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Chaffee B, Lauten K, Sharma E, Everard C, Duffy K, Park-Lee E, Taylor E, Tolliver E, Watkins-Bryant T, Iafolla T, Compton W, Kimmel H, Hyland A, Silveira M. Oral Health in the Population Assessment of Tobacco and Health Study. J Dent Res 2022; 101:1046-1054. [PMID: 35403466 PMCID: PMC9305842 DOI: 10.1177/00220345221086272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Tobacco use is a well-established risk factor for multiple adverse oral conditions. Few nationally representative oral health data sets encompass the current diversity of tobacco and nicotine products. This investigation examines the validity of oral health measures in the Population Assessment of Tobacco and Health (PATH) Study to assess relationships between tobacco use and oral health. Cross-sectional data from PATH Study wave 4 (N = 33,643 US adults, collected 2016-2018) were used to obtain estimates for 6 self-reported oral conditions (e.g., bone loss around teeth, tooth extractions) and compared with analogous estimates from the National Health and Nutrition Examination Survey (NHANES) cycle 2017-2018 (N = 5,856). Within the PATH Study, associations were calculated between tobacco use status and lifetime and past 12-mo experience of adverse oral conditions using survey-weighted multivariable logistic regression. Nationally representative estimates of oral conditions between the PATH Study and NHANES were similar (e.g., ever-experience of bone loss around teeth: PATH Study 15.2%, 95% CI, 14.4%-15.9%; NHANES 16.6%, 95% CI, 14.9%-18.4%). In the PATH Study, combustible tobacco smoking was consistently associated with lifetime and past 12-mo experience of adverse oral health (e.g., exclusive cigarette smoking vs. never tobacco use, adjusted odds ratio [AOR] for loose teeth in past 12 mo: 2.02; 95% CI, 1.52-2.69). Exclusive smokeless tobacco use was associated with greater odds of loose teeth (AOR, 1.93; 95% CI, 1.15-3.26) and lifetime precancerous lesions (AOR, 3.85; 95% CI, 1.73-8.57). Use of other noncigarette products (e.g., pipes) was inconsistently associated with oral health outcomes. PATH Study oral health measures closely align with self-reported measures from NHANES and are internally concurrent. Observed associations with tobacco use and the ability to examine emerging tobacco products support application of PATH Study data in dental research, particularly to examine potential oral health effects of novel tobacco products and longitudinal changes in tobacco use behaviors.
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Affiliation(s)
- B.W. Chaffee
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - C.D. Everard
- National Institute on Drug Abuse, Kelly Government Solutions, Bethesda, MD, USA
| | - K. Duffy
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - E. Park-Lee
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - E. Taylor
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - E. Tolliver
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - T. Watkins-Bryant
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - T. Iafolla
- National Institute on Dental and Craniofacial Research, Bethesda, MD, USA
| | - W.M. Compton
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - H.L. Kimmel
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - A. Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - M.L. Silveira
- National Institute on Drug Abuse, Kelly Government Solutions, Bethesda, MD, USA
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Cummings KM, Hyland A, Zevon M, Kelly M, Long MA, Demmy TL, Dexter E, Reed R, Epstein J, Houston T, Jenkins D, Mahoney M, O'Connor R, Marshall JR, Reid ME, Smith JL, Chmura M, Warren GW. An institutional universal standardized tobacco use assessment and intervention in cancer patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kudrimoti MR, Arnold SM, Valentino J, Gal T, Hyland A, Singh A, Rangnekar V, Cummings KM, Marshall JR, Warren GW. The accuracy of tobacco assessment during definitive radiotherapy or chemoradiotherapy in patients with head and neck cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Borland R, Yong HH, O'Connor RJ, Hyland A, Thompson ME. The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four Country study. Nicotine Tob Res 2011; 12 Suppl:S45-50. [PMID: 20889480 DOI: 10.1093/ntr/ntq038] [Citation(s) in RCA: 267] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing recognition that the two measures in the Heaviness of Smoking Index (HSI), time to first cigarette of the day (TTFC) and daily consumption (cigarettes per day [CPD]), are strong predictors of quitting behavior. METHODS Use of Waves 1-4 of International Tobacco Control cohort with around 8,000 respondents per wave and 6,000 for prediction of quit outcomes at the next wave. We measured TTFC and CPD at each wave and quit outcomes at the next wave. We also looked at the relative utility of the standard categorical scoring compared with a continuous score using the square root of CPD minus the natural log of TTFC in minutes. RESULTS We found considerable consistency of the measures across years with a small decrease as duration between measurements increased. For a 3-year gap, the correlations were .72 and .70 for the continuous and categorical composite HSI measures, respectively, and were at least .63 for the individual components. Both TTFC and CPD independently predicted maintenance of quit attempts (for at least 1 month) in each of the three wave-to-wave replications, and these effects were maintained when controlling for demographic factors. CPD also predicted making attempts consistently, but the results for TTFC was not consistently significant. DISCUSSION Both TTFC and CPD are fairly reliable over time and are important predictors of quitting. There are only small effects of mode of computing the scores, and the two items can be used either individually or combined as the HSI.
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Affiliation(s)
- R Borland
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Victoria, Australia.
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Liu RL, Yang Y, Travers MJ, Fong GT, O'Connor RJ, Hyland A, Li L, Nan Y, Feng GZ, Li Q, Jiang Y. A cross-sectional study on levels of second-hand smoke in restaurants and bars in five cities in China. Tob Control 2010; 19 Suppl 2:i24-9. [PMID: 20008154 PMCID: PMC2976000 DOI: 10.1136/tc.2009.029959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 05/11/2009] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess indoor second-hand smoke (SHS) exposure in restaurants and bars via PM(2.5) (fine particles 2.5 μm in diameter and smaller) level measurements in five cities in China. METHODS The study was conducted from July to September in 2007 in Beijing, Xi'an, Wuhan, Kunming and Guiyang. Portable aerosol monitors were used to measure PM(2.5) concentrations in 404 restaurants and bars. The occupant density and the active smoker density were calculated for each venue sampled. RESULTS Among the 404 surveyed venues, 23 had complete smoking bans, 9 had partial smoking bans and 313 (77.5%) were observed to have allowed smoking during sampling. The geometric mean of indoor PM(2.5) levels in venues with smoking observed was 208 μg/m(3) and 99 μg/m(3) in venues without observed smoking. When outdoor PM(2.5) levels were adjusted, indoor PM(2.5) levels in venues with smoking observed were consistently significantly higher than in venues without smoking observed (F=80.49, p<0.001). Indoor PM(2.5) levels were positively correlated with outdoor PM(2.5) levels (partial rho=0.37 p<0.001) and active smoker density (partial rho=0.34, p<0.001). CONCLUSIONS Consistent with findings in other countries, PM(2.5) levels in smoking places are significantly higher than those in smoke-free places and are strongly related to the number and density of active smokers. These findings document the high levels of SHS in hospitality venues in China and point to the urgent need for comprehensive smoke-free laws in China to protect the public from SHS hazards, as called for in Article 8 of the Framework Convention on Tobacco Control, which was ratified by China in 2005.
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Affiliation(s)
- R L Liu
- Chinese National Center for Disease Control and Prevention (now School of Public Health, University of California, Berkeley, California, USA)
| | - Y Yang
- Chinese National Center for Disease Control and Prevention, Beijing, China
| | - M J Travers
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - G T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - R J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - L Li
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Y Nan
- Chinese National Center for Disease Control and Prevention, Beijing, China
| | - G Z Feng
- Chinese National Center for Disease Control and Prevention, Beijing, China
| | - Q Li
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Y Jiang
- Chinese National Center for Disease Control and Prevention, Beijing, China
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Li Q, Hyland A, O'Connor R, Zhao G, Du L, Li X, Fong GT. Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey. Tob Control 2010; 19 Suppl 2:i40-6. [PMID: 19679889 PMCID: PMC2976027 DOI: 10.1136/tc.2009.029850] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 07/01/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine levels of support for comprehensive smoke-free policies in six large Chinese cities. METHODS Data from Wave 1 of the International Tobacco Control (ITC) China Survey (April-August 2006) were analysed. The ITC China Survey employed a multistage sampling design in Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan (none of which has comprehensive smoke-free policies in place). Face-to-face interviews were conducted with 4815 smokers and 1270 non-smokers. Multivariate logistic regression models were used to identify factors associated with support for comprehensive smoke-free policies. RESULTS About one in two Chinese urban smokers and four in five non-smokers believed that secondhand smoke (SHS) causes lung cancer. The majority of respondents supported comprehensive smoke-free policies in hospitals, schools and public transport vehicles while support for smoke-free workplaces, restaurants and bars was lower. Levels of support were generally comparable between smokers and non-smokers. Support for comprehensive smoke-free policies was positively associated with knowledge about the harm of SHS. Respondents who worked in a smoke-free worksite or who frequented smoke-free indoor entertainment places were more likely to support comprehensive smoking restriction in bars and restaurants. CONCLUSION Considerable support for smoke-free policies exists in these six large cities in China. Greater public education about the dangers of SHS may further increase support. Experiencing the benefits of smoke-free indoor entertainment places and/or workplaces increases support for these policies and suggests that some initial smoke-free policy implementation may hasten the diffusion of these public health policies.
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Affiliation(s)
- Q Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, P R China.
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Brennan E, Cameron M, Warne C, Durkin S, Borland R, Travers MJ, Hyland A, Wakefield MA. Secondhand smoke drift: Examining the influence of indoor smoking bans on indoor and outdoor air quality at pubs and bars. Nicotine Tob Res 2010; 12:271-7. [DOI: 10.1093/ntr/ntp204] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
AIM To explore predictors of smoking relapse and how predictors vary according to duration of abstinence. DESIGN, SETTING AND PARTICIPANTS A longitudinal survey of 1296 ex-smokers recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom and United States). Measurements Quitters were interviewed by telephone at varying durations of abstinence (from 1 day to approximately 3 years) and then followed-up approximately 1 year later. Theorized predictors of relapse (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) and nicotine dependence were measured in the survey. FINDINGS Relapse was associated with lower abstinence self-efficacy and a higher frequency of urges to smoke, but only after the first month or so of quitting. Both these measures mediated relationships between perceived benefits of smoking and relapse. Perceived costs of smoking and benefits of quitting were unrelated to relapse. CONCLUSIONS Challenging perceived benefits of smoking may be an effective way to increase abstinence self-efficacy and reduce frequency of urges to smoke (particularly after the initial weeks of quitting), in order to reduce subsequent relapse risk.
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Affiliation(s)
- N Herd
- Department of Psychology, The University of Melbourne, Australia
| | - R Borland
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Australia
| | - A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
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9
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Liu RL, Yang Y, Travers MJ, Fong GT, O'Connor RJ, Hyland A, Li L, Nan Y, Feng GZ, Li Q, Jiang Y. A cross-sectional study on levels of secondhand smoke in restaurants and bars in five cities in China. Tob Control 2009; 20:397-402. [PMID: 19748882 DOI: 10.1136/tc.2009.033233] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess indoor secondhand smoke (SHS) exposure in restaurants and bars via PM(2.5) level measurements in five cities in China. METHODS The study was conducted from July to September in 2007 in Beijing, Xi'an, Wuhan, Kunming and Guiyang. PM(2.5) concentrations were measured in 404 restaurants and bars using portable aerosol monitors. The occupant density and the active smoker density were calculated for each venue sampled. RESULTS Among the 404 surveyed venues, 23 had complete smoking bans, nine had partial smoking bans and 313 (77.5%) had smoking observed during sampling. The geometric mean of indoor PM(2.5) levels in venues with smoking observed was 208 μg/m(3) and 99 μg/m(3) in venues without smoking observed. When outdoor PM(2.5) levels were adjusted, indoor PM(2.5) levels in venues with smoking observed were consistently significantly higher than those in venues without smoking observed (F=80.49, p<0.001). Indoor PM(2.5) levels were positively correlated with outdoor PM(2.5) levels (partial ρ=0.37 p<0.001) and active smoker density (partial ρ=0.34, p<0.001). CONCLUSIONS Consistent with findings in other countries, PM(2.5) levels in smoking places are significantly higher than those in smoke-free places and are strongly related to the number and density of active smokers. These findings document the high levels of SHS in hospitality venues in China and point to the urgent need for comprehensive smoke-free laws in China to protect the public from SHS hazards, as called for in Article 8 of the Framework Convention on Tobacco Control, which was ratified by China in 2005.
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Affiliation(s)
- R L Liu
- Chinese National Center for Disease Control and Prevention, Beiing, China.
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10
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Peppone LJ, Piazza KM, Mahoney MC, Morrow GR, Mustian KM, Palesh OG, Hyland A. Associations between adult and childhood secondhand smoke exposures and fecundity and fetal loss among women who visited a cancer hospital. Tob Control 2008; 18:115-20. [PMID: 19039010 DOI: 10.1136/tc.2008.027961] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- L J Peppone
- Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
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Abstract
OBJECTIVE To compare tobacco smoke-derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol. METHODS The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM(2.5)) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007. RESULTS Geometric mean PM(2.5) levels were highest in Syria (372 microg/m(3)), Romania (366 microg/m(3)) and Lebanon (346 microg/m(3)), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 microg/m(3), Uruguay at 18 microg/m(3) and New Zealand at 8 microg/m(3)). On average, the PM(2.5) levels in places where smoking was observed was 8.9 times greater (95% CI 8.0 to 10) than levels in places where smoking was not observed. CONCLUSIONS Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.
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Affiliation(s)
- A Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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12
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Peppone LJ, Moysich KB, Reid ME, Morrow GR, Hyland A. Colorectal cancer risk from cigarette smoking increases over 5 decades. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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O'Connor RJ, Bauer JE, Giovino GA, Hammond D, Hyland A, Fong GT, Cummings KM. Prevalence of behaviors related to cigarette-caused fires: a survey of Ontario smokers. Inj Prev 2007; 13:237-42. [PMID: 17686933 PMCID: PMC2598319 DOI: 10.1136/ip.2006.013391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify the prevalence and correlates of behaviors related to the risk of cigarette-caused fires. DESIGN AND SETTING Random-digit-dialed telephone survey in Ontario, Canada, July-September, 2005. SUBJECTS 596 current cigarette smokers. OUTCOME MEASURES Prevalence of fire-risk events and behaviors such as burning clothing or objects in the home, leaving lit cigarettes unattended, dozing while smoking, and smoking in bed and correlates of these behaviors. Respondents were also asked if they ever worry about cigarette-caused fires. RESULTS One in four smokers admitted to leaving lit cigarettes unattended in the last 30 days, while 15% admitted to smoking while in bed. Leaving lit cigarettes unattended was independent of demographic, socioeconomic or nicotine dependence indicators, but was related to worry about burning other persons with a cigarette (OR 1.72, 95% CI 1.04 to 2.85) and smoking inside the home (OR 2.98, 95% CI 1.66 to 5.35). Persons who were not white (OR 3.97, 95% CI 1.80 to 8.80), aged 18-24 years (OR 3.75, 95% CI 1.41 to 9.96), who had high nicotine dependence (OR 9.13, 95% CI 2.22 to 37.52) and worried about burning objects in their home (OR 2.43, 95% CI 1.31 to 4.52) were more likely to smoke in bed. 10 (1.7%) smokers reported having ever had a fire in their home started by a cigarette. CONCLUSIONS Smokers engage in behaviors such as smoking in bed and leaving lit cigarettes unattended that may place them at an increased risk of cigarette-caused fires. As governments move to regulate cigarette ignition propensity, it is important to establish surveillance for behaviors related to fire risk.
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Affiliation(s)
- R J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Borland R, Yong HH, Cummings KM, Hyland A, Anderson S, Fong GT. Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2007; 15 Suppl 3:iii42-50. [PMID: 16754946 PMCID: PMC2593064 DOI: 10.1136/tc.2005.012492] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report on prevalence, trends and determinants of smoke-free home policies in smokers' homes in different countries and to estimate the effects of these policies on smoking cessation. DESIGN Two waves of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of smokers conducted by telephone. Wave 1 was conducted in October/December 2002 with broadly representative samples of over 2000 adult (>or= 18 years) cigarette smokers in each of the following four countries: Canada, the United States, the United Kingdom, and Australia, 75% of whom were followed up at Wave 2 on average seven months later. KEY MEASURES Levels of smoking restrictions in homes (both waves). RESULTS Australian smokers were most likely to live in smoke-free homes and UK smokers least likely (34% v 15% at Wave 1). Levels of smoke-free homes increased between waves. Logistic regressions indicated that the main independent predictors of smokers reporting smoke-free homes or implementation of a smoke-free policy between waves included household factors such as having a child, particularly a young child, and having other non-smoking adults in the household. Positive attitudes to smoke-free public places and/or reported presence of smoke-free public places were independent predictors of having or implementing smoke-free homes, supporting a social diffusion model for smoking restrictions. Intentions to quit at Wave 1 and quitting activity between survey waves were associated with implementing bans between Waves 1 and 2. Presence of bans at Wave 1 was associated with significantly greater proportions of quit attempts, and success among those who tried at Wave 2. There was no significant interaction between the predictive models and country. CONCLUSIONS Smoke-free public places seem to stimulate adoption of smoke-free homes, a strategy associated with both increased frequency of quit attempts, and of the success of those attempts.
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Affiliation(s)
- R Borland
- Cancer Control Research Institute, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC 3053, Australia.
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Borland R, Yong HH, Siahpush M, Hyland A, Campbell S, Hastings G, Cummings KM, Fong GT. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2007; 15 Suppl 3:iii34-41. [PMID: 16754945 PMCID: PMC2593054 DOI: 10.1136/tc.2004.008748] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore determinants of support for and reported compliance with smoke-free policies in restaurants and bars across the four countries of the International Tobacco Control (ITC) Four Country Survey. DESIGN Separate telephone cross-sectional surveys conducted between October and December 2002 with broadly representative samples of over 2000 adult (>or=18 years) cigarette smokers in each of the following four countries: the United States, Canada, the United Kingdom, and Australia. OUTCOME MEASURES Support for smoke-free policies in restaurants and pubs/bars and reported compliance with existing policies. RESULTS Reported total bans on indoor smoking in restaurants varied from 62% in Australia to 5% in the UK. Smoking bans in bars were less common, with California in the USA being the only major part of any country with documented bans. Support for bans in both restaurants and bars was related to the existence of bans, beliefs about passive smoking being harmful, lower average cigarette consumption, and older age. Self-reported compliance with a smoking ban was generally high and was associated with greater support for the ban. CONCLUSIONS Among current cigarette smokers, support for smoking bans was associated with living in a place where the law prohibits smoking. Smokers adjust and both accept and comply with smoke-free laws. Associates of support and compliance are remarkably similar across countries given the notably different levels of smoke-free policies.
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Affiliation(s)
- R Borland
- Cancer Control Research Institute, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC 3053, Australia.
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16
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Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, Anderson S, Cummings KM, Allwright S, Mulcahy M, Howell F, Clancy L, Thompson ME, Connolly G, Driezen P. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control 2007; 15 Suppl 3:iii51-8. [PMID: 16754947 PMCID: PMC2593063 DOI: 10.1136/tc.2005.013649] [Citation(s) in RCA: 229] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004. DESIGN Quasi-experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n = 769) and the UK (n = 416), surveyed before the law (December 2003 to January 2004) and 8-9 months after the law (December 2004 to January 2005). MAIN OUTCOME MEASURES Respondents' reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law. RESULTS The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke-free law was a "good" or "very good" thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post-legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit. CONCLUSION The Ireland smoke-free law stands as a positive example of how a population-level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.
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Affiliation(s)
- G T Fong
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada.
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Hyland A, Laux FL, Higbee C, Hastings G, Ross H, Chaloupka FJ, Fong GT, Cummings KM. Cigarette purchase patterns in four countries and the relationship with cessation: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2007; 15 Suppl 3:iii59-64. [PMID: 16754948 PMCID: PMC2593061 DOI: 10.1136/tc.2005.012203] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Higher cigarette prices result in decreased cigarette consumption, but some smokers may seek lower-taxed cigarette sources. This price avoidance behaviour likely dampens the health impact of higher cigarette prices although it has not been thoroughly studied. OBJECTIVE To describe the characteristics of smokers who purchase low/untaxed cigarettes and to examine how this behaviour is associated with subsequent changes in smoking behaviours. METHODS Telephone survey data from 8930 smokers from the International Tobacco Control (ITC) Four Country Survey (ITC-4) were used to assess cigarette purchase patterns and smoking behaviours in Wave 1 conducted from October to December 2002 and subsequently followed seven months later in Wave 2. Respondents' smoking status, attempts to quit, amount smoked, and cigarette purchase patterns were assessed in both waves. RESULTS Rates of purchase from a low/untaxed source at the respondents' last cigarette purchase differed notably between countries at Wave 1, from less than 1% in Australia to 15% in the United Kingdom. In the UK, but not the other countries, this increased significantly to 20% at Wave 2. Smokers who were older, white/English speakers, had higher incomes, and had higher levels of education were more likely to report purchasing cigarettes from a low/untaxed source on their last purchase. Those who reported purchasing from a low/untaxed source on their last purchase at Wave 1 were less likely to have tried to quit smoking quit smoking by Wave 2 (relative risk 0.70, p < 0.01), while no overall significant association with smoking cessation was observed. CONCLUSION Data from this study indicate that there are lower levels of making a quit attempt among purchasers of low/untaxed cigarettes compared to purchasers of full-priced cigarettes. The availability of low/untaxed cigarettes may mitigate the influence of increases in cigarette prices.
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Affiliation(s)
- A Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, New York 14263, USA
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Hyland A, Borland R, Li Q, Yong HH, McNeill A, Fong GT, O'Connor RJ, Cummings KM. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15 Suppl 3:iii83-94. [PMID: 16754952 PMCID: PMC2593055 DOI: 10.1136/tc.2005.013516] [Citation(s) in RCA: 302] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 03/22/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND The International Tobacco Control (ITC) Four Country Survey (ITC-4) is a prospective cohort study designed to evaluate the psychosocial and behavioural impact of national-level tobacco control policies enacted in the Australia, Canada, the UK, and the USA. Wave 1 of ITC-4 survey was conducted between October 2002 and December 2002. Wave 2 survey was conducted between May 2003 and August 2003. OBJECTIVE To test for individual-level predictors of smoking cessation behaviours (that is, quit attempts and smoking cessation) among cigarette smokers in the ITC Four Country Study measured between Wave 1 and Wave 2. This set of predictors will serve as the base for evaluating the added effect of tobacco control policies and other factors. METHODS Respondents included in this study are 6682 adult current smokers in the Wave 1 main survey who completed the Wave 2 follow-up (1665 were in Canada, 1329 were in the USA, 1837 were in the UK and 1851 were in Australia). RESULTS Factors predictive of making a quit attempt included intention to quit, making a quit attempt in the previous year, longer duration of past quit attempts, less nicotine dependence, more negative attitudes about smoking, and younger age. Lower levels of nicotine dependence were the main factor that predicted future cessation among those that made a quit attempt. CONCLUSION Intention to quit and other cognitive variables were associated with quit attempts, but not cessation. Behavioural variables related to task difficulty, including measures of dependence, predicted both making attempts and their success. Predictors of making quit attempts and cessation were similar for each of the four countries, but there were some differences in predictors of success.
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Affiliation(s)
- A Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA
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Hyland A, Wakefield M, Higbee C, Szczypka G, Cummings KM. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res 2006; 21:348-54. [PMID: 16740679 DOI: 10.1093/her/cyl048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study was to assess the relationship between exposure to state-sponsored anti-tobacco advertising and smoking cessation. Cessation rates in 2001 among a cohort of 2061 smokers who participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed a follow-up survey in 2001 were merged with 2000-01 television advertising exposure data from Nielsen Media Research. The relative risk for quitting was estimated to be 10% higher for every 5000 units of exposure to state anti-tobacco television advertising over the 2-year period, although this did not quite achieve statistical significance. The association was even larger among those who reported that the level of information in the media about the dangers of smoking had increased 'a lot' between 1993 and 2001 (RR = 1.19, 95% CI = 1.03-1.38). These data are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Elm.arlton Streets, Buffalo, NY 14263, USA
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Thompson ME, Fong GT, Hammond D, Boudreau C, Driezen P, Hyland A, Borland R, Cummings KM, Hastings GB, Siahpush M, Mackintosh AM, Laux FL. Methods of the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15 Suppl 3:iii12-8. [PMID: 16754941 PMCID: PMC2593059 DOI: 10.1136/tc.2005.013870] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 04/07/2006] [Indexed: 11/03/2022]
Abstract
This paper outlines the design features, data collection methods and analytic strategies of the International Tobacco Control (ITC) Four Country Survey, a prospective study of more than 2000 longitudinal respondents per country with yearly replenishments. This survey possesses unique features that sets it apart among surveys on tobacco use and cessation. One of these features is the use of theory-driven conceptual models. In this paper, however, the focus is on the two key statistical features of the survey: longitudinal and "quasi-experimental" designs. Although it is often possible to address the same scientific questions with a cross-sectional or a longitudinal study, the latter has the major advantage of being able to distinguish changes over time within individuals from differences among people at baseline (that is, differences between age and cohort effects). Furthermore, quasi-experiments, where countries not implementing a given new tobacco control policy act as the control group to which the country implementing such a policy will be compared, provide much stronger evidence than observational studies on the effects of national-level tobacco control policies. In summary, application of rigorous research methods enables this survey to be a rich data resource, not only to evaluate policies, but also to gain new insights into the natural history of smoking cessation, through longitudinal analyses of smoker behaviour.
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Affiliation(s)
- M E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
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Fong GT, Cummings KM, Borland R, Hastings G, Hyland A, Giovino GA, Hammond D, Thompson ME. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tob Control 2006; 15 Suppl 3:iii3-11. [PMID: 16754944 PMCID: PMC2593053 DOI: 10.1136/tc.2005.015438] [Citation(s) in RCA: 272] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 04/26/2006] [Indexed: 11/04/2022]
Abstract
This paper describes the conceptual model that underlies the International Tobacco Control Policy Evaluation Project (ITC Project), whose mission is to measure the psychosocial and behavioural impact of key policies of the Framework Convention on Tobacco Control (FCTC) among adult smokers, and in some countries, among adult non-smokers and among youth. The evaluation framework utilises multiple country controls, a longitudinal design, and a pre-specified, theory-driven conceptual model to test hypotheses about the anticipated effects of specific policies. The ITC Project consists of parallel prospective cohort surveys of representative samples of adult smokers currently in nine countries (inhabited by over 45% of the world's smokers), with other countries being added in the future. Collectively, the ITC Surveys constitute the first-ever international cohort study of tobacco use. The conceptual model of the ITC Project draws on the psychosocial and health communication literature and assumes that tobacco control policies influence tobacco related behaviours through a causal chain of psychological events, with some variables more closely related to the policy itself (policy-specific variables) and other variables that are more downstream from the policy, which have been identified by health behaviour and social psychological theories as being important causal precursors of behaviour (psychosocial mediators). We discuss the objectives of the ITC Project and its potential for building the evidence base for the FCTC.
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Affiliation(s)
- G T Fong
- Department of Psychology, University of Waterloo, Ontario N2L 3G1, Canada.
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22
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Abstract
BACKGROUND On 28 June 2004, New York State (NY) became the first jurisdiction to require cigarettes to meet a reduced ignition propensity (RIP) standard. This law resulted in cigarette manufacturers modifying nearly all of their brands sold in NY. However, the same cigarette brands sold in other states were not modified to meet the RIP standard. OBJECTIVES This paper examines relationships between the RIP law and smokers' awareness of changes in the performance of their cigarettes (that is, going out more frequently, change in taste), and smoking behaviour. METHODS Data for this analysis come from a nationwide survey of 2088 adult smokers (> 18 years of age) conducted in the USA between July and December 2004. 143 of the smokers included in the survey were residents of NY while the remainder were from other states (n = 1945). Survey participants were asked whether their cigarettes "ever go out between puffs" and whether they had noticed any change in the taste of their cigarettes in the past 12 months. RESULTS NY smokers were three times more likely than smokers in other states to report that their cigarettes often went out between puffs (17.3% v 5.6%). However, NY smokers appeared no more likely to report noticing differences in cigarette taste, an intention to quit smoking, or to have made quit attempts. CONCLUSIONS A significant minority of smokers in NY reported noticing changes in the performance of their cigarettes following the RIP law, as would be expected. However, the RIP law appears to have had no impact on the smoking habits of New Yorkers, countering arguments made by cigarette manufacturers that the law would impact consumer acceptability.
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Affiliation(s)
- R J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Hyland A, Wakefield M, Higbee C, Szczypka G, Cummings KM. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res 2006; 21:296-302. [PMID: 16286480 DOI: 10.1093/her/cyh068] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The objective of this study was to assess the relationship between exposure to state-sponsored anti-tobacco advertising and smoking cessation. Cessation rates in 2001 among a cohort of 2061 smokers who participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed a follow-up survey in 2001 were merged with the 2000-01 television advertising exposure data from Nielsen Media Research. The relative risk for quitting was estimated to be 10% higher for every 5000 units of exposure to state anti-tobacco television advertising over the 2-year period, although this did not quite achieve statistical significance. The association was even larger among those who reported that the level of information in the media about the dangers of smoking had increased 'a lot' between 1993 and 2001 (RR = 1.19, 95% CI = 1.03-1.38). These data are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Hyland A, Goldstein R, Brown A, O'Connor R, Cummings KM. Happy Birthday Marlboro: the cigarette whose taste outlasts its customers. Tob Control 2006; 15:75-7. [PMID: 16565446 PMCID: PMC2563567 DOI: 10.1136/tc.2005.015198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Marlboro is 50 years old--and still killing its customers.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Carpenter CM, Connolly GN, Travers M, Hyland A, Cummings KM. Health meetings do not belong in smoky cities. Tob Control 2006; 15:69-70. [PMID: 16436410 PMCID: PMC2563636 DOI: 10.1136/tc.2005.013755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Farrelly MC, Nonnemaker JM, Chou R, Hyland A, Peterson KK, Bauer UE. Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law. Tob Control 2005; 14:236-41. [PMID: 16046685 PMCID: PMC1748080 DOI: 10.1136/tc.2004.008839] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the impact on hospitality workers' exposure to secondhand smoke of New York's smoke-free law that prohibits smoking in all places of employment, including restaurants, bars, and bowling facilities. DESIGN Pre-post longitudinal follow up design. SETTINGS Restaurants, bars, and bowling facilities in New York State. SUBJECTS At baseline, 104 non-smoking workers in restaurants, bars, and bowling facilities were recruited with newspaper ads, flyers, and radio announcements. Of these, 68 completed a telephone survey and provided at least one saliva cotinine specimen at baseline. At three, six, and 12 month follow up studies, 47, 38, and 32 workers from the baseline sample of 68 completed a telephone survey and provided at least one saliva cotinine specimen. INTERVENTION The smoke-free law went into effect 24 July 2003. MAIN OUTCOME MEASURES Self reported sensory and respiratory symptoms and exposure to secondhand smoke; self administered saliva cotinine specimens. Analyses were limited to subjects in all four study periods who completed a telephone survey and provided at least one saliva cotinine specimen. RESULTS All analyses were limited to participants who completed both an interview and a saliva specimen for all waves of data collection (n = 30) and who had cotinine concentrations < or = 15 ng/ml (n = 24). Hours of exposure to secondhand smoke in hospitality jobs decreased from 12.1 hours (95% confidence interval (CI) 8.0 to 16.3 hours) to 0.2 hours (95% CI -0.1 to 0.5 hours) (p < 0.01) and saliva cotinine concentration decreased from 3.6 ng/ml (95% CI 2.6 to 4.7 ng/ml) to 0.8 ng/ml (95% CI 0.4 to 1.2 ng/ml) (p < 0.01) from baseline to the 12 month follow up. The prevalence of workers reporting sensory symptoms declined from 88% (95% CI 66% to 96%) to 38% (95% CI 20% to 59%) (p < 0.01); there was no change in the overall prevalence of upper respiratory symptoms (p < 0.16). CONCLUSION New York's smoke-free law had its intended effect of protecting hospitality workers from exposure to secondhand smoke within three months of implementation. One year after implementation, the results suggest continued compliance with the law.
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Affiliation(s)
- M C Farrelly
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
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Hahn T, Benekli M, Wong C, Moysich KB, Hyland A, Michalek AM, Alam A, Baer MR, Bambach B, Czuczman MS, Wetzler M, Becker JL, McCarthy PL. A prognostic model for prolonged event-free survival after autologous or allogeneic blood or marrow transplantation for relapsed and refractory Hodgkin's disease. Bone Marrow Transplant 2005; 35:557-66. [PMID: 15665852 DOI: 10.1038/sj.bmt.1704789] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are several prognostic models for Hodgkin's disease (HD) patients, but none evaluating patient characteristics at time of blood and marrow transplantation (BMT). We developed a prognostic model for event-free survival (EFS) post-BMT based on HD patient characteristics measured at the time of autologous (auto) or allogeneic (allo) BMT. Between 1/1991 and 12/2001, 64 relapsed or refractory HD patients received an auto (n=46) or allo (n=18) BMT. A multivariate prognostic model was developed measuring time to relapse, progression or death. Median follow-up was 51.7 months; median EFS for auto and allo BMT was 36 and 3 months, respectively (P=0.001). Significant multivariate predictors of shorter EFS were chemotherapy-resistant disease, KPS <90 and > or =3 chemotherapy regimens pre-BMT. Patients with two to three adverse factors had significantly shorter EFS at 2 years (58 vs 11% in auto; 38 vs 0% in allo BMT patients). Despite a selection bias favoring auto BMT, the model was valid in both auto and allo BMT groups. We were able to differentiate patients at high vs low risk for adverse outcomes post-BMT. This prognostic model may prove useful in predicting patient outcomes and identifying high-risk patients for novel treatment strategies. Validation of this model in a larger cohort of patients is warranted.
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Affiliation(s)
- T Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Abstract
OBJECTIVE To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. BACKGROUND Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. METHODS Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. RESULTS 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. CONCLUSION Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Lwebuga-Mukasa JS, Ayirookuzhi SJ, Hyland A. Traffic volumes and respiratory health care utilization among residents in close proximity to the Peace Bridge before and after September 11, 2001. J Asthma 2004; 40:855-64. [PMID: 14743825 DOI: 10.1081/jas-120023576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A recent study based on data over a 10-year period (1991-2000) showed a positive association between health care utilization and prevalence of asthma, and commercial traffic at a U.S.-Canada border crossing. We wanted to determine whether decreases in total traffic would also be associated with decreases in health care utilization for respiratory illnesses. Following September 11, 2001, there was a 50% drop in total traffic at the Peace Bridge border crossing point between Buffalo, New York and Fort Erie, Ontario, Canada. To investigate the impact of such a traffic decline on health care utilization for respiratory illnesses, weekly respiratory admissions to Kaleida Health System, Western New York's largest health care provider were analyzed according to ICD9CM classification and compared with total weekly traffic volumes for 3-month periods in 2000 and 2001 (August, September, and October). The total number of patients admitted to hospital or seen in emergency departments for respiratory illnesses during the 3-month periods of both years was 5288. A 50% drop in total traffic following Labor Day and September 11, 2001, from week 4 to week 7 was found to be statistically significant (p = 0.031) when a one-way ANOVA was performed. Likewise, the drop in total respiratory cases approached statistical significance (p = 0.052) when a one-way ANOVA was conducted. The results suggest an association between decrease in traffic volumes with decrease in health care utilization for respiratory diseases. These results suggest that current levels of traffic may be impacting on the respiratory health of residents in the nearby community.
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Affiliation(s)
- J S Lwebuga-Mukasa
- Center for Asthma and Environmental Exposure, Lung Biol Research Program, Dept of Internal Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Kaleida Health Buffalo General Division, Buffalo NY 14203, USA.
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Farrelly MC, Nimsch CT, Hyland A, Cummings M. The effects of higher cigarette prices on tar and nicotine consumption in a cohort of adult smokers. Health Econ 2004; 13:49-58. [PMID: 14724893 DOI: 10.1002/hec.820] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The objective of this paper is to estimate the demand for tar and nicotine in cigarettes as a function of cigarette prices in a cohort of cigarette 11,966 smokers followed for 5 years. Data for the analysis come from a longitudinal telephone survey of 11,966 smokers who were interviewed in 1988 and 1993 as part of the Community Intervention Trial for Smoking Cessation (COMMIT). Separate models are estimated for three age groups to account for differences in levels of addiction and brand loyalty across age. We found that smokers respond to higher cigarette prices by reducing the number of cigarettes smoked per day but also by switching to cigarettes that are higher in tar and nicotine per cigarette.
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Affiliation(s)
- M C Farrelly
- Research Triangle Institute, Research Triangle Park, North Carolina 27709, USA.
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Abstract
OBJECTIVE To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. DATA SOURCES Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. STUDY SELECTION 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. DATA EXTRACTION Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. DATA SYNTHESIS In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. CONCLUSION All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.
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Affiliation(s)
- M Scollo
- VicHealth Centre for Tobacco Control, The Cancer Council, Victoria, Melbourne, Australia.
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Bowen DJ, Orlandi MA, Lichtenstein E, Cummings KM, Hyland A. Intervention effects on youth tobacco use in the community intervention trial (COMMIT). J Epidemiol Community Health 2003; 57:159-60. [PMID: 12540695 PMCID: PMC1732382 DOI: 10.1136/jech.57.2.159-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bowen DJ, Orlandi MA, Lichtenstein E, Cummings KM, Hyland A. Intervention effects on youth tobacco use in the Community Intervention Trial (COMMIT). Tob Control 2002; 11:382. [PMID: 12432170 PMCID: PMC1747686 DOI: 10.1136/tc.11.4.382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hyland A, Garten S, Giovino GA, Cummings KM. Mentholated cigarettes and smoking cessation: findings from COMMIT. Community Intervention Trial for Smoking Cessation. Tob Control 2002; 11:135-9. [PMID: 12035007 PMCID: PMC1763856 DOI: 10.1136/tc.11.2.135] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between the use of menthol cigarettes and smoking cessation, amount smoked, and time to first cigarette in the morning. BACKGROUND The majority of African American smokers smoke mentholated cigarettes. Some evidence suggests that African Americans may be more nicotine dependent than whites. One theory is that menthol in cigarettes is responsible for enhancing the dependence producing capacity of cigarettes; however, few studies have prospectively examined the association between menthol use and indicators of nicotine dependence. METHODS Baseline smokers from the Community Intervention Trial for Smoking Cessation (COMMIT) completed a telephone tobacco use survey in 1988 and were re-interviewed in 1993. Use of mentholated cigarettes was assessed by self report at baseline. Indicators of dependence examined were six month cessation in 1993, amount smoked among continuing smokers in 1993, and time to first cigarette in the morning in 1988. Multivariate regression techniques were used to assess the association of baseline menthol use with these outcomes while controlling for other factors related to dependence. RESULTS Overall, 24% of the sample smoked a mentholated brand in 1988. No consistent associations were observed for menthol use and indicators of dependence in both overall and race specific analyses. Factors significantly associated with increased menthol use were female sex, age 25-34 years, African American and Asian race/ethnicity, greater education, greater than 60 minutes to the first cigarette in the morning, two or more past quit attempts, and use of premium brand cigarettes. Canadian respondents and those who smoked 15-24 cigarettes per day had lower rates of menthol use. Use of mentholated cigarettes was not associated with quitting, amount smoked, or time to first cigarette in the morning. CONCLUSION Future work is needed to clarify the physiological and sociocultural mechanisms involved in mentholated cigarette smoking.
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Affiliation(s)
- A Hyland
- Roswell Park Cancer Institute, Department of Cancer Prevention, Epidemiology, and Biostatistics, Buffalo, New York 14263, USA.
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Cummings KM, Morley CP, Hyland A. Failed promises of the cigarette industry and its effect on consumer misperceptions about the health risks of smoking. Tob Control 2002; 11 Suppl 1:I110-7. [PMID: 11893821 PMCID: PMC1766060 DOI: 10.1136/tc.11.suppl_1.i110] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In January 1954, US tobacco manufacturers jointly sponsored an advocacy advertisement entitled "A Frank Statement to Cigarette Smokers" which appeared in 448 newspapers in 258 cities reaching an estimated 43 245 000 Americans. The advertisement questioned research findings implicating smoking as a cause of cancer, promised consumers that their cigarettes were safe, and pledged to support impartial research to investigate allegations that smoking was harmful to human health. OBJECTIVE To examine (1) the extent to which cigarette companies fulfilled the promises made to consumers in the 1954 "Frank Statement", and (2) the effect of these promises on consumer knowledge, beliefs, and smoking practices. METHODS This study reviews statements made since 1954 by the tobacco companies individually and collectively through the Tobacco Institute and Tobacco Industry Research Committee/Council for Tobacco Research on the subject of smoking as a cause disease, and the industry's pledge to support and disclose the results of impartial research on smoking and health. Many of the industry documents evaluated in this study were obtained from a collection consisting of 116 documents entitled the "Statement of Defendants' Misrepresentations" prepared by attorneys representing the state of Connecticut in the Medicaid litigation against the tobacco industry in 1998. In addition, we searched for corroborating material from tobacco industry documents collected from the tobacco industry's document websites. In order to contrast industry statements on smoking and health with what smokers' actually believed about smoking we reviewed reports of public polling data on smokers' knowledge and beliefs about smoking and disease gathered from tobacco industry sources and from surveys conducted by public health researchers. RESULTS Analysis of public statements issued by the tobacco industry sources over the past five decades shows that the companies maintained the stance that smoking had not been proven to be injurious to health through 1999. The public statements of the tobacco industry are in sharp contrast to the private views expressed by many of their own scientists. The tobacco documents reveal that many scientists within the tobacco industry acknowledged as early as the 1950s that cigarette smoking was unsafe. The sincerity of the industry's promise to support research to find out if smoking was harmful to health and to disclose information about the health effects of smoking can also be questioned based upon the industry's own documents which reveal: (1) scepticism about the scientific value of the smoking and health research program established by the industry; and (2) evidence that research findings implicating smoking as a health problem were often not published or disclosed outside the industry. Industry documents also show that the companies knew that their own customers were misinformed about smoking and health issues. CONCLUSION It is clear that the cigarette companies failed to fulfill the promises made to consumers in the 1954 "Frank Statement" advertisement. The failure of cigarette manufacturers to honour these promises has resulted in a public that even today remains misinformed about the health risks of smoking.
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Affiliation(s)
- K M Cummings
- Department of Cancer Prevention, Epidemiology & Biostatistics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263, USA
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Abstract
OBJECTIVE To describe variation in Tobacco Institute (TI) lobbying expenditures across states and test whether these expenditures vary in relationship to measures of tobacco control activity at the state level. INDEPENDENT VARIABLE Data for this study came from the TI's State Activities Division (SAD) annual budgets for the years 1991-97, excluding 1993. These data include budgetary information pertaining to state and local lobbying activity and special projects reported by state. DEPENDENT VARIABLES The following measures of state tobacco control activity during the period 1991 to 1997 were considered: (1) American Stop Smoking Intervention Study (ASSIST) funding; (2) voter initiatives to raise cigarette taxes; (3) cigarette excise tax level; (4) workplace smoking restrictions; (5) the intensification of smoke-free air laws covering private worksites, government worksites, and restaurants; (6) the intensification of strength of sales to minors laws; (7) the intensification of strength of laws that punish minors for possessing, purchasing, and/or using cigarettes; (8) state status as a major grower of tobacco; (9) partisan control of state government, 1996; and (10) an overall composite index reflecting a state's strength of tobacco control, combining cigarette prices with workplace and home smoking bans. RESULTS The overall annual budget for the TI declined steadily during the 1990s, from $47.7 million in 1991 to $28.1 million by 1996. The proportion of the TI's budget allocated to the SAD remained relatively stable at about 30%. TI expenditures for lobbyists were highest in California where tobacco control activity has been strong for the past decade. We found significant associations between TI SAD expenditures and cigarette excise tax levels, the status of a state as a recipient of federal ASSIST funds, and changes in the strength of statewide laws that penalise minors for possessing, purchasing, and/or using cigarettes. We found little or no association between state and local lobbying budgets of the TI and changes in statewide smoke-free air laws, although we did find evidence of TI special project expenditures earmarked to specific states and localities to resist clean indoor air legislation/regulations (that is, Maryland and New York City). We found no significant correlation between TI lobbying expenditures and sales to minors' laws, status as a major producer of tobacco, or partisan control of state government. CONCLUSIONS The findings from this study support the hypothesis that in the 1990s tobacco control activities such as raising cigarette excise taxes and participation in ASSIST attracted TI resources to undermine these efforts.
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Affiliation(s)
- C P Morley
- Department of Cancer Prevention, Epidemiology & Biostatistics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Ramnath N, Hernandez FJ, Tan DF, Huberman JA, Natarajan N, Beck AF, Hyland A, Todorov IT, Brooks JS, Bepler G. MCM2 is an independent predictor of survival in patients with non-small-cell lung cancer. J Clin Oncol 2001; 19:4259-66. [PMID: 11709570 DOI: 10.1200/jco.2001.19.22.4259] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Minichromosome maintenance protein 2 (MCM2) is a component of the prereplicative complex. It is essential for eukaryotic DNA replication and is only expressed in proliferating cells. The prognostic utility of MCM2 compared with Ki-67, another marker of proliferating cells, on survival of patients with non-small-cell lung cancer (NSCLC) was studied. PATIENTS AND METHODS We examined the immunohistochemical expression of MCM2 and Ki-67 in primary pathologic tumor specimens from 221 NSCLC patients. For each marker, the fraction of tumor cells with positive staining was assessed as a percentage and categorized into four groups: 0% to 24%, 25% to 49%, 50% to 74%, and > or = 75%. MCM2 and Ki-67 immunoreactivities were compared with each other, and associations with pathologic and clinical parameters predictive of survival were analyzed with the chi(2) test. Cox regression models were used to assess associations between MCM2 and Ki-67 and survival while controlling for confounders. RESULTS Independent variables significantly associated with survival were tumor stage, performance status, and staining category. Patients with less than 25% MCM2 immunoreactivity had a longer median survival time than patients with > or = 25% MCM2 immunoreactivity (46 v 31 months; P =.039) and a lower relative risk (RR) of death (RR, 0.55, 95% confidence interval, 0.34 to 0.88). There was no significant association between survival and Ki-67 expression. CONCLUSION Immunostaining of tumor cells for MCM2 is an independent prognostic parameter of survival for patients with NSCLC. Interpretable results can be obtained on more than 96% of paraffin-embedded specimens, and approximately 35% will be in the favorable subgroup, with less than 25% positively stained tumor cells. Whether MCM2 is predictive of response to therapy needs to be studied.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenosquamous/chemistry
- Carcinoma, Adenosquamous/mortality
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Large Cell/chemistry
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/chemistry
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Cell Count
- Female
- Humans
- Immunoenzyme Techniques
- Ki-67 Antigen/analysis
- Lung Neoplasms/chemistry
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Minichromosome Maintenance Complex Component 2
- Neoplasm Staging
- Nuclear Proteins/analysis
- Prognosis
- Survival Rate
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Affiliation(s)
- N Ramnath
- Lung Cancer Program, Roswell Park Cancer Institute, Buffalo, NY, USA
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Affiliation(s)
- K M Cummings
- Department of Cancer Prevention, Epidemiology & Biostatistics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Hyland A, Cummings KM. Laws restricting self-service tobacco displays: will they help? Prev Med 2001; 33:59-60. [PMID: 11482997 DOI: 10.1006/pmed.2001.0854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Hyland
- Department of Cancer Prevention, Epidemiology, and Biostatistics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263, USA.
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Abstract
The actin cytoskeleton underlies several normal cellular functions and is deranged during carcinogenesis. Gelsolin, a multifunctional actin-binding protein, is downregulated in several types of tumors and its abnormal expression is one of the most common defects noted in invasive breast carcinoma (ICA). This study utilizes immunohistochemistry to examine the expression of gelsolin in 95 ICA, 59 ductal carcinoma in situ (DCIS) and 36 benign lesions, including 17 atypical ductal hyperplasia (ADH). Cytoplasmic staining was scored as positive, reduced or negative. Gelsolin expression was then correlated with patient's age, tumor size, histologic grade and lymph node status. All unremarkable breast biopsies, 88% of ADH, 44% of DCIS and 28% of ICA were positive for gelsolin. This represents a significant difference among the groups (p = < 0.0001) and the trend towards reduced gelsolin with the progression to ICA is significantly linear (p = < 0.0001). For invasive carcinoma, patients older than 44 years were significantly more likely to have decreased expression of gelsolin than patients 44 years old and younger (p = 0.007). Bivariate analysis showed no correlation of gelsolin expression with lymph node status (p = 0.62), tumor size (p = 0.10), histologic grade (p = 0.42), estrogen receptor status (p = 1.0) or other clinicopathologic parameters. In clinical follow-up, there were 18 breast tumor related deaths within a median follow-up time of 4.2 years. Survival analysis indicated that the level of gelsolin expression may be associated with survival (p = 0.06). In summary, the frequency of gelsolin deficiency increases significantly with progression from ADH to DCIS to ICA. Additionally, gelsolin expression may be an independent marker of prognosis.
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Affiliation(s)
- J S Winston
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Abstract
OBJECTIVES The aim of this study was to develop a simulation model to predict the effects of taxes on the smoking rate and smoking-attributable deaths. METHODS The model projects the number of smokers and smoking-related deaths from a baseline year forward. The effects of taxes of different sizes, indexed and unindexed, and temporary vs sustained are modeled. RESULTS The model predicts that sustained tax increases have the potential to substantially reduce the number of smokers and the number of premature deaths, with the effects growing over time. Indexing taxes to inflation stems erosion of the tax effect. CONCLUSIONS Tax hikes have the ability to substantially affect smoking rates in the near term. These effects grow over time and lead to substantial savings in lives and health care costs.
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Affiliation(s)
- D T Levy
- Department of the University of Baltimore and Pacific Institute for Research and Evaluation, Rockville, Maryland 20852, USA
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Cummings KM, Hastrup JL, Swedrock T, Hyland A, Perla J, Pauly JL. Consumer perception of risk associated with filters contaminated with glass fibers. Cancer Epidemiol Biomarkers Prev 2000; 9:977-9. [PMID: 11008918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The filters in Eclipse, a new cigarette-like smoking article marketed by R. J. Reynolds Tobacco Company, are contaminated with glass fibers, fragments, and particles. Reported herein are the results of a study in which consumers were questioned about their opinions as to whether exposure to glass fibers in such a filter poses an added health risk beyond that from smoking and whether the manufacturer has an obligation to inform consumers about the glass contamination problem. The study queried 137 adults who were interviewed while waiting at a Division of Motor Vehicles office in Erie County, New York in 1997. All but one person expressed the view that the presence of glass fibers on the filters poses an added health risk beyond that associated with exposure to tobacco smoke alone. Nearly all expressed the position that the cigarette manufacturer has a duty to inform the public about the potential for glass exposure.
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Affiliation(s)
- K M Cummings
- Department of Cancer Prevention, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Abstract
OBJECTIVES We developed a simulation model to predict the effects of policies aimed at reducing smoking initiation by youths younger than 18 years. METHODS The model projected the number of smokers, never smokers, and ex-smokers by age, sex, and racial/ethnic group and the effects of reductions in youth initiation. RESULTS The model predicted that even if tobacco policies eliminated youth initiation, the number of smokers would not be halved for more than 30 years. If initiation were halved and some of the initiation were delayed rather than eliminated, substantially smaller reductions would result. CONCLUSIONS Policies that increase cessation rates are needed to reduce the number of current smokers and the more near-term health problems.
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Affiliation(s)
- D T Levy
- Department of Economics, University of Baltimore, Md., USA.
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Abstract
A pilot study consisting of 76 compliance checks was conducted in October 1998 in Chautauqua County, New York, by a 15-year-old white female. Half of the merchants were randomized to be checked under a standard protocol whereby the minor was instructed to answer truthfully when asked about her age. The remaining stores were checked under a new protocol that permitted the minor to state that she was 18 years old if asked about her age. It was found that untruthful age reporting during compliance checks has little impact on the overall compliance rate.
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Affiliation(s)
- A Hyland
- Department of Cancer Prevention, Epidemiology, and Biostatistics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Green DM, Hyland A, Barcos MP, Reynolds JA, Lee RJ, Hall BC, Zevon MA. Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence. J Clin Oncol 2000; 18:1492-9. [PMID: 10735897 DOI: 10.1200/jco.2000.18.7.1492] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the frequency of and risk factors for second malignant neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in children and adolescents. PATIENTS AND METHODS One hundred eighty-two consecutive, previously untreated patients with Hodgkin's disease who were younger than 20 years of age at diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo, NY) for treatment between January 1, 1960, and December 31, 1989, were studied. Sex-specific standardized incidence ratios (SIRs) were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to SMN incidence. RESULTS Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. The cumulative percentage of patients who developed an SMN was 26.27 +/- 6.75% at 30 years after diagnosis. The SIR was 9.39 (95% confidence interval [CI], 4.05 to 18.49) for male patients and 10.16 (95% CI, 5.56 to 17.05) for female patients. The most frequent SMNs were thyroid cancer, breast cancer, nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Multivariate analysis of sex, treatment with any alkylating agent, treatment with doxorubicin, splenectomy, and relapse (as a time-dependent covariate) with time to SMN onset gave nonsignificant results. CONCLUSION Successfully treated children and adolescents with Hodgkin's disease have a substantial risk for the occurrence of subsequent neoplasms. The most frequent SMNs (skin, thyroid, and breast) are readily detected by physical examination and available screening procedures.
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Affiliation(s)
- D M Green
- Departments of Pediatrics, Cancer Prevention, Epidemiology and Biostatistics, Pathology, Radiation Medicine, and Psychology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Green DM, Hyland A, Chung CS, Zevon MA, Hall BC. Cancer and cardiac mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. J Clin Oncol 1999; 17:3207-15. [PMID: 10506620 DOI: 10.1200/jco.1999.17.10.3207] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of cardiac disease and second malignant neoplasms on late mortality rate and to identify risk factors for late mortality among 15-year survivors of cancer diagnosed during childhood or adolescence. PATIENTS AND METHODS Gender-specific all-cause and cause-specific (cardiac disease, cancer) standardized mortality ratios were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to survival. RESULTS Patients who survived for 15 years after diagnosis had excess subsequent all-cause, cancer (second malignant neoplasms only), and cardiac mortality rates. No decrease in the late mortality rate by treatment era (1960 to 1970, 1971 to 1984) was identified. Risk factors for males included disease recurrence during the first 15 years after diagnosis, treatment with doxorubicin, and the diagnosis of Hodgkin's disease. Those for females included treatment with radiation therapy, treatment with an alkylating agent, and disease recurrence during the first 15 years after diagnosis. Cox regression analysis demonstrated that only an initial duration of remission of less than 15 years (P <.01) and treatment with doxorubicin (P =.08) were significantly associated with shorter survival time for males. No variable was significantly associated with shorter survival time for females in Cox regression analysis. CONCLUSION Fifteen-year survivors of childhood cancer have excess mortality. More effective treatments must be developed to reduce this excess risk. Fifteen-year relapse-free survivors did not have excess mortality. This group will require continued observation to determine whether excess mortality will become apparent as more events occur.
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Affiliation(s)
- D M Green
- Department of Cancer Prevention, Pediatrics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Abstract
On January 10, 1995, New York City's mayor signed into law a bill restricting smoking in most public facilities including restaurant dining areas, workplaces, and sports stadiums. This law was the subject of extensive public debate and was considered quite controversial at the time it was enacted. Passage of the smoking law (known as the New York City Smoke-Free Air Act) helped pave the way for other localities in New York to enact similar restrictions on smoking in public facilities. This article documents the process of enacting the New York City Smoke-Free Air Act.
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Affiliation(s)
- H Clarke
- Department of Cancer Control and Epidemiology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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