Preventing Substance Abuse with American Indian Youth

Substance abuse is one of the worst problems experienced by American Indian people. In this article, methods to prevent substance abuse among Indian young people are described and the future implications of drug and alcohol abuse prevention efforts with Indian youth are discussed.

Predicting 10-year alcohol use trajectories among men age 50 years and older

OBJECTIVE

To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories.

DESIGN

Longitudinal data were used to derive a semiparametric group-based model.

PARTICIPANTS

Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview.

MEASUREMENTS

Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease.

RESULTS

The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6% of cohort), increasing drinkers (5.5%), decreasing drinkers (7.6%), consistent at-risk drinkers (15.6%), and consistent moderate drinkers (30.7%). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95% confidence intervals (95% CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95% CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95% CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95% CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95% CI: 0.39-0.76).

CONCLUSION

Only 30.7% of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.

Characteristics of US counties with no mammography capacity

Access to screening mammography may be limited by the availability of facilities and machines, and nationwide mammography capacity has been declining. We assessed nationwide capacity at state and county levels from 2003 to 2009, the most recent year for which complete data were available. Using mammography facility certification and inspection data from the Food and Drug Administration, we geocoded all mammography facilities in the United States and determined the total number of fully accredited mammography machines in each US County. We categorized mammography capacity as counties with zero capacity (i.e., 0 machines) or counties with capacity (i.e.,≥1 machines), and then compared those two categories by sociodemographic, health care, and geographic characteristics. We found that mammography capacity was not distributed equally across counties within states and that more than 27 % of counties had zero capacity. Although the number of mammography facilities and machines decreased slightly from 2003 to 2009, the percentage of counties with zero capacity changed little. In adjusted analyses, having zero mammography capacity was most strongly associated with low population density (OR = 11.0; 95 % CI 7.7-15.9), low primary care physician density (OR = 8.9; 95 % CI 6.8-11.7), and a low percentage of insured residents (OR = 3.3; 95 % CI 2.5-4.3) when compared with counties having at least one mammography machine. Mammography capacity has been and remains a concern for a portion of the US population--a population that is mostly but not entirely rural.

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline

OBJECTIVES

To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN

Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING

Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS

One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS

Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS

All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION

Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

The effect of caregiving on women in families with Duchenne/Becker muscular dystrophy

Duchenne/Becker muscular dystrophy (DBMD) is a disorder of progressive muscle weakness that causes an increasing need for assistance with activities of daily living. Our objective was to assess the psychosocial health and contributing factors among female caregivers in families with DBMD. We conducted a survey of adult women among families with DBMD in the United States (US) from June 2006 through January 2007, collecting data related to the care recipient, perception of caregiving demands, personal factors, and socio-ecologic factors. Life satisfaction, stress, and distress were assessed as outcomes. Existing validated instruments were used when available. We received responses from 1238 women who were caring for someone with DBMD, 24.2% of whom were caring for two or more people with DBMD. Caregivers were more likely to be married/cohabitating than women in the general US population, and a high level of resiliency was reported by 89.3% of caregivers. However, the rate of serious psychological distress was significantly higher among caregivers than among the general population. Likewise, 46.4% reported a high level of stress, and only 61.7% reported that they were satisfied with their life. A high level of caregiving demands based on the Zarit Burden Interview (ZBI) was reported by 50.4% of caregivers. The post-ambulatory phase of DBMD was associated with decreased social support and increased ZBI scores. In multivariate logistic regression modelling, life satisfaction was dependent on high social support, high resiliency, high income, and form of DBMD. Distress and high stress were predicted by low resiliency, low social support, and low income. Employment outside of the home was also a predictor of high stress. Interventions focused on resiliency and social support are likely to improve the quality of life of DBMD caregivers, and perhaps caregivers of children with other disabilities or special health care needs as well.

Adherence to american academy of pediatrics recommendations for cardiac care among female carriers of duchenne and becker muscular dystrophy

OBJECTIVE

The goal was to assess women's knowledge and heart health behaviors consistent with the American Academy of Pediatrics recommendations for cardiac care among female carriers of Duchenne/Becker muscular dystrophy.

METHODS

Using an advocacy group mailing list and working with 50 Muscular Dystrophy Association clinics, we surveyed women who had given birth to a son with Duchenne/Becker muscular dystrophy, thought that they were definitely or probably (>/=50% likelihood) a Duchenne/Becker muscular dystrophy carrier, or both. Self-report data classified respondents as carriers, noncarriers, or women with unknown status.

RESULTS

The respondents included 833 Duchenne/Becker muscular dystrophy carriers, 376 noncarriers, and 192 women with unknown status. Carriers were more likely than noncarriers and women in the unknown-status group to have ever undergone electrocardiography or other heart testing and to have seen a cardiologist in the past year, but they were not more likely to report a recent blood pressure or cholesterol level check. Only 64.4% of the carriers had ever had a heart test; 18.3% had seen a cardiologist in the past year. Only 62.9% of the carriers were aware of their cardiomyopathy risks before participating in the survey; 69.3% had informed their health care provider of their carrier status. Among carriers who had informed their provider, 70.2% had ever had a heart test and 21.4% had seen a cardiologist in the past year. In adjusted logistic regression models, factors that significantly increased the likelihood among carriers of ever having had a heart test and seeing a cardiologist in the previous year included older age (>/=50 years), feeling informed about their cardiomyopathy risks before the survey, and having told their provider about their carrier status.

CONCLUSION

More health education efforts are needed for both patients and their providers, to improve adherence to the American Academy of Pediatrics cardiac care guidelines for female Duchenne/Becker muscular dystrophy carriers.

Identifying social drinkers likely to consume alcohol during pregnancy: findings from a prospective cohort study

To prevent fetal alcohol syndrome, some social drinkers who may become pregnant need more than a brief caution, but they can be difficult to detect in clinical settings. National Longitudinal Survey of Youth data from 754 women who completed up to four alcohol history interviews during their college-age years (18-21), and semiparametric group-based models were used to identify groups more likely to drink during a future pregnancy. Two drinking trajectories were observed. About 87% of the women were occasional or nondrinkers during their college-age years; 13% were frequent drinkers. Among first-births to women 22 yr. and older, the adjusted odds ratio for alcohol use during that pregnancy for frequent drinkers versus occasional and nondrinkers was 2.29 (95% confidence interval: 1.25-4.17). This finding suggests women who report frequent drinking during their college-age years may require additional assistance to reduce their risk of drinking during subsequent pregnancies.

Changes in the Prevalence of Alcohol Use during Pregnancy among Recent and At-Risk Drinkers in the NLSY Cohort

PURPOSE

To support efforts to prevent fetal alcohol syndrome (FAS), population-based data are needed on the prevalence of alcohol use at any time during gestation, particularly among women who were recent and at-risk drinkers.

METHODS

We used National Longitudinal Survey of Labor Market Experiences in Youth (NLSY) files to estimate the prevalence of any drinking during pregnancy and to evaluate alcohol history risk factors among 6676 births reported by women with prepregnancy drinking data. Prevalence estimates were obtained for 2-year intervals for all 1982-1995 births and for subsets with prepregnancy recent and at-risk drinking.

RESULTS

Among all births, drinking during pregnancy declined from 38.3% in 1982-1983 to 23.0% in 1994-1995 (p < 0.0001). Drinking during pregnancy also declined over time among recent and at-risk drinkers (p < 0.0001), but the 1994-1995 prevalences were still high (39.3% and 29.0%, respectively). Adjusted logistic models confirmed both the decrease in risk for the later birth years and the persistent heightened risk for births among recent and at-risk drinkers.

CONCLUSIONS

In addition to ongoing universal prevention strategies that have helped reduce the prevalence of drinking during pregnancy, selective and indicated prevention approaches are needed to encourage abstinence during pregnancy among recent and at-risk drinkers.

Impact of women's experiences during mammography on adherence to rescreening (United States)

OBJECTIVE

To examine the relationship between womens' experiences during mammography and their likelihood of being rescreened after receiving a negative or benign mammogram.

METHODS

Telephone interview and medical record data were collected from a random sample of enrollees from four states in a national screening program targeting uninsured and underinsured women at least 30 months after they had undergone an index mammogram in 1997. We calculated 30-month rescreening rates by prior mammography characteristics including pain and embarrassment, worry, convenience of appointment time, treatment by staff, and financial considerations.

RESULTS

Of the 2,000 women in the sampling frame, 1,895 (93.6%) were located, 1,685 (88.6%) were interviewed and 1,680 provided data required for our analysis. Overall, 81.5% of the women had undergone rescreening. More than 90% of the women reported being 'satisfied' or 'very satisfied' with treatment by facility staff, facility location and wait time during the appointment. Statistically significant decreased rescreening rates were seen for women who reported feeling embarrassed and for women reporting dissatisfaction with ability to schedule a convenient appointment time.

CONCLUSION

These results suggest that providing additional reassurance and privacy may increase rescreening rates.

Recall of age of weaning and other breastfeeding variables

BACKGROUND

Many studies of the impact of breastfeeding on child or maternal health have relied on data reported retrospectively. The goal of this study was to assess recall accuracy among breastfeeding mothers of retrospectively collected data on age of weaning, reasons for cessation, breast pain, lactation mastitis, and pumping.

METHODS

Women in Michigan and Nebraska, U.S.A. were interviewed by telephone every 3 weeks during the first 3 months after the birth of their child, and mailed a questionnaire at 6 months. A subset was interviewed again by telephone approximately 1-3.5 years after the birth. The results for the three recall periods, collected 1994-1998, were compared using correlation, linear and Cox regression analysis, and sensitivity and specificity estimates.

RESULTS

The 184 participants were aged 18-42, mostly white (95%) and 63% had an older child. The age of weaning tended to be overestimated in interviews 1-3.5 years after birth compared to those within 3 weeks of the event, by approximately one month for 1-3.5 year recall and two weeks for 6-month recall (p < 0.001 in both cases). Recall accuracy of reasons for weaning varied greatly by reason, with mastitis and return to work having the most recall validity. The sensitivity of 1-3.5 year recall of mastitis was 80%, but was only 54% for nipple cracks or sores.

CONCLUSION

Breastfeeding duration among short-term breastfeeders tended to be somewhat overestimated when measured at 1-3.5 years post-partum. Reporting of other breastfeeding characteristics had variable reliability. Studies employing retrospective breastfeeding data should consider the possibility of such errors.

Efforts to Locate Low-Income Women for a Study on Mammography Rescreening: Implications for Public Health Practice

Public health practice often requires locating individuals in the community. This article presents information on the methods and amount of time and effort required to locate over 2300 low-income and minority women in Maryland, New York, Ohio, and Texas for a mammography rescreening study. In 1999, we identified 2528 low-income women who had a mammogram in 1997 funded by the National Breast and Cervical Cancer Early Detection Program. Starting 30 months after that mammogram, we made numerous attempts to locate each woman while recording the number of calls, letters, and tracing attempts used and the date she was found. More than 93% of the women were located. On average, it took 73.8 days (range 1-492 days) and 7.2 calls and letters (range 1-48) to reach each woman. Locating women in racial and ethnic minority groups required more time and effort. About 10% of all located women were found only after our subject tracing protocol was implemented. The percentage of located women increased markedly with more months of effort and additional calls and letters. Because women who were more difficult to locate were less likely to have been rescreened, the mammography rescreening percentages at the end of the study were slightly lower than they would have been had we terminated location efforts after 1-3 months. Locating low-income women in the community is difficult, particularly when obtaining a high response rate from all groups is important. Terminating data collection prematurely may decrease minority group representation and introduce bias.

Clinical breast examination: practical recommendations for optimizing performance and reporting

Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer.

On-Schedule Mammography Rescreening in the National Breast and Cervical Cancer Early Detection Program

Objective: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cancer screening to many low-income, underinsured women annually but does not routinely collect all data necessary for precise estimation of mammography rescreening rates among enrollees. Materials and Methods: To determine the percentages rescreened and to identify factors that encourage on-schedule rescreening, telephone interview and medical record data were collected from 1685 enrollees in Maryland, New York, Ohio, and Texas at least 30 months after their 1997 index mammogram. Results: Overall, 72.4% [95% confidence interval (95% CI) = 70.1–74.7] were rescreened within 18 months and 81.5% (95% CI = 79.6–83.5) within 30 months. At 30 months, the adjusted odds ratios (ORs) for rescreening were higher among Hispanics (OR = 1.95, 95% CI = 1.15–3.28), women with a history of breast cancer before the index mammogram (OR = 3.36, 95% CI = 1.07–10.53), and those who had used hormone replacement therapy before their index mammogram (OR =1.94, 95% CI = 1.30–2.91). The 30-month adjusted ORs were lower for women who reported poor health status (OR = 0.60, 95% CI = 0.42–0.85), did not have a usual source of care (OR = 0.61, 95% CI = 0.40–0.94), did not know if they could have another free mammogram (OR = 0.28, 95% CI = 0.14–0.51), described their index screen as their first mammogram ever (OR for no prior mammograms versus three or more = 0.40, 95% CI = 0.27–0.60), did not recall receiving a rescreening reminder (OR = 0.35, 95% CI = 0.25–0.48), or did not think they had been encouraged to rescreen by their provider (OR = 0.61, 95% CI = 0.44–0.86). Discussion: Rescreening behavior in this sample of NBCCEDP enrollees was comparable with that observed in other populations. To facilitate routine rescreening among low-income women, ongoing efforts are needed to ensure they receive annual reminders and encouragements from their medical providers and that they know how to obtain the services they need.

On-schedule mammography rescreening in the National Breast and Cervical Cancer Early Detection Program

OBJECTIVE

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cancer screening to many low-income, underinsured women annually but does not routinely collect all data necessary for precise estimation of mammography rescreening rates among enrollees.

MATERIALS AND METHODS

To determine the percentages rescreened and to identify factors that encourage on-schedule rescreening, telephone interview and medical record data were collected from 1685 enrollees in Maryland, New York, Ohio, and Texas at least 30 months after their 1997 index mammogram.

RESULTS

Overall, 72.4% [95% confidence interval (95% CI) = 70.1-74.7] were rescreened within 18 months and 81.5% (95% CI = 79.6-83.5) within 30 months. At 30 months, the adjusted odds ratios (ORs) for rescreening were higher among Hispanics (OR = 1.95, 95% CI = 1.15-3.28), women with a history of breast cancer before the index mammogram (OR = 3.36, 95% CI = 1.07-10.53), and those who had used hormone replacement therapy before their index mammogram (OR =1.94, 95% CI = 1.30-2.91). The 30-month adjusted ORs were lower for women who reported poor health status (OR = 0.60, 95% CI = 0.42-0.85), did not have a usual source of care (OR = 0.61, 95% CI = 0.40-0.94), did not know if they could have another free mammogram (OR = 0.28, 95% CI = 0.14-0.51), described their index screen as their first mammogram ever (OR for no prior mammograms versus three or more = 0.40, 95% CI = 0.27-0.60), did not recall receiving a rescreening reminder (OR = 0.35, 95% CI = 0.25-0.48), or did not think they had been encouraged to rescreen by their provider (OR = 0.61, 95% CI = 0.44-0.86).

DISCUSSION

Rescreening behavior in this sample of NBCCEDP enrollees was comparable with that observed in other populations. To facilitate routine rescreening among low-income women, ongoing efforts are needed to ensure that they receive annual reminders and encouragements from their medical providers and that they know how to obtain the services they need.

Risk factors for failure to detect a cancer during clinical breast examinations (United States)

BACKGROUND

Although clinical breast examinations (CBEs) provide important opportunities to detect breast cancer, little is known about factors that affect cancer detection during CBEs performed in community settings. To evaluate several potential factors, we analyzed data from 1,056,153 cancer screening records reported to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

METHODS

Using case-series methods, we compared 2159 cancers missed during CBEs with 3161 cancers detected during CBEs. Cancers missed during CBE were found by mammography and confirmed by biopsy or fine needle aspiration.

RESULTS

After controling for cancer stage, tumor size, and breast symptoms at time of CBE, we found that patient age and CBE history were significantly associated with the likelihood of cancer detection. Compared to women 50-59, women 40-49 were more likely to have their cancer detected during CBE (odds ratio (OR) = 1.84, 95% confidence interval (95% CI) 1.47-2.29), while women 70 and older were less likely to have it detected (OR = 0.74, 95% CI: 0.55-1.00). Among women receiving their first NBCCEDP-funded CBE, 67.5% had their cancer detected by CBE. Among women receiving their second or third CBE, the values were 59.3 and 48.8%, respectively. In an adjusted logistic model, a significant inverse relationship was observed between number of prior CBEs and percent of cancers detected in the index CBE (OR = 0.79, 95% CI: 0.72-0.88).

CONCLUSIONS

Among women diagnosed with breast cancer, older women and those who have had multiple CBEs were more likely to have their cancer missed during CBE.

Activities of epidemiologists in state and territorial cancer control programs, 1999

The Council of State and Territorial Epidemiologists surveyed the chronic disease program directors in 1999. Forty-eight (89%) of the health agencies responded. Nearly 90 percent reported having an epidemiologist who devoted some time to cancer control activities. More than 90 percent reported the availability and use of the mortality, incidence, and risk factor data. Almost 70 percent of the respondents produced annual cancer reports, but less than half reported publishing in a state bulletin or scientific journal. These findings suggest that despite widespread access to epidemiologic expertise and cancer-related data, considerable variability persists in the use and dissemination of crucial cancer statistics.

Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States

In 1994-1998, the authors followed 946 breastfeeding women from Michigan and Nebraska for the first 3 months postpartum or until they stopped breastfeeding to describe mastitis incidence, mastitis treatment, and any associations between mastitis occurrence and hypothesized host characteristics and behaviors. Participants were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until they ceased breastfeeding. A total of 9.5% reported provider-diagnosed lactation mastitis at least once during the 12-week period, with 64% diagnosed via telephone. After adjustment in a logistic regression model, history of mastitis with a previous child (odds ratio (OR) = 4.0, 95% confidence interval (CI): 2.64, 6.11), cracks and nipple sores in the same week as mastitis (OR = 3.4, 95% CI: 2.04, 5.51), using an antifungal nipple cream (presumably for nipple thrush) in the same 3-week interval as mastitis (OR = 3.4, 95% CI: 1.37, 8.54), and (for women with no prior mastitis history) using a manual breast pump (OR = 3.3, 95% CI: 1.92, 5.62) strongly predicted mastitis. Feeding fewer than 10 times per day was protective regardless of whether or not feeding frequency in the same week or the week before mastitis was included in the model (for the same week: 7-9 times: OR = 0.6, 95% CI: 0.41, 1.01; < or =6 times: OR = 0.4, 95% CI: 0.19, 0.82). Duration of feeding was not associated with mastitis risk.

Mammography and breast cancer detection by race and Hispanic ethnicity: results from a national program (United States)

OBJECTIVE

Some of the racial and ethnic variation in breast cancer incidence rates may reflect differential use of mammography. We report breast cancer rates using mammography and diagnostic data from five race/ethnicity groups.

METHODS

Mammography data were analyzed for 573,751 women who received breast cancer screening between July 1991 and March 1998 from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Abnormal mammography rates, breast cancer detection rates, and cancer stage distribution data are presented by race/ethnicity and screening round (first or subsequent).

RESULTS

For the first screening round, percentages of abnormal mammographies ranged from 7.3% among black women to 9.3% among Asian/Pacific Islander women. Cancer detection rates ranged from 4.9 cancers per 1000 mammograms for Hispanic and American Indian/Alaska Native (AI/AN) women to 7.7 per 1000 for white women. Subsequent round rates were lower but varied similarly. AI/AN women had the highest percentage (68%) of first-round cancers detected in the early stage (range for the other groups: 52-63%).

CONCLUSIONS

Breast cancer detection rates for racial and ethnic groups in this program varied less than published population-based incidence rates. Differential use of mammography among these groups may account for some of the variation reported for breast cancer incidence.

Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998

BACKGROUND AND METHODS

Mammography programs have received extensive study, but little is known about the outcome of clinical breast examinations (CBEs) performed in community settings. Consequently, we analyzed data from the National Breast and Cervical Cancer Early Detection Program on CBEs provided to low-income women from 1995 through 1998 and determined the percentage of CBEs considered to be abnormal, suspicious for cancer; the rates of cancer detection; and the sensitivity, specificity, and positive predictive value of CBEs.

RESULTS

We analyzed data from 752081 CBEs and found that 6.9% of all CBEs were coded abnormal, suspicious for cancer, and that 5.0 cancers were detected per 1000 examinations (95% confidence interval [CI] = 4.9-5.2). The values observed for sensitivity (58.8%) and specificity (93.4%) were comparable to those reported for the CBE component of clinical trials. The observed positive predictive value was 4.3%. About 74% of all records also reported mammography results. The cancer-detection rate among records reporting an abnormal CBE and normal mammography was 7.4 cancers per 1000 records (95% CI = 6. 3-8.4). When the CBE was normal but the mammography was abnormal, the rate was 42.0 cancers per 1000 records (95% CI = 39.9-44.1). When both CBE and mammography results were abnormal, the rate was 170.3 cancers per 1000 records (95% CI = 162.7-177.9). Cancer detection could not be attributed entirely to CBE or mammography on 38% of the records in the latter subset because the tests were performed on the same day.

CONCLUSION

CBEs performed in community-based screening programs can detect breast cancers as effectively as CBEs performed in clinical trials and may modestly improve early-detection campaigns.

Implementing recommendations for the early detection of breast and cervical cancer among low-income women

SCOPE OF THE PROBLEM

Among U.S. women, breast cancer is the most commonly diagnosed cancer and remains second only to lung cancer as a cause of cancer-related mortality. The American Cancer Society (ACS) estimates that 182,800 new cases of female breast cancer and 41,200 deaths from breast cancer will occur in 2000. Since the 1950s, the incidence of invasive cervical cancer and mortality from this disease have decreased substantially; much of the decline is attributed to widespread use of the Papanicolaou (Pap) test. ACS estimates that 12,800 new cases of invasive cervical cancer will be diagnosed, and 4,600 deaths from this disease will occur in the United States in 2000.

ETIOLOGIC FACTORS

The risk for breast cancer increases with advancing age; other risk factors include personal or family history of breast cancer, certain benign breast diseases, early age at menarche, late age at menopause, white race, nulliparity, and igher socioeconomic status. Risk factors for cervical cancer include certain human papilloma virus infections, early age at first intercourse, multiple male sex partners, a history of sexually transmitted diseases, and low socioeconomic status. Black, Hispanic, or American Indian racial/ethnic background is considered a risk factor because cervical cancer detection and death rates are higher among these women.

RECOMMENDATIONS FOR PREVENTION

Because studies of the etiology of breast cancer have failed to identify feasible primary prevention strategies suitable for use in the general population, reducing mortality from breast cancer through early detection has become a high priority. The potential for reducing death rates from breast cancer is contingent on increasing mammography screening rates and subsequently detecting the disease at an early stage--when more treatment options are available and survival rates are higher. Effective control of cervical cancer depends primarily on early detection of precancerous lesions through use of the Papanicolaou test, followed by timely evaluation and treatment. Thus, the intended outcome of cervical cancer screening differs from that of breast cancer screening. In 1991, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was implemented to increase breast and cervical cancer screening among uninsured, low-income women.

RESEARCH AGENDA

To support recommended priority activities for NBCCEDP, CDC has developed a research agenda comprising six priorities. These six priorities are a) determining effective strategies to communicate changes in NBCCEDP policy to cancer screening providers and women enrolled in the program; b) identifying effective strategies to increase the proportion of enrolled women who complete routine breast and cervical cancer rescreening according to NBCCEDP policy; c) identifying effective strategies to increase NBCCEDP enrollment among eligible women who have never received breast or cervical cancerscreening; d) evaluating variations in clinical practice patterns among providers of NBCCEDP screening services; e) determining optimal models for providing case-management services to women in NBCCEDP who have an abnormal screening result, precancerous breast or cervical lesion, or a diagnosis of cancer; and f) conducting economic analyses to determine costs of providing screening services in NBCCEDP.

CONCLUSION

The NBCCEDP, through federal, state, territorial, and tribal governments, in collaboration with national and community-based organizations, has increased access to breast and cervical cancer screening among low-income and uninsured women. This initiative enabled the United States to make substantial progress toward achieving the Healthy People 2000 objectives for breast and cervical cancer control among racial/ethnic minorities and persons who are medically underserved. A continuing challenge for the future is to increase national commitment to providing screening services for all eligible uninsured women to ultimately reduce morbidity and mortality from breast and cervical cancer.

Sociocultural influences on smoking and drinking

Numerous research studies have shown that sociocultural factors influence the initiation and continued use of alcohol and tobacco among adolescents and adults. Few studies have examined the effects of sociocultural factors on the tendency of smokers to drink and drinkers to smoke. However, the limited evidence available suggests that such factors exist and that the strength of the association between alcohol and tobacco use behaviors varies with the levels of alcohol use. Public health interventions focused on concurrent tobacco and alcohol use could yield further reductions in the morbidity and mortality associated with these substances.

Factors that may discourage annual mammography among low-income women with access to free mammograms: a study using multi-ethnic, multiracial focus groups

Age-eligible women enrolled in the National Breast and Cervical Cancer Early Detection Program can obtain free or low-cost mammograms annually, but many do not routinely complete rescreening. This study investigated the rescreening behavior of low-income women by conducting 8 focus groups in Texas with enrollees who had access to free mammograms. Concerns mentioned in the focus groups included fear of radiation, anxiety that the test might not find a cancer that was there, and worries that cancer might be detected. In all groups, some women mentioned the embarrassment, discomfort, or pain they experienced during a prior mammogram, although no one indicated they would refuse to have another mammogram because of these concerns. Findings highlight the useful insights that can be obtained from focus groups and underscore the need for more research on aspects of the experience of mammography that may affect rescreening.

Tobacco cessation with patients recovering from alcohol and other substance abuse

This article focuses on the problem of tobacco cessation in the patient recovering from alcohol or other substance abuse. The authors review the epidemiology of the problem, specific health risks to this population from continued tobacco use, and recent research findings that address previous treatment concerns. Recommendations for counseling by physicians are made. These include an algorithm for determining the patient's stage of readiness for making a quit attempt, specific counseling tasks based on the patients stage, and motivational counseling strategies aimed at increasing the patients motivation to quit.

Prevalence of morphologic defects in spermatozoa from beef bulls

OBJECTIVE

To determine the overall prevalence of morphologic defects in spermatozoa from beef bulls and to determine whether prevalence varies with the age of the bull.

DESIGN

Cross-sectional observational study.

ANIMALS

2,497 beef bulls that were evaluated for breeding soundness in 1994 by 29 practicing veterinarians in a 5-state geographic region.

PROCEDURE

Slides of spermatozoa from each bull were made and submitted by practicing veterinarians for morphologic evaluation. One hundred spermatozoa per slide were examined, and each was classified as having 1 of 9 morphologic defects or as normal.

RESULTS

63% of bulls evaluated were 10 to 12 months old, and 20% were 13 to 18 months old. A mean of 70.6% of spermatozoa was classified as normal. Most common defects were proximal droplets (8.4%), distal midpiece reflexes (6.7%), separated heads (5.5%), and distal droplets (3.8%). Other defects were seen < 2% of the time. Bulls 10 to 12 months of age had a higher prevalence of proximal and distal droplet defects than older bulls.

CLINICAL IMPLICATIONS

Practitioners conducting breeding soundness evaluations in beef bulls must be aware of common spermatozoal defects. Bulls that are evaluated at a young age will have more defects than older bulls and should be reevaluated, particularly for those defects for which prevalence decreases with age.

Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial

AIMS

To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment.

DESIGN AND SETTING

A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition.

PARTICIPANTS

Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge.

INTERVENTION

Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care.

FINDINGS

Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant.

CONCLUSIONS

Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.

Depression screening scores during residential drug treatment and risk of drug use after discharge

Depression is a highly prevalent disorder among patients in residential drug treatment, and the prognosis for recovery from chemical dependency among depressed persons is uncertain. This report presents one-year follow-up data on alcohol, cocaine, and marijuana use among patients who completed the Center for Epidemiologic Studies Depression Scale (CES-D) during their inpatient stay in one of 12 residential treatment programs in the Midwest. At 12-month follow-up, CES-D scores in the depressed range were significantly associated with risk of relapse for alcohol and marijuana use, but not for cocaine use.

Practical steps to smoking cessation for recovering alcoholics

Smoking rates among persons with a history of alcohol abuse are triple that of the general public. Strong evidence indicates that the risk of cancer and cardiovascular disease is higher in recovering alcoholics than in peers who smoke, but do not drink alcohol. Yet these persons often receive less than optimal tobacco counseling out of fear that attempts at smoking cessation will jeopardize their sobriety. Recent research, however, does not support this belief; rather, it suggests that smoking cessation may actually enhance alcohol abstinence. A model for more effective counseling of smokers in recovery is presented, including an algorithm for assessing stages of readiness to change, with activities tailored for each stage. Specific motivational counseling techniques may be useful in encouraging recovering alcoholics to progress to the point that they are ready to change their smoking behavior.

Training chemical dependency counselors to treat nicotine dependence

To test the effectiveness of providing chemical dependency (CD) staff with a knowledge-and-skills-building workshop on treatment of nicotine dependence, we employed a nested cross-sectional design with six outpatient CD programs in Nebraska (3 intervention, 3 control sites). Data on tobacco counseling provided by CD staff were obtained by telephone from sequential samples of smokers currently receiving alcohol treatment at each participating site. Intervention site clients with clinic visits after the staff training workshop were no more likely than intervention-site clients with clinic visits before the workshop to report having been counseled about their smoking (OR = 0.95, 95% confidence interval (CI): 0.74-1.21). However, control-site clients were significantly more likely to report having been counseled about smoking during the second half of the study (OR = 2.15, 95% CI: 1.49-3.08), even though staff training was not provided at control sites until data collection had been completed. These findings suggest that in some alcohol treatment programs simple monitoring of staff counseling practices may be sufficient to increase the frequency of attention to tobacco. In others, more intensive efforts might be needed to shift CD staff toward more consistent treatment of nicotine dependence.

Feasibility of smoking cessation counseling by phone with alcohol treatment center graduates

Several studies have tested the effectiveness of telephone counseling as a smoking cessation intervention, but few have addressed its application with the special population of smokers who are also problem drinkers or recovering alcoholics. Two hundred and eighty-eight male and female subjects were recruited from six residential alcohol treatment programs in Nebraska, Iowa, and Kansas to receive three postreatment telephone calls based on the stages of change model. Most subjects (71%) participated in at least one telephone counseling session, but only 38% participated in all three. Those who completed of session were significantly (p < .01) more likely to have advanced one stage of change in their readiness to quit smoking and to report having quit smoking for at least 24 hours since leaving treatment (p < .01). Stage-based telephone counseling appears to be a feasible approach to addressing smoking cessation among recovering alcoholics, with a modest positive effect on subsequent tobacco use.

Nicotine dependence and intentions to quit smoking in three samples of male and female recovering alcoholics and problem drinkers

We report gender-specific data on tobacco use and quitting smoking from three studies of nicotine-related issues during alcoholism treatment. Study 1 data are from 309 alcoholism treatment professionals who were current or former smokers with a personal history of alcoholism or problem drinking. Study 2 data are from 496 smokers receiving counseling for their problems with alcohol in outpatient alcoholism treatment centers. Study 3 data are from 90 smokers receiving intensive alcoholism treatment in residential or inpatient programs. Interest in smoking cessation was high in all groups. Significant gender differences were apparent among the recovering alcoholics but not among the problem drinkers. Severity of alcohol use problems also showed some association with smoking cessation behaviors.

Predictors of tobacco quit attempts among recovering alcoholics

Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. During the first 6 months after discharge from residential alcohol treatment, 31% of all participants reported having quit smoking for 48 hrs or longer. Demographic and drug use history variables did not predict quit attempts, but two baseline tobacco use variables did, specifically the Fagerstrom Test for Nicotine Dependence and stage of readiness to quit smoking, p < .01. Participants with high or very high nicotine dependence scores were significantly less likely than those with moderate or low scores to attempt smoking cessation. Compared to those in precontemplation at baseline, those in the preparation stage of readiness to change were about 12 times more likely to make a serious quit attempt.

Nicotine addiction counseling for chemically dependent patients

A total of 771 professionals employed in alcohol treatment programs in Nebraska were surveyed to determine whether their personal alcohol and tobacco use status or characteristics of their treatment programs were related to whether they provided nicotine addiction counseling. About a third of respondents agreed that clients in active treatment should be urged to quit smoking. Compared with respondents who had never smoked, current smokers were one-half to one-third as likely to provide such counseling. Greater knowledge of the effects of nicotine addiction and employment in programs that provided nicotine addiction education or treatment increased the odds of counselors' providing nicotine counseling. Counselors' alcohol use status was not associated with nicotine counseling practices.

Alcohol and tobacco use in the Minnesota Heart Health Program

Correlations between alcohol intake and cigarette smoking have been extensively documented. Prospective data on the relationship between smoking and alcohol remain quite limited. The Minnesota Heart Health Program (MHHP) collected such data as part of a 10-year research and demonstration project intended to reduce the prevalence of heart disease. The study involved six communities, three that received intervention and three, comparison. The current analyses focused upon baseline relationships and longitudinal changes in alcohol and tobacco use. Contrary to prediction, those who quit smoking were no more likely than continuing smokers to reduce alcohol intake. Furthermore, alcohol intake at baseline did not predict smoking status at follow-up. Gender differences were found in a number of comparisons. Further study is needed of changes in smoking and drinking patterns over time in the general population.

Acute encephalopathy and seizure rates in children under age two years in Oregon and Washington state

A surveillance network was established in Oregon and Washington state to identify cases of certain neurologic illnesses during a one-year period (August 1, 1987 to July 31, 1988) among children 1-24 months of age. Reported here are the observed case occurrence rates and findings from capture-recapture analyses used to predict rates that would have been observed had ascertainment been complete. The network consisted of a hospital component involving 98% of all eligible facilities, a provider component involving 93% of all eligible pediatricians and neurologists, and a research staff component of record abstractors. Of 3,876 potential cases reported, 626 met the study criteria. The observed rates for the primary diagnostic groups were: encephalopathies, 16 per 100,000 children; infantile spasms, 10 per 100,000 children; afebrile seizures, 159 per 100,000 children; and complex febrile seizures, 101 per 100,000 children. Of the 626 qualifying cases, 41% were reported by two or more surveillance components. Capture-recapture analyses with log-linear modeling to control for source dependence suggested 80% of all study cases were detected. Comparable percentages for the four illness groups were: encephalopathies, 82%; infantile spasms, 94%; afebrile seizures, 69%; and complex febrile seizures, 91%. The predicted rate for afebrile seizures, corrected for under-ascertainment, exceeded the upper 95% confidence interval bound around the observed rate. For all other conditions, predicted rates fell within the 95% confidence intervals around the observed rates. These findings suggest capture-recapture analyses should be applied to the full sample of cases and to relevant disease substrata.

Risk of serious acute neurological illness after immunization with diphtheria-tetanus-pertussis vaccine. A population-based case-control study

OBJECTIVE

To evaluate the association between serious acute neurological illness and receipt of whole-cell pertussis vaccine, given as diphtheria-tetanus-pertussis (DTP) vaccine.

DESIGN

Population-based case-control study.

SETTING

Outpatient and inpatient hospital settings, physician practices, and the general population in Washington and Oregon states.

SUBJECTS

A total of 424 confirmed cases of neurological illness were identified prospectively during a 12-month period by statewide active surveillance from the population of 218,000 children 1 to 24 months of age living in Washington and Oregon (estimated 368,000 DTP immunizations given). Each case child was matched to two population control children by birth date (+/- 5 days), gender, and county of birth. Written immunization records were used to determine whether illness occurred within 7 days of immunization in case children, or within 7 days of the same reference date in control children, thus qualifying as exposed.

MAIN OUTCOME MEASURES

Outpatient and inpatient cases of complex febrile seizures, seizures without fever, infantile spasms, and acute encephalitis/encephalopathy confirmed by an expert panel masked to immunization history.

RESULTS

The estimated odds ratio (OR) for onset of serious acute neurological illness within 7 days for young children exposed to DTP vaccine was 1.1 (95% confidence interval [CI], 0.6 to 2.0). When the analysis was restricted to children with encephalopathy or complicated seizures and adjusted for factors possibly affecting vaccine administration, the OR was 3.6 (95% CI, 0.8 to 15.2). Odds ratios for specific study diagnoses varied, but all CIs included 1. No elevated risk was observed for the largest group of illnesses studied, nonfebrile seizures (OR, 0.5; 95% CI, 0.2 to 1.5).

CONCLUSIONS

This study did not find any statistically significant increased risk of onset of serious acute neurological illness in the 7 days after DTP vaccine exposure for young children.

Cigarette smoking cessation and alcohol treatment

Cigarette smoking is common among problem drinkers and recovering alcoholics but most cessation research has not addressed this special population of smokers. Confidential survey data were collected from over 700 alcoholism counselors and medical personnel in residential and outpatient chemical dependency units (CDUs) in Nebraska to identify the quit smoking method these experts recommend and to assess their personal experiences with smoking cessation. A total of 334 respondents (45% of the group) self-identified as a recovering alcoholic, 51 (7%) as a problem drinker, and 350 (48%) as having no history of alcohol problems. Over 63% of all respondents were former or current smokers. The most frequently recommended quitting methods for people still in treatment for alcohol problems were relying on a support group (69%), adhering to Alcoholics Anonymous (AA) principles (64%), and quitting "cold turkey" (45%). In an adjusted logistic regression model, quitting "cold turkey" and relying on the principles of AA significantly increased a respondent's odds of personally becoming a successful tobacco quitter. We conclude that many recovering alcoholics and problem drinkers can successfully quit smoking and should be encouraged to use abstinence coping skills learned in alcohol treatment.

Recovering staff and smoking in chemical dependency programs in rural Nebraska

The problem of cigarette smoking among those who are recovering from alcohol dependence is becoming more apparent as chemical dependency units (CDUs) are beginning to restrict smoking for clients and staff and more actively encourage nicotine abstinence. To date, little is known about effective smoking cessation techniques for people with a history of alcohol problems. To obtain new data, a survey of personal experiences with smoking cessation and professional recommendations about nicotine dependence was administered to 124 recovering treatment professionals in CDUs in rural Nebraska. Among the 99 staff with a history of smoking, 81 (80%) had tried to quit smoking and 38 were former smokers at the time of the survey. Quitting "cold turkey" was the most popular smoking cessation method. Reliance on AA principles was second. The results suggest that recovering staff can successfully quit smoking by applying their professional practice guidelines for alcohol treatment to their personal problems with tobacco.

Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington

Despite extensive study of vaccine safety and decades of effort to immunize infants and toddlers, little is known about the comprehensiveness of vaccine coverage in US children younger than 2 years of age. Provider and parent data from a population-based sample of 1163 children from two states were analyzed to assess coverage rates at three ages and to evaluate characteristics of children and their families that predict failure to immunize on schedule. Overall, 78% of the children had received their first dose of diphtheria and tetanus toxoids with pertussis vaccine (DTP) and their first dose of oral poliovirus (OPV) by 92 days of age. Similarly, 77% had received their third dose of DTP and their second dose of OPV by their first birthday. However, by their second birthday only 60% had received the full series of four doses of DTP, three doses of OPV, and one dose of the measles, mumps, and rubella vaccines. When considered singly, several variables including child birth order, family income, maternal education, and marital status significantly predicted failure to immunize on schedule. In multivariate logistic models, only birth order and maternal education consistently predicted vaccine status at each of the three ages. Compared with first-born children, those who were later-born were 1.7 times more likely to be incompletely immunized at 2 years of age (95% confidence interval: 1.2, 2.3). Children of more educated mothers were significantly less likely to be underimmunized at all ages.(ABSTRACT TRUNCATED AT 250 WORDS)

Nicotine dependence and alcoholism epidemiology and treatment

Nicotine dependence in alcohol-involved adults is a long-ignored treatment problem. The absence of its discussion in the literature is difficult to defend in light of medical and epidemiological data on the cost and prevalence of this dual addition. Most descriptive studies of alcohol abusers published in the past 20 years have reported tobacco use rates of at least 90%. There is a crucial need to educate treatment professionals and their clients about the additional health risks associated with joint nicotine dependence and alcoholism. Historically, certain barriers to active intervention have existed in drug abuse treatment facilities, including (1) concerns that urging clients to quit smoking might have an adverse effect on their maintenance of sobriety, (2) a tendency to minimize the strength and severity of nicotine addition, (3) a lack of informative data on how best to treat smoking in recovering alcoholics, and (4) financial issues related to marketing and insurance compensation. Recent data obtained from recovering alcoholics who have tried to quit smoking and anecdotal reports from alcoholism treatment centers that have begun addressing nicotine addiction are now challenging these barriers. Education, role modeling, environmental control, and development of staff expertise can be incorporated into standard alcoholism treatment programs to jointly treat these paired addictions.

Response bias associated with asking former study participants to assist in new research

To limit research costs, former parent-participants from a completed pediatric neurology study were asked to assist with new research on behavioral contributors to childhood injury. An evaluation of the response bias associated with this recontact effort showed that 224 parents who completed the survey did not differ from the 51 who failed to complete it in race, age, education, or income. Nonresponders were significantly less likely to be married than responders.

Nicotine dependence and alcoholism epidemiology and treatment

Nicotine dependence in alcohol-involved adults is a long-ignored treatment problem. The absence of its discussion in the literature is difficult to defend in light of medical and epidemiological data on the cost and prevalence of this dual addiction. Most descriptive studies of alcohol abusers published in the past 20 years have reported tobacco use rates of at least 90%. There is a crucial need to educate treatment professionals and their clients about the additional health risks associated with joint nicotine dependence and alcoholism. Historically, certain barriers to active intervention have existed in drug abuse treatment facilities, including (1) concerns that urging clients to quit smoking might have an adverse effect on their maintenance of sobriety, (2) a tendency to minimize the strength and severity of nicotine addiction, (3) a lack of informative data on how best to treat smoking in recovering alcoholics, and (4) financial issues related to marketing and insurance compensation. Recent data obtained from recovering alcoholics who have tried to quit smoking and anecdotal reports from alcoholism treatment centers that have begun addressing nicotine addiction are now challenging these barriers. Education, role modeling, environmental control, and development of staff expertise can be incorporated into standard alcoholism treatment programs to jointly treat these paired addictions.

Cigarette smoking cessation attempts by recovering alcoholics

Survey data on the smoking cessation experiences of 77 recovering alcoholics are reported. A comparison of successful and unsuccessful quitters addressed questions about optimal timing of cessation efforts, relative severity of alcohol and tobacco abuse histories, and the impact of cessation efforts on the maintenance of sobriety. Findings suggest that recovering alcoholics can successfully quit smoking without jeopardizing sobriety but that individuals with more severe substance abuse histories may be less successful. Although successful quitters tended to wait longer before attempting cessation, a comparison of the two groups was not statistically significant.

Skills methods to prevent smoking

School health educators have devoted much attention to cigarette smoking. Recent years have seen the testing of interventions to prevent smoking. To date, controlled studies have not evaluated the added value of skills methods for preventing smoking. This article describes such an evaluation with sixth-grade students from two schools. Subjects were pretested and randomly assigned to receive conventional health education methods or to receive skills intervention. Both conditions included films, peer testimonials, discussions, and homework. Health education condition subjects additionally participated in oral quizzes, games, and debates. Skills condition subjects additionally learned problem-solving, self-instruction, and interpersonal communication methods. At postintervention, skills condition subjects, more than health education condition subjects, had better scores on measures of smoking-related knowledge, attitudes, and intentions. In addition, reported cigarette use, validated by biochemical data collection, was lower in the skills condition than in the health education condition at all postintervention measurements, including a 24-month follow-up. The article discusses the strengths, limits, and implications of the study for other smoking prevention efforts in schools.

Self-control skills for preventing smoking

This study evaluated the effects of self-control skills intervention to prevent smoking with middle school subjects. Informed and consenting subjects were pretested, then by school were randomly divided into three conditions: experimental, placebo, and test-only control. Experimental condition subjects received self-control skills intervention covering self-instruction, self-reinforcement, problem solving, and interpersonal communication. Placebo condition subjects received a discussion-oriented intervention employing health education methods to prevent smoking. Results at 15-month follow-up indicated that self-control and placebo condition subjects, relative to control condition subjects, improved more on measures of health knowledge and nonsmoking intentions. Self-control skills subjects had better 15-month follow-up scores than subjects in the other two conditions on measures of communication, self-instruction, self-praise, cigarette refusals, and noncompliance to smoke. Self-control condition subjects reported less weekly cigarette smoking compared with placebo and control condition subjects at final follow-up.

The double triumph: sustained sobriety and successful cigarette smoking cessation

Conventional practice wisdom has long shielded alcohol treatment center clients from social and medical pressures to quit smoking. But, recent findings of increased cancer risk are forcing a re-examination of traditional practices. Detailed case histories of 14 recovering alcoholics who successfully quit smoking suggest the feasibility of cessation efforts even in the face of severe substance abuse histories.

Assessment of refusal skill in minority youth

The Assertive Friend Cartoon Test was developed and evaluated for Native American youth. Preliminary findings on this refusal skill assessment approach are reported. Psychometric data and feedback from adolescent ethnic group spokespersons support using cartoons to augment paper-pencil measurement.

Urging the alcoholic client to quit smoking cigarettes

Cigarette smoking is highly correlated with alcohol abuse. Yet information regarding smoking cessation for alcoholics is largely absent. To begin addressing this gap, 311 alcohol treatment professionals staffing 23 inpatient facilities in Washington state reviewed a list of 8 different time points, including "never," at which an alcohol-involved adult could be urged to quit smoking cigarettes. Respondents first selected those time points at which they favored and then those at which they personally encouraged smoking cessation. One year after the onset of sobriety emerged as the preferred time point. Responses were analyzed according to the treatment staff's self-reported alcohol and smoking status. Staff who described themselves as alcoholics and smokers were significantly less likely than nonalcoholic-nonsmokers to urge smoking cessation efforts.