Formative evaluation of a practice-based smoking cessation program for diverse populations

BACKGROUND

Smoking rates are higher among those living at or below poverty and among persons with lower levels of education. We report on a formative research project examining patient perceptions of tobacco cessation strategies among diverse, low socioeconomic, urban smokers cared for in community-based primary care medical offices.

METHOD

We conducted 10 focus groups among low socioeconomic status participants recruited from urban primary care medical offices in Buffalo and Niagara Falls, New York. Participants included current or former smokers, who were stratified by age-group (18-39 years and 40+ years). The focus groups discussed perceptions of tobacco cessation strategies, previous quit attempts, and use/attitudes regarding technology and social media as potential platforms for cessation support.

RESULTS

Participants (n = 96) included predominantly African Americans (n = 62, 65%) and European Americans (n = 16, 16%); 56% were older than 40 years and 92% were low income. Most participants were supportive of cessation message delivery via phone; however, the age-groups varied in their attitudes on quitting smoking, desired frequency of phone contacts, and social media usage. Participants aged 18 to 39 years reported more Internet use, greater use of text messaging, and were more open to health information via social media.

CONCLUSIONS

Based on significant variation between younger and older smokers' perceptions of tobacco addiction and use of communication technologies, it appears reasonable to stratify the content and platform of health messaging by the target age-group.

Automated tobacco assessment and cessation support for cancer patients

BACKGROUND

Tobacco assessment and cessation support are not routinely included in cancer care. An automated tobacco assessment and cessation program was developed to increase the delivery of tobacco cessation support for cancer patients.

METHODS

A structured tobacco assessment was incorporated into the electronic health record at Roswell Park Cancer Institute to identify tobacco use in cancer patients at diagnosis and during follow-up. All patients who reported tobacco use within the past 30 days were automatically referred to a dedicated cessation program that provided cessation counseling. Data were analyzed for referral accuracy and interest in cessation support.

RESULTS

Between October 2010 and December 2012, 11,868 patients were screened for tobacco use, and 2765 were identified as tobacco users and were referred to the cessation service. In referred patients, 1381 of those patients received only a mailed invitation to contact the cessation service, and 1384 received a mailing as well as telephone contact attempts from the cessation service. In the 1126 (81.4%) patients contacted by telephone, 51 (4.5%) reported no tobacco use within the past 30 days, 35 (3.1%) were medically unable to participate, and 30 (2.7%) declined participation. Of the 1381 patients who received only a mailed invitation, 16 (1.2%) contacted the cessation program for assistance. Three questions at initial consult and follow-up generated over 98% of referrals. Tobacco assessment frequency every 4 weeks delayed referral in < 1% of patients.

CONCLUSIONS

An automated electronic health record-based tobacco assessment and cessation referral program can identify substantial numbers of smokers who are receptive to enrollment in a cessation support service.

Nicotine replacement therapy distribution to light daily smokers calling a quitline

BACKGROUND

With an increasing prevalence of lighter smokers presenting for cessation assistance, outcome-based recommendations are needed to inform nicotine replacement therapy (NRT) distribution protocols by quitlines.

METHODS

A quasi-experimental design was utilized to compare quit rates based on samples selected from the time period before and after NRT (gum or lozenge) was offered to light daily smokers (1-9 cigarettes) contacting the New York State Smokers' Quitline. Outcome measures included self-reported 7- and 30-day abstinence rates, numbers of daily cigarettes among continuing smokers, and cost per quit analyses.

RESULTS

Among responders to the follow-up survey, quit rates were higher for those given NRT compared with those not offered NRT at both 7 (33.0% vs. 27.2%; Relative Risk [RR] = 2.25 [95% CI: 1.15, 4.40; p < .05]) and 30 days (28.0% vs. 21.9%; RR = 2.63 [95% CI: 1.25, 5.54; p < .05]). Similar results were obtained based on intent-to-treat analyses for both 7 (13.4% vs. 11.3%; RR = 1.92 [95% CI: 1.08, 3.39; p < .05]) and 30 days (11.4% vs. 9.1%; RR = 2.29 [95% CI: 1.20, 4.40; p < .05]). Among continuing smokers, the mean number of cigarettes smoked per day increased from enrollment to follow-up in both groups, but less so in those receiving NRT. The additional cost associated with providing a 2-week free supply of nicotine replacement to smokers was $52 for gum and $74 for lozenge.

CONCLUSIONS

This study demonstrates that light daily smokers (1-9 cigarettes) who contact a telephone quitline are interested in using NRT if offered and are able to achieve higher quit rates compared with those not offered NRT.

Profiling oxidative DNA damage: effects of antioxidants

The goal of this research was to determine whether antioxidant usage could be correlated with changes in DNA damage levels. Liquid Chromatography-tandem Mass Spectrometry (LC-MS/MS) was used to simultaneously measure five different oxidatively-induced base modifications in the DNA of WBC. Measurements of the five modifications were made before and after an 8-week trial during which participants took the SU.VI.MAX supplement. Levels of the five DNA modifications were compared among different groupings: users versus non-users of antioxidant supplements, before versus after the supplement intervention and men versus women. The statistical significance of differences between groups was most significant for pyrimidine base modifications and the observed trends reflect trends reported in epidemiological studies of antioxidant usage. A combination of modifications derived from pyrimidine bases is suggested as a superior indicator of oxidative stress.

Impact of varenicline on cue-specific craving assessed in the natural environment among treatment-seeking smokers

RATIONALE

Varenicline is believed to work, in part, by reducing craving responses to smoking cues and by reducing general levels of craving; however, these hypotheses have never been evaluated with craving assessed in the natural environments of treatment-seeking smokers.

OBJECTIVES

Ecological momentary assessment procedures were used to assess the impact of varenicline on cue-specific and general craving in treatment-seeking smokers prior to quitting.

METHODS

For 5 weeks prior to quitting, 60 smokers carried personal digital assistants that assessed their response to smoking or neutral cues. During week 1 (baseline), participants did not receive medication; during weeks 2-4 (drug manipulation), participants were randomized to receive varenicline or placebo; during week 5 (standard therapy), all participants received varenicline. Craving was assessed before each cue; cue-specific craving and attention to cue were assessed after each cue.

RESULTS

During all phases, smoking cues elicited greater craving than neutral cues; the magnitude of this effect declined after the first week. General craving declined across each phase of the study. Relative to the placebo condition, varenicline was associated with a greater decline in general craving over the drug manipulation phase. Varenicline did not significantly attenuate cue-specific craving during any phase of the study.

CONCLUSIONS

Smoking cues delivered in the natural environment elicited strong craving responses in treatment-seeking smokers, but cue-specific craving was not affected by varenicline administered prior to the quit attempt. These findings suggest that the clinical efficacy of varenicline is not mediated by changes in cue-specific craving during the pre-quit period of treatment-seeking smokers.

The effects of extended pre-quit varenicline treatment on smoking behavior and short-term abstinence: a randomized clinical trial

Preclinical research and learning theory suggest that a longer duration of varenicline treatment prior to the target quit date (TQD) would reduce smoking rates before cessation and improve abstinence outcomes. A double-blind randomized controlled trial tested this hypothesis in 60 smokers randomized to either an Extended run-in group (4 weeks of pre-TQD varenicline) or a Standard run-in group (3 weeks of placebo, 1 week of pre-TQD varenicline); all the participants received 11 weeks of post-TQD varenicline and brief counseling. During the pre-quit run-in, the reduction in smoking rates was greater in the Extended run-in group than in the Standard run-in group (42% vs. 24%, P < 0.01), and this effect was greater in women than in men (57% vs. 26%, P = 0.001). The rate of continuous abstinence during the final 4 weeks of treatment was higher among women in the Extended group compared to women in the Standard run-in group (67% vs. 35%). Although these data suggest that extension of varenicline treatment reduces smoking during the pre-quit period and may further enhance cessation rates, confirmatory evidence is needed from phase III clinical trials.

Evaluation of an intervention to enhance the delivery of smoking cessation services to patients with cancer

We describe a brief staff training program to improve the delivery of tobacco cessation services to patients with head and neck cancers. This study utilized a quasi-experimental design to compare the delivery of smoking cessation components and outcomes among patients exposed to either usual care (UC) or an enhanced cessation (EC) program implemented following a 1-h staff education program. Of the 179 subjects enrolled, 112 were recontacted by phone 1 month after their clinic visit. More patients in EC compared to UC reported that they were asked about their smoking status (94.2% vs. 76.6%, p = 0.01), advised to quit (92.3% vs. 72.3%, p = 0.01), prescribed cessation medications (30.8% vs. 3.3%, p < 0.001), and received a support call (53.8% vs. 11.7%, p < 0.001) at the 1-month follow-up. Quit attempts and quit rates between groups were similar. The EC intervention improved the delivery of cessation services in a busy clinical setting, but this failed to increase cessation rates after 1 month.

Approaches to breast cancer screening among primary care physicians in rural areas of crete, Greece

The aim of this study was to assess levels of knowledge regarding breast cancer screening among primary care physicians in rural areas of Crete. A cross-sectional survey of 106 general practitioners and internists and 83 trainee general practitioners (GPs) employed as of October 2004 and practicing at 14 primary health centers in Crete was performed. It was a self-administered survey with 27 items exploring knowledge, attitudes, and behaviors concerning delivery of general preventive and cancer screening services. The main outcome measures were responses to four items on approaches to breast cancer screening practices. Overall response rate was 55% (primary care physicians (PCPs) = 53%; trainee GPs = 60%). Respondents demonstrated a limited awareness of international recommendations for breast cancer screening and exhibited marked variation in their responses to survey items. Agreement with current international guidelines ranged from 31% to 58% for the individual survey items. This survey revealed limited knowledge among PCPs to well-publicized breast cancer screening guidelines and variations in approaches to breast cancer early detection.

Reduction in oxidatively generated DNA damage following smoking cessation

Background

Cigarette smoking is a known cause of cancer, and cancer may be in part due to effects of oxidative stress. However, whether smoking cessation reverses oxidatively induced DNA damage unclear. The current study sought to examine the extent to which three DNA lesions showed significant reductions after participants quit smoking.

Methods

Participants (n = 19) in this study were recruited from an ongoing 16-week smoking cessation clinical trial and provided blood samples from which leukocyte DNA was extracted and assessed for 3 DNA lesions (thymine glycol modification [d(T^gpA)]; formamide breakdown of pyrimidine bases [d(T^gpA)]; 8-oxo-7,8-dihydroguanine [d(G^h)]) via liquid chromatography tandem mass spectrometry (LC-MS/MS). Change in lesions over time was assessed using generalized estimating equations, controlling for gender, age, and treatment condition.

Results

Overall time effects for the d(T^gpA) (χ²(3) = 8.068, p < 0.045), d(P^fpA) (χ²(3) = 8.477, p < 0.037), and d(G^h) (χ²(3) = 37.599, p < 0.001) lesions were seen, indicating levels of each decreased significantly after CO-confirmed smoking cessation. The d(T^gpA) and d(P^fpA) lesions show relatively greater rebound at Week 16 compared to the d(G^h) lesion (88% of baseline for d(T^gpA), 64% of baseline for d(P^fpA), vs 46% of baseline for d(G^h)).

Conclusions

Overall, results from this analysis suggest that cigarette smoking contributes to oxidatively induced DNA damage, and that smoking cessation appears to reduce levels of specific damage markers between 30-50 percent in the short term. Future research may shed light on the broader array of oxidative damage influenced by smoking and over longer durations of abstinence, to provide further insights into mechanisms underlying carcinogenesis.

US smokers' reactions to a brief trial of oral nicotine products

BACKGROUND

It has been suggested that cigarette smokers will switch to alternative oral nicotine delivery products to reduce their health risks if informed of the relative risk difference. However, it is important to assess how smokers are likely to use cigarette alternatives before making predictions about their potential to promote individual or population harm reduction.

OBJECTIVES

This study examines smokers' interest in using a smokeless tobacco or a nicotine replacement product as a substitute for their cigarettes.

METHODS

The study included 67 adult cigarette smokers, not currently interested in quitting, who were given an opportunity to sample four alternative oral nicotine products: 1) Camel Snus, 2) Marlboro Snus, 3) Stonewall dissolvable tobacco tablets, and 4) Commit nicotine lozenges. At visit 1, subjects were presented information about the relative benefits/risks of oral nicotine delivery compared to cigarettes. At visit 2, subjects were given a supply of each of the four products to sample at home for a week. At visit 3, subjects received a one-week supply of their preferred product to see if using such products reduced or eliminated cigarette use.

RESULTS

After multiple product sampling, participants preferred the Commit lozenges over the three smokeless tobacco products (p = 0.011). Following the one week single-product trial experience, GEE models controlling for gender, age, level of education, baseline cigarettes use, and alternative product chosen, indicated a significant decline in cigarettes smoked per day across one week of single-product sampling (p < 0.01, from 11.8 to 8.7 cigarettes per day), but no change in alternative product use (approximately 4.5 units per day). Biomarkers of exposure showed no change in cotinine, but a 19% reduction in exhaled CO (p < 0.001).

CONCLUSIONS

Findings from this study show that smokers, who are currently unwilling to make a quit attempt, may be willing to use alternative products in the short term as a temporary substitute for smoking. However, this use is more likely to be for partial substitution (i.e. they will continue to smoke, albeit at a lower rate) rather than complete substitution. Of the various substitutes offered, smokers were more willing to use a nicotine replacement product over a tobacco-based product.

Secondhand smoke transfer in multiunit housing

INTRODUCTION

The home can represent a significant source of secondhand smoke (SHS), especially for individuals who live in close proximity to one another in multiunit housing (MUH). The objective of this study was to quantify real-time SHS transfer between smoke-permitted and smoke-free living units within the same MUH structure.

METHODS

Air monitors were used to assess PM₂.₅, an environmental marker for SHS, in 14 smoke-free living units and 16 smoke-permitted units within 11 MUH buildings in the Buffalo, New York, area between July 2008 and August 2009. Air monitors were operated concurrently in both smoke-permitted and smoke-free units within each building. When feasible, additional monitors were stationed in shared hallways and on outdoor patios. Participants completed logs to document activities that could affect air quality.

RESULTS

Evidence of SHS transfer from smoke-permitted units was detected in 2 of the 14 smoke-free units and 6 of the 8 hallways. Real-time PM₂.₅ plots and participant logs suggest that SHS transfer is a function of many determinants, including ventilation and proximity between units. Following stratification by time of day, median PM₂.₅ levels were greatest between 4:00 PM and 11:59 PM but varied by location: 10.2 μg/m³ in smoke-free units, 18.9 μg/m³ in hallways, and 29.4 μg/m³ in smoke-permitted units.

CONCLUSIONS

This study documents SHS incursions from smoke-permitted units into smoke-free units and adjacent hallways within the same building. Since many factors appear to impact the amount of SHS transfer between these areas, the implementation of a smoke-free building policy represents the most effective way to ensure that residents of MUH units are not exposed to SHS.

Strategies for smoking cessation: what is new and what works?

While the prevalence of smoking in the USA has declined over the past half century, there still remain over 40 million current smokers, ensuring that smoking will continue to be a major factor influencing premature morbidity and mortality rates for years to come. Most people begin smoking during their teenage years and struggle to quit as adults. Nicotine dependence should be considered a chronic health condition with exacerbations and remissions. Clinicians have an important role to play in helping their patients to stop smoking. The systematic identification of all smokers is the initial step in addressing smoking cessation. Providing both pharmacotherapy and counseling support for all quit attempts helps to optimize rates of cessation. First-line pharmacotherapy to support a quit attempt include nicotine replacement (gum, patch, lozenge, nasal spray or inhaler), bupropion or varenicline. Use of these agents can increase quit rates by 1.5- to threefold. Several studies have shown that combining the nicotine patch with either gum or nasal spray can increase quit rates over single modality therapy. Recent studies have also suggested that giving smokers stop-smoking medications for several weeks in advance of their quit date may help to boost long-term quit rates. New medications are under development, including a nicotine vaccine and faster delivery nicotine medications. However, from a public health perspective, a ban on the sale of nicotine-containing combustion tobacco products may represent the most straightforward means to minimize the harm caused by tobacco use.

Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer

BACKGROUND

Women treated with therapeutic chest radiation may develop breast cancer.

PURPOSE

To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.

DATA SOURCES

Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).

STUDY SELECTION

Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation?

DATA EXTRACTION

Three investigators independently extracted data and assessed study quality.

DATA SYNTHESIS

Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited.

LIMITATION

The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.

CONCLUSION

Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.

Multiunit housing residents' experiences and attitudes toward smoke-free policies

INTRODUCTION

Secondhand smoke (SHS) causes significant disease and death. A person's home represents a prominent source of SHS, and the potential for exposure is elevated among those who live in close proximity to smokers in multiunit housing (MUH). This study assessed the prevalence and predictors of SHS exposure and smoke-free policy support among MUH residents.

METHODS

Data were obtained from 5,936 MUH residents who participated in the New York State Adult Tobacco Survey between May 2007 and May 2009. Bivariate analyses were used to assess the prevalence of smoke-free home policies, SHS incursions, and support for smoke-free policies. Logistic regression was used to identify predictors of these measures while adjusting for gender, age, ethnicity, education, region, children in household, and housing type.

RESULTS

A total of 73.1% of respondents reported a personal smoke-free home policy in their home. Among these individuals, 46.2% indicated that SHS has ever entered their home in the past year, while 9.2% reported daily incursions. Overall, a majority of respondents (55.6%) support a policy that bans smoking in all areas of their building, including residential units; support was significantly higher among ethnic minorities and individuals who reside with children.

DISCUSSION

Nearly half of New York MUH residents with a smoke-free home policy have experienced a SHS incursion in their home. Since a majority of MUH residents support smoke-free policies and nearly three quarters already prohibit smoking in their home, opportunities exist for initiatives to promote smoke-free building policies.

Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer

BACKGROUND

Women treated with therapeutic chest radiation may develop breast cancer.

PURPOSE

To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.

DATA SOURCES

Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).

STUDY SELECTION

Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation?

DATA EXTRACTION

Three investigators independently extracted data and assessed study quality.

DATA SYNTHESIS

Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited.

LIMITATION

The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.

CONCLUSION

Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.

Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing

INTRODUCTION

Exposure to secondhand smoke causes disease and premature death. Although many municipalities have instituted policies prohibiting smoking in public areas, personal living areas remain largely unregulated. Individuals who reside in multiunit housing (MUH) facilities where smoking is permitted are particularly susceptible to involuntary exposure. This study assessed the prevalence and predictors of smoke-free policy implementation and support among owners and managers of MUH throughout Western New York State.

METHODS

A telephone survey was administered to a sample of owners and managers of MUH buildings in the Erie and Niagara counties, New York. A total of 127 respondents completed the survey between March and July 2008 (62% response rate). Logistic regression was used to assess predictors of policy implementation and support, while adjusting for participant smoking status, quantity of units owned/managed, government subsidy status, as well as building age, construction type, and size.

RESULTS

Only 13% of participants reported smoking restrictions within any of their buildings. Among those without a smoke-free policy, 75% would be interested in restricting smoking in at least one of their units, with interest being significantly higher among participants with government-subsidized units (odds ratio = 3.12, 95% CI = 1.14-8.52). Primary barriers to policy implementation included concern over increased vacancy (27%) and a decreased market base (21%).

DISCUSSION

Few Western New York MUH owners and managers have implemented smoke-free policies in their buildings, but most are receptive to doing so. Therefore, opportunities exist for interventions to enhance policy acceptance, implementation, and enforcement among these individuals.

Changes in cancer incidence patterns among a northeastern American Indian population: 1955-1969 versus 1990-2004

PURPOSE

This manuscript examines shifts in patterns of cancer incidence among the Seneca Nation of Indians (SNI) for the interval 1955-1969 compared to 1990-2004.

METHODS

A retrospective cohort design was used to examine cancer incidence among the SNI during 2 time intervals: 1955-1969 and 1990-2004. Person-years at risk were multiplied by cancer incidence rates for New York State, exclusive of New York City, over 5-year intervals. A computer-aided match with the New York State Cancer Registry was used to identify incident cancers. Overall and site-specific standardized incidence ratios (SIRs = observed/expected x 100), and 95% confidence intervals (CIs), were calculated for both time periods.

RESULTS

During the earlier interval, deficits in overall cancer incidence were noted among males (SIR = 56, CI 36-82) and females (SIR = 71, CI 50-98), and for female breast cancers (SIR = 21, CI 4-62). During the more recent intervals, deficits in overall cancer incidence persisted among both genders (males SIR = 63, CI 52-77; females SIR = 67, CI 55-80). Deficits were also noted among males for cancers of the lung (SIR = 60, CI 33-98), prostate (SIR = 51, CI = 33-76) and bladder (SIR = 17, CI = 2-61) and among females for breast (SIR = 33, CI = 20-53) and uterus (SIR = 36, CI = 10-92). No cancer sites demonstrated increased incidence. Persons ages 60-69 years, 70-79 years, and ages 80+ years tended to exhibit deficits in overall incidence.

CONCLUSIONS

Despite marked changes over time, deficits in overall cancer incidence have persisted between the time intervals studied. Tribal-specific cancer data are important for the development and implementation of comprehensive cancer control plans which align with local needs.

Efficacy expectations for colorectal cancer screening in primary care: identifying barriers and facilitators for patients and clinicians

Physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs) in primary care (PC) specialties, as well as patients, participated in a series of peer-level focus groups to explore how colorectal cancer (CRC) screening is approached in PC. Twenty-seven focus groups were conducted, including 8 groups composed of MDs (n = 56), 7 with NP/PAs (n = 47), and 12 with patients (n = 103). Clinicians (MDs, NPs, PAs) reported discussing CRC screening during well visits and were alerted to patients in need of screening through flow sheets, chart reminders (paper, electronic) or by office personnel, and cited lack of time, patient reluctance, and challenges related to scheduling colonoscopy as barriers to screening. Clinicians identified communication skills and the convenience of office-based screening procedures as facilitators of CRC screening. Patients recalled discussing CRC screening during PC office visits and most commonly identified colonoscopy and fecal occult blood test as common CRC screening tests. Physician recommendation and knowing someone who has/had cancer were the most common factors motivating patients' decision to complete CRC screening. Results are framed according to patient and clinician perceptions of self-efficacy related to CRC screening.

Fifty years of cancer in an American Indian population

BACKGROUND

A clear understanding of cancer patterns among American Indian tribal groups has been complicated by a variety of issues. A retrospective cohort study design was applied to a Seneca Nation of Indians (SNI) cohort for the period from 1955 through 2004.

METHODS

Incident cancers were identified through a computer match with the New York State Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for the overall interval as well as for each of the 5 10-year intervals. The SNI cohort consisted of 3935 men and 4193 women with a total of 120,403 person-years.

RESULTS

Significant deficits in cancer incidence were noted among men for all sites combined (SIR, 69), and for lung (SIR, 59), prostate (SIR, 54), urinary bladder (SIR, 8), and Hodgkin lymphoma (SIR, 0); no cancer sites were identified with significantly elevated incidence. Women demonstrated significantly reduced cancer incidence for all sites combined (SIR, 70) and for breast (SIR, 39), colorectal (SIR, 72), ovary (SIR, 37), uterus (SIR, 42), bladder (SIR, 20), pancreas (SIR, 10), and non-Hodgkin lymphoma (SIR, 39); elevated incidence was noted for cancers of the lung (SIR, 139) and liver (SIR, 405).

CONCLUSIONS

To the authors' knowledge, the current study represents the most comprehensive investigation to date of cancer patterns among an American Indian tribal group and provides insights for the development of tribal cancer control programming.

"Cancer Control Practices": translation and cultural adaptation of an instrument in Crete, Greece

BACKGROUND

Although early detection and systematic prevention of cancer improves outcomes and reduces mortality, General Practitioners' (GP) effectiveness remains an issue that merits further investigation.

METHODS

To explore cancer control practices of Greek GPs, a version of the Cancer Control Practices questionnaire, originally developed in Western New York in 2001, was translated and culturally adapted.

RESULTS

Its reliability was found satisfactory in most the items.

CONCLUSIONS

The instrument can be useful in determining Greek GPs' knowledge and application of internationally established cancer-related guidelines, barriers they face in daily practice, and educational or training needs.

Associations between adult and childhood secondhand smoke exposures and fecundity and fetal loss among women who visited a cancer hospital

BACKGROUND

A large percentage of the population continues to be exposed to secondhand smoke (SHS). Although studies have consistently linked active smoking to various pregnancy outcomes, results from the few studies examining SHS exposure and pregnancy difficulties have been inconsistent.

METHODS

Approximately 4800 women who presented to Roswell Park Cancer Institute between 1982 and 1998 and reported being pregnant at least once were queried about their childhood and adult exposures to SHS using a standardised questionnaire. Women were asked to report on selected prenatal pregnancy outcomes (fetal loss and difficulty becoming pregnant).

RESULTS

Approximately 11.3% of women reported difficulty becoming pregnant, while 32% reported a fetal loss or 12.4% reported multiple fetal losses. 40% reported any prenatal pregnancy difficulty (fetal loss and/or difficulty becoming pregnant). SHS exposures from their parents were associated with difficulty becoming pregnant (OR = 1.27, 95% CI 1.03 to 1.56) and lasting >1 year (OR = 1.34, 95% CI 1.12 to 1.60). Exposure to SHS in both at home during childhood and at the time of survey completion was also associated with fetal loss (OR = 1.39, 95% CI 1.17 to 1.66) and multiple fetal losses (OR = 1.62, 95% CI 1.25 to 2.11). Increasing current daily hours of SHS exposure as an adult was related to the occurrence of both multiple fetal loss and reduced fecundity (p(trend) < 0.05).

CONCLUSIONS

Reports of exposures to SHS during childhood and as an adult were associated with increased odds for prenatal pregnancy difficulties. These findings underscore the public health perspective that all people, especially women in their reproductive years, should be fully protected from tobacco smoke.