several sites, cancer incidence was not significantly elevated for any cancer site. Results from this investigation will contribute to the understanding of patterns of malignant disease among native peoples and aid in directing cancer control programs and services available to native groups.

Incidence of nosocomial aspergillosis in patients with leukemia over a twenty-year period

The incidence of invasive nosocomial aspergillosis was studied in leukemia patients at an oncology center from 1964 to 1983. A total of 97 cases of aspergillosis occurred in 1,866 patients, yielding an overall case rate of 5.2 cases per 100 patients and an incidence rate of 9.1 per 10,000 patient days. The highest incidence rate was in patients with chronic myelogenous leukemia (13.7 cases per 10,000 patient days), followed by patients with acute myelogeneous leukemia (10.6 cases per 10,000 patient days). Subdividing patients after 1978 into those receiving bone marrow transplantation and those who did not demonstrated the predisposition of transplant recipients to aspergillosis. The rates of aspergillosis among those patients who did not receive a bone marrow transplant were highest for patients with acute myelogeneous leukemia. Increases in the annual rates of aspergillosis over time coincided with the level of internal renovation activity and major construction projects upwind of patient care facilities.

Mortality in a northeastern Native American cohort, 1955-1984

Patterns of mortality among members of the Seneca Nation of Indians between January 1, 1955, and December 31, 1984, were investigated. The study cohort consisted of all members of the Seneca Nation residing in New York State who were listed in the tribal rolls as of January 1, 1955 (n = 3,262). Deaths among cohort members were identified through a computer match against New York State vital records files. Sex-specific standardized mortality ratios (SMRs) were calculated on the basis of mortality patterns exhibited by the general population of New York State, exclusive of New York City. Seneca Nation males demonstrated an excess of deaths from all causes (SMR = 124), while all-cause mortality among Seneca Nation females did not differ from that expected (SMR = 106). Both males and females exhibited excess mortality from infectious diseases, diabetes mellitus, cirrhosis of the liver, and accidents and injuries. Excess mortality was also noted among males for deaths due to atherosclerosis and hernia/intestinal obstruction and among females for deaths due to pneumonia, chronic nephritis, and homicide. Both sexes exhibited a deficit of deaths due to malignant neoplasms and circulatory diseases. Findings from this study will be useful to those responsible for the planning and implementation of health care programs among the Seneca Nation of Indians and other Native American groups.

Years of potential life lost among a Native American population

The determination of years of potential life lost (YPLL) can aid in monitoring changes in premature mortality among various population groups. While premature mortality has been shown to differ among blacks and whites, patterns of YPLL have not been well established among other racial groups. The Seneca Nation of Indians (SNI) is a Native American group residing primarily in western New York State (NYS). A review of SNI necrology records revealed that 55 percent (510 of 924) of the deaths between 1955 and 1984 occurred before 65 years of age. The proportion of premature deaths among males exceeded the proportion in females. SNI males demonstrated an increased risk of premature death (odds ratio = 1.43) relative to SNI females. Both the percentage of premature deaths and the number of YPLL per death were greater among SNI members compared with NYS residents. Almost one-half of all YPLL among the SNI were attributable to accidents and injuries. Heart disease, digestive diseases, and malignant neoplasms also represented important contributors to YPLL for both SNI males and females. This investigation identifies important causes of premature death among a Native American population and underscores the preventable nature of premature loss of life.

Adoption of smoking policies by automobile dealerships

Despite an increase in policies regulating smoking at the workplace, little research has been conducted on organizational factors that may be associated with the adoption of those policies. In November 1986, a survey assessing tobacco use habits was sent to 3,432 employees of 68 auto dealerships in western New York. Managers at the worksites were surveyed by telephone in 1986 and 1 year later to assess their attitudes about smoking by employees and changes in smoking policy implementation. At the time of the initial survey, 21 percent (N = 14) of businesses had smoking restrictions. Among the 54 worksites with no smoking restrictions, 14 (26 percent) adopted smoking policies within a year. The strongest predictor of policy adoption was an interaction between the presence of floating smoking restrictions (not tied to a specific area) and the manager's willingness to impose smoking restrictions on employees. Adoption of policies was also more likely to occur among worksites with younger employees. That adoption of smoking policies was more likely to occur among worksites with floating smoking policies underscores the idea that focusing efforts at the managerial level within an organization can accelerate the diffusion process. In addition, the presence of unions and employee concerns about smoking policies are likely to impact upon management's decisions regarding implementation of policies. Given the potential of smoking prohibitions to influence the smoking habits of employees, future studies should begin to focus on ways to facilitate the adoption of smoking policies in worksites.

Correlates of adolescents' use of smokeless tobacco

Data are presented on the prevalence and correlates of smokeless tobacco use among a group of 568 adolescents from five public schools located in western New York State. Two of the five schools were located in rural communities, two were located in suburbs of Buffalo, and one school was located in the city of Buffalo. Nineteen percent of males reported current use of smokeless tobacco. There was very little regular use among girls, although 18% reported having tried it. Sharp regional differences in the use of smokeless tobacco were observed with the highest percentage of users among students from rural communities. Experimentation with cigarette smoking was associated with use of smokeless tobacco, however, few regular users of smokeless tobacco were current smokers. As is the case with cigarette smoking, social influences, especially those of peers and family members, were important factors associated with use of smokeless tobacco. Study findings suggest that programs that attempt to prepare students to cope with social pressures for using and stress the immediate negative consequences of use (i.e., stained teeth, bad breath) are more likely to be successful in discouraging adolescents from using smokeless tobacco than programs that only educate about the detrimental health effects of chewing and/or dipping tobacco.

Correlates of participation in a worksite stop-smoking contest

Smokers employed at Roswell Park Memorial Institute, a cancer hospital and research center located in Buffalo, New York, were offered the opportunity to participate in a quit-smoking contest in which cash prizes were awarded for stopping smoking. Information on the smoking habits and attitudes of employees collected in a survey 3 months before the contest was used to predict the characteristics of smokers associated with contest participation. The same variables were also used to predict cessation among contest participants 3 months after the start of the contest. Overall, 14% of smokers enrolled in the contest, with one-third still abstinent 3 months later. Contest participation was associated with the smoker's reported desire to stop smoking and the number of symptoms related to smoking. Smoking cessation was related to the strength of the smoking habit, the confidence in the ability to quit, and the smoking status and relationship of the respondent's partner in the contest.

Format and quitting instructions as factors influencing the impact of a self-administered quit smoking program

This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by-day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self-help booklets were developed for comparison in this study. Each varied on a combination of the two study factors, but were similar in content, length, style, and readability. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigarette smokers who called a stop smoking hotline in Buffalo, New York seeking information on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects reported of being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self-management skills were no more effective than the control booklet (6 month non-smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting.

Nosocomial infection rates at an oncology center

Nosocomial infection rates were computed for 5,031 patients at an oncology center during a 20-month period. Twelve percent of the patients developed nosocomial infections, accounting for a total of 802 infections. The overall incidence of nosocomial infections during this study period was 6.27 infections per 1,000 patient days. The highest incidence of nosocomial infections was found in patients having acute myelogenous leukemia (30.49 infections per 1,000 patient days); bone and joint cancer (27.27 infections per 1,000 patient days); and liver cancer (26.58 infections per 1,000 patient days). The respiratory tract was the most common site of infection, followed by bloodstream, surgical wound, and urinary tract infections. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and coagulase-negative staphylococci were most frequently implicated as pathogens. The distribution of specific types of infection according to underlying malignancy was also tabulated. These data provide nosocomial infection rates, common pathogens, and sites of infection for cancer patients, thus assisting in directing appropriate therapy for these patients.

Impact of a newspaper mediated quit smoking program

We present the results of a survey conducted to evaluate the impact of a newspaper mediated smoking cessation program conducted in Buffalo, New York in January 1987. Over half of all smokers surveyed reported exposure to the newspaper series; 13 per cent reported that the series prompted them to try to quit smoking, and 4 per cent stopped smoking for at least one week. We estimate that over 9,600 smokers in Erie County, New York stopped smoking for at least one week as a result of the newspaper's smoking cessation program.

Physician advice to quit smoking: who gets it and who doesn't

This is a study of physicians' stop-smoking advice to patients in a university-affiliated family medicine outpatient center. The study population consisted of 311 cigarette-smoking patients of 28 family-practice residents. Patients were monitored for three months to assess changes in their smoking habits and to measure the effects of advice from their physicians. Reports of advice were correlated with both patient and physician characteristics. Forty-one percent of the patients said they had been told by their physician to stop smoking during the three-month follow-up period. Heavy smokers (more than 26 cigarettes a day) (p = .02) and those being treated for tobacco-related conditions (p = .06) were most likely to report that their physician had advised them to quit smoking. Patients seen by a physician who was a cigarette smoker were less likely to report stop-smoking advice than patients seen by a nonsmoking physician (26 percent versus 44 percent, p = .02). Selectivity in the types of patients advised to quit smoking appears to reflect the physicians' personal judgments about the patients' likelihood of following their advice.

Vitamin A and tumor recurrence in bladder cancer

Results are presented from an investigation concerning the effects of vitamin A on tumor recurrence in a group of 102 patients having early-stage bladder cancer. An odd's ratio of 1.34 was found for tumor recurrence between high and low consumers of vitamin A (p greater than 0.05). Moreover, the rate of tumor recurrence per 1,000 person-months at risk was found to be 1.8 times higher among low, relative to high, consumers of vitamin A (p less than 0.05). While these results are encouraging, larger data sets need to be assembled and analyzed before any definitive conclusions can be reached.

Cigarette advertising and black-white differences in brand preference

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers. Future research focusing on understanding the reasons for cigarette brand preferences may provide ideas for anti smoking campaigns aimed at specific target groups.

Weight gain following smoking cessation: a possible role for nicotine replacement in weight management

This study examined nicotine dependence as a factor in weight gain following smoking cessation in a group of 104 recent ex-smokers. Nicotine dependence was measured using the eight-item Fagerstrom Tolerance Questionnaire. Findings support the hypothesis that weight gain following smoking cessation is greater among more nicotine dependent persons. Heavier smokers (greater than or equal to 26 cigs/day), those who reported smoking when they are ill, and those who reported smoking their first cigarette of the day within 30 minutes of waking up reported the greatest increases in weight one month after quitting. Twenty subjects reported using nicotine gum to help them quit smoking. A significant inverse correlation (r = -.17) was found between weight gain and the number of pieces of nicotine gum chewed per day. Stratification by the number of cigarettes smoked daily (greater than or equal to 26 cigs/versus less than 26 cigs/day) indicated that the correlation between weight gain and the number of pieces of nicotine gum chewed per day was significant only for heavy smokers (r = -.37 versus r = -.08). This finding suggests that nicotine replacement may help prevent weight gain following smoking cessation, especially for the more dependent smokers.

Cigarette smoking in women with cancers of the breast and reproductive organs

This case-control study addressed the relationship between cigarette smoking and cancers of the breast (1,741 cases), endometrium (476 cases), uterine cervix (1,174 cases), and ovary (296 cases). The lifetime smoking history of cases was compared with that of 2,128 controls, and relative risks (odds ratios) for smoking were estimated using multiple logistic regression to adjust for potential confounding by age, marital status, number of pregnancies, and Quetelet's index. With increasing amount smoked there was a statistically significant decrease in endometrial cancer risk and a statistically significant increase in cervical cancer risk. In the highest smoking category (greater than or equal to 15 pack-yr), the endometrial cancer relative risk was 0.57 [95% confidence interval (CI) of 0.37, 0.86] and the cervical cancer relative risk was 1.81 (95% CI of 1.47, 2.22). There was no apparent relationship between smoking and cancers of the breast or ovary.

Compliance of pediatric and adolescent cancer patients

Compliance with self-administered therapy in pediatric and adolescent patients is not always complete. Noncompliance may result in erroneous conclusions about the efficacy of a given therapy and lead to unnecessary tests and alteration of treatment regimens. To examine the causes of noncompliance, 46 cancer patients aged 2.5 to 23 years (mean age, 6.85 years) and 40 parents were extensively interviewed at 2 weeks, 20 weeks, and 50 weeks post-diagnosis. The results of self-reported compliance were corroborated by serum bioassay of the prescribed medications. A significant correlation between the age of patient and compliance with chemotherapeutic agents and nonchemotherapeutic medications was found (P less than 0.05 and P less than 0.02, respectively), with adolescent patients being compliant less often. Over the course of therapy, compliance among patients decreased, but not significantly. A significant negative correlation was found between compliance and the number of children in the family. Compliers and noncompliers did differ significantly in how well they understood instructions concerning how to take their medication (P = 0.04). No significant correlations between compliance and stage of the disease, number or type of drugs used, complexity of the regimen, degree of satisfaction with information given to the patient, understanding of disease, treatment, or belief in medication efficacy were found. The main reasons given for noncompliance were forgetfulness, busy schedules, and nonavailability of medication. More compliers than noncompliers were in agreement with their parents regarding who was responsible for the administration of the medication. Compliance is a complex and multifaceted issue which interrelates with a large number of medical and social factors.

The current status of early detection and screening for colorectal cancer

There are several approaches to the early detection of colorectal cancer that currently are in use in various segments of the health care system. Herein, the status of cancer control research regarding symptom and risk factor assessment, sigmoidoscopy and colonoscopy, double contrast barium enema, and fecal occult blood testing is reviewed. In addition to the different technologies of early cancer detection, there are different models of disease control intervention. These include the routine clinical activities of primary care providers as well as programmatic screening of mass populations. The currently available techniques for early colorectal cancer detection appear better suited for existing patient care settings than for programs outside the direct supervision and follow-up of the health professional.

An outbreak of invasive aspergillosis among allogeneic bone marrow transplants: a case-control study

Between April 1982 and March 1983, 10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related to Aspergillus infection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor of Aspergillus infection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when transplanting certain patients.

An appointment reminder system's effect on reducing the number of hypertension patients who drop out from care

We evaluated the effects of an appointment reminder system on the appointment-keeping behavior and blood pressure control status of hypertensive patients receiving care in an urban medical clinic. The study population consisted of 973 adult hypertensive patients receiving medical care at a family practice clinic affiliated with the Wayne State University School of Medicine, Detroit, Michigan. Of the 973 patients enrolled in the study, 486 were randomly assigned to a group that received appointment reminder cards and telephone calls to reschedule missed appointments, and 487 were assigned to a nonintervention control group. Patients were followed-up with regard to their appointment-keeping behavior and blood pressure control status, five to eight months after being entered in the study. The study results indicate that patients in the appointment reminder group kept significantly more appointments and were less likely to drop out of treatment than patients in the control group. The dropout rate was 46 percent lower among patients in the appointment reminder group than in the control group. Patients in the appointment reminder group also demonstrated slightly better blood pressure control at the end of the study compared with patients in the control group, although none of the differences in blood pressure levels between groups were statistically significant at the 5 percent level.

Comparison of three methods of teaching women how to perform breast self-examination

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.