Decrease Tobacco Use Research Articles

Abstract A83: University of Guam/University of Hawaii Cancer Center Partnership: Twelve years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to build capacity to reduce cancer health disparities (CHD) of Pacific Islanders in Guam, Hawaii, and the US-associated Pacific Islands (USAPI) through cancer research, training, and outreach. It has been funded by sequential U56 and U54 grants from the NCI. At the core of the partnership activities are jointly conducted research products of regional relevance and global importance. Over the past period of U54 funding, six research projects were related to betel nut use exploring the associations of betel nut use and health related conditions and behaviors among users in Micronesia; sociocultural factors affecting betel nut chewing in Guam; the influence of betel nut use on the oral microbiome; the identification of alkaloids present in the varieties of betel nut on Guam; identification of salivary biomarkers in betel nut consumption; and the functional assessment of molecular components of betel nut involved in pro-inflammatory mechanisms of immune cells. Other research projects are addressing CHD-related research questions around cancer risk and risk perception: health information trends and needs in the Pacific among adults and youth; feasibility of electrical breast densitometry in assessing breast cancer risk; and breast cancer risk factors for Pacific Islander women. Collectively, over 60 manuscripts have been published, over 75 abstracts have been presented at national and international conferences, and at least 8 new grants have been awarded to members of the partnership. Since the Fall Semester 2009, 16 MS degree students at UOG have received fellowship support from the U54 grant, and two UOG graduates are enrolled in doctoral programs at US mainland institutions. Two students received an MS degree and two students received a PhD degree at UHCC with U54 fellowship support. One PhD graduate is now a faculty member at UOG and engaged in the partnership. Over the past six years, UOG developed a cancer health disparities curriculum tailored for the Pacific region, now a permanently sustained track in UOG's Micronesian Studies Program. In addition, mentorship and career development is provided to early stage investigators (ESI) at UOG: UHCC investigators have mentored 10 UOG ESI since 2009. Four UOG faculty received summer fellowships at UHCC; two subsequently secured pilot funding. Outreach projects are exploring community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the effectiveness of a social network-based approach to reducing tobacco-related cancer risk. Outreach activities have also contributed to the introduction and passage of significant public health legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports patient services in Guam as well as the Guam Cancer Registry. In conclusion, the unique multi-ethnic, sociocultural, and geographic characteristics of the UOG/UHCC partnership provide for many unique and important cancer research, training, and outreach opportunities with regional and global relevance. The Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among minority students attending the partner institutions. Outreach has resulted in model tobacco control policy in Guam. A regional research infrastructure has been established and resources have been leveraged to address Pacific Islander cancer health disparities in Guam, Hawaii, and the USAPI. Supported by NCI awards U54CA143727 and U54 CA143728. Citation Format: Hali R. Robinett, Rachael T. Leon Guerrero, Robert A. Underwood, Neal A. Palafox, David C. Ward, Carl-Wilhelm Vogel. University of Guam/University of Hawaii Cancer Center Partnership: Twelve years of progress in addressing cancer health disparities in Pacific Islanders. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A83.

Exposure and Metabolic Activation Biomarkers of Carcinogenic Tobacco-Specific Nitrosamines.

Lung cancer is the leading cause of cancer death in the world, and cigarette smoking is its main cause. Oral cavity cancer is another debilitating and often fatal cancer closely linked to tobacco product use. While great strides have been made in decreasing tobacco use in the United States and some other countries, there are still an estimated 1 billion men and 250 million women in the world who are cigarette smokers and there are hundreds of millions of smokeless tobacco users, all at risk for cancer. Worldwide, lung cancer kills about three people per minute. This Account focuses on metabolites and biomarkers of two powerful tobacco-specific nitrosamine carcinogens, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN), considered to be among the main causes of lung cancer and oral cavity cancer in people who use tobacco products. Three properties of NNK and NNN are critical for successful biomarker studies: they are present in all tobacco products, they are tobacco-specific and are not found in any other product, and they are strong carcinogens. NNK and NNN are converted in humans to urinary metabolites that can be quantified by mass spectrometry as biomarkers of exposure to these carcinogens. They are also metabolized to diazonium ions and related electrophiles that react with DNA to form addition products that can be detected and quantified by mass spectrometry. These urinary metabolites and DNA addition products can serve as biomarkers of exposure and metabolic activation, respectively. The biomarkers of exposure, in particular the urinary NNK metabolites 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides, have been extensively applied to document tobacco-specific lung carcinogen uptake in smokers and nonsmokers exposed to secondhand tobacco smoke. Highly sensitive mass spectrometric methods have been developed for quantitative analysis of these NNK metabolites as well as metabolites of NNN in human urine, blood, and toenails. Urinary and serum NNAL have been related to lung cancer risk, and urinary NNN has been related to esophageal cancer risk in prospective epidemiology studies. These results are consistent with carcinogenicity studies of NNK, NNAL, and NNN in rats, which show that NNK and NNAL induce mainly lung tumors, while NNN causes tumors of the esophagus and oral cavity. Biomarkers of metabolic activation of NNK and NNN applied in human studies include the metabolism of deuterium labeled substrates to distinguish NNK and NNN metabolism from that of nicotine and the determination of DNA and hemoglobin adducts in tissues, blood, and oral cells from people exposed to tobacco products. As these methods are continually improved in parallel with the ever increasing sensitivity and selectivity of mass spectrometers, development of a comprehensive biomarker panel for identifying tobacco users at high risk for cancer appears to be a realistic goal. Targeting high risk individuals for smoking cessation and cancer surveillance can potentially decrease the risk of developing fatal cancers.

Effects of a new tobacco law on the knowledge, attitudes, and habits of smokers in San José and Jacó, Costa Rica

Smoking is a leading cause of death worldwide. Many nations have implemented bans on smoking in public places to try to increase national health and to relieve the economic burden caused by the deteriorating health of smokers. In 2012, Costa Rica passed similar legislation barring smoking in any area that was deemed a gathering place for people, including outdoor areas such as bus stops and parks.This project evaluated a verbal questionnaire in order to determine the knowledge, attitudes, and habits of smokers, as well as to ascertain establishment compliance, in San José and Jacó, Costa Rica. The survey was completed by 150 smokers and 54 establishments over a span of two months. General knowledge of the law was found to be at a relatively low level, with most participants only having the most basic knowledge of the specific locations in which the law prohibits smoking. However, it was also found that men were more likely to have a deeper knowledge of the law than women (p=0.02). A tendency was found between the type of smoker and the change in smoking habits after the law passed where heavy smokers diminished their tobacco use, medium smokers sustained the same use, and light smokers slightly increased their use. (p=0.19). When combining other demographic groups with their changes in smoking habits, no significant tendency was found; the law does not appear to have a direct effect on any specific subgroup. This is not for lack of proper implementation, as 81.48% of establishments had the required no smoking sign of correct size and color. The overall effectiveness of the new law in decreasing tobacco use has been minimal, regardless of education level, gender, or job type.

Smoking Cessation and Electronic Cigarette Use among Head and Neck Cancer Patients.

(1) Investigate electronic cigarette (e-cig) use among head and neck (HN) cancer patients; (2) define quit methods, success, motivations, and barriers to smoking cessation; and (3) determine the impact of e-cig use in smoking cessation. Cross-sectional study. Tertiary care center. An in-office survey was administered to HN cancer patients ≥ 19 years of age with past/present tobacco use. Patient demographics were collected. Quit methods, success, and motivations/barriers were surveyed. The Alcohol Use Disorders Identification Test was used to correlate alcohol use and cessation. Independent variables associated with cessation were studied with Fisher's exact test and Student's t test. Subgroup analysis was performed for e-cig users. Of 110 eligible patients, 106 (96%) enrolled (83% male, 82% Caucasian), of whom 69 (65%) successfully quit. Age of first tobacco use did not differ between the smoking and cessation groups (P = .14), nor did hazardous drinking (30% smoking vs 14% cessation; P = .072). "Cold turkey" (ie, stopping abruptly without smoking cessation aids) was the most common method attempted (n = 88, 83%) and most successful (n = 65, 94%). There was no statistical difference in age, sex, race, drinking, or socioeconomic status between e-cig users and nonusers. Nonusers achieved higher quit rates as compared with e-cig users (72% vs 39%; P = .0057). E-cig use did not decrease the number of cigarettes smoked (463 cigarettes/month) versus that of nonusers (341 cigarettes/month; P = .2). Seventy percent of e-cig users wore a nicotine patch. HN cancer patients desire smoking cessation. E-cig did not decrease tobacco use, and patients who utilize e-cigs are less likely to achieve smoking cessation.

Abstract A08: University of Guam/University of Hawaii Cancer Center Partnership: An 11-year partnership to advance cancer health equity in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to build capacity to reduce cancer health disparities (CHD) in Guam, Hawaii, and the US-associated Pacific Islands (USAPI) through cancer research, training, and outreach. Since 2003, the UOG/UHCC Partnership has provided scholarships and training in CHD research to a growing number of graduate students at UOG and UHCC with a special focus on Pacific Islanders who are underrepresented in the fields of cancer research and healthcare. UHCC investigators provide mentorship to early stage investigators (ESI) at UOG through annual meetings and workshops, monthly video teleconferences, electronic communications, and summer fellowships at UHCC. A system has been established to review, award, and evaluate new and ongoing pre-pilot, pilot, and full research projects. Outreach activities draw upon the principles of community-based participatory research to increase tobacco cessation, reduce cancer risk, and strengthen tobacco control policy. Since Fall Semester 2009, 16 master's degree students at UOG have received fellowship support, and two UOG graduates are enrolled in doctoral programs at US mainland institutions. Two PhD students at UHCC are currently receiving fellowship support, and three master's degree students have graduated from UH. One scholar is now in a tenure track faculty position at UOG and engaged in the Partnership. Over the past five years, UOG developed a cancer health disparities curriculum tailored for the Pacific region, now a permanently sustained track in UOG's Micronesian Studies Program. In addition, mentorship and career development is provided to ESI at UOG: UHCC investigators have mentored 10 UOG ESI since 2009. Four UOG faculty received summer fellowships at UHCC; two subsequently secured pilot funding. Research of regional relevance and global importance is jointly conducted by investigators at UOG and UHCC, including six betel nut related pilot projects that are exploring the associations of betel nut use and health related conditions and behaviors among users in Micronesia; sociocultural factors affecting betel nut chewing in Guam; the influence of betel nut use on the oral microbiome; the identification of alkaloids present in the varieties of betel nut on Guam; identification of salivary biomarkers in betel nut consumption; and the functional assessment of molecular components of betel nut involved in pro-inflammatory mechanisms of immune cells. Other research projects are addressing CHD-related research questions around cancer risk and risk perception: health information trends and needs in the Pacific among adults and youth; feasibility of electrical breast densitometry in assessing breast cancer risk; and breast cancer risk factors for Pacific Islander women. Outreach projects are exploring community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the effectiveness of a social network-based approach to reducing tobacco-related cancer risk. Outreach activities have also contributed to the introduction and passage of significant public health legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports patient services in Guam as well as the Guam Cancer Registry. Almost 50 papers have been published, and at least 7 grants have been awarded to members of the partnership as a result of the work of the partnership. In conclusion, the unique multi-ethnic, sociocultural, and geographic characteristics of the UOG/UHCC partnership provide for many unique and important cancer research, training, and outreach opportunities with regional and global relevance. The Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among minority students attending the partner institutions. Outreach has resulted in model tobacco control policy in Guam. A regional research infrastructure has been established and resources have been leveraged to address Pacific Islander cancer health disparities in Guam, Hawaii, and the USAPI. Supported by NCI awards U54CA143727 and U54 CA143728. Citation Format: Hali R. Robinett, Rachael T. Leon Guerrero, Robert A. Underwood, Neal A. Palafox, David C. Ward, Carl-Wilhelm Vogel. University of Guam/University of Hawaii Cancer Center Partnership: An 11-year partnership to advance cancer health equity in Pacific Islanders. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A08.

Tobacco use among foster youth: Evidence of health disparities

Youth aging out of foster care face a challenging road to independence. Following exposure to myriad risk factors such as abuse, neglect, parental substance use, and severe housing mobility, supportive services decrease upon exit from care, often increasing risk for substance use, homelessness, and unemployment. Although tobacco use is also highly prevalent, little attention has been paid to screening, assessment, and treatment of tobacco use in this vulnerable group. The current study (N=116) reports on tobacco use prevalence, consequences, and co-occurrence with other substances in a sample of youth (ages 18 to 19) exiting the foster care system. In the face of an overall decrease in tobacco use among general population adolescents and young adults, results suggest disproportionate levels of lifetime, recent, and daily use among foster youth. Prevalence of recent tobacco use (46%) is nearly triple national rates, while daily smoking (32%) is almost four times that of general population young adults. Tobacco users were more likely than non-users to drink (70% vs. 40%) and to smoke marijuana (72% vs. 25%). We strongly encourage researchers and practitioners to increase attention to this tobacco-related health disparity.

Tobacco Use Among Healthcare Workers: Impact of a Worksite Policy Change at a US Military Community Hospital

Introductions:Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.Aims/Methods:Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.Results:Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.Conclusions:Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

Do brief alcohol interventions reduce tobacco use among adolescents and young adults? A systematic review and meta-analysis.

This meta-analysis synthesizes studies of brief interventions (BIs) that targeted alcohol consumption and reported both alcohol and tobacco outcomes. It examines whether BIs reduce alcohol and tobacco use for adolescents and young adults among interventions that (1) directly targeted tobacco and alcohol use, or (2) did not target tobacco use but measured it as a secondary outcome. Multiple databases and grey literature sources were searched (1980-2012) resulting in the identification of 18 randomized or controlled quasi-experimental studies (5949 participants). Analyses were conducted using random effects inverse-variance weighted three-level models. BIs were associated with a significant reduction in alcohol consumption relative to control groups [g = 0.11, 95 % CI (0.04, 0.17)] but not with a significant decrease in tobacco use [g = 0.07, 95 % CI (-0.01, 0.16)]. Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes. Post-hoc exploratory analysis revealed potential questions to address with future research.

Evaluation of Tobacco Control Law at Cafe’ and Restaurants

Objective: This study was conducted in order to evaluate ideas of some cafe and restaurants’ clients and workers about the tobacco control law three years after entering into force in a central district in Ankara in 2008. Methods: In the descriptive study;105 management, 113 worker and 386 client was visited, face to face interviews were done using two different questionnaire form and another form for managements’ evaluation. SPSS 15.0 statistical package program, Chi-square and t-tests were used. Administrative leave was taken. Results: Mean age of workers was 30.1±8.32 years; 82.3% were men, 54.0% smoker; with clients the values are 27.7±8.61 years; 53.6% women and 39.4% were smokers. There’s a difference between smokers and non- smokers’ ideas about the hazards; death due to second-hand smoking (p=0.024; p<0.01). 80.3% of smokers and 74.3% of non-smokers knew the law in restaurants serving alcoholic beverages. Acceptance of the idea of the law could help to quit smoking was significantly different between smoker/non smoker workers and smoker/non smoker clients (p=0.004;p<0.001). According to observations, 7.6% of the managements didn’t have law related plaque, 94.1% had smoking free areas, 57.1% had show window, 22.7% had smoking individuals and 12.6% had ashtray. Conclusion: Tobacco use is an individualistic reality but also a public health issue. Publicly acceptance of 45 law and implementations are needed besides individual perceptions. Implementations must be inspected and Smokers’ observance of the rules must be supplied in order to decrease tobacco use and related health complications.

American Stroke Association Stroke Council Update

This report represents the Spring 2015 update of the Stroke Council. Much has happened in the last 12 months, and we want to particularly focus on the major developments in acute stroke therapy and their implications, progress in the American Stroke Association (ASA)/American Heart Association (AHA) quality initiatives and tiered systems of stroke care, and the approval of a new code for the National Institutes of Health Stroke Scale (NIHSS). Each Stroke Council Update starts with restating our 2020 Goals: to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%. In December 2014, we had further evidence that our efforts are bearing fruits. In 2011, stroke fell from the number 3 to the number 4 cause of death in the United States, and in December, stroke fell from number 4 to number 5. This development, which reflects the continued decrease in age-adjusted mortality rates for stroke, is a remarkable testament to concerted educational and public health efforts to control blood pressure, decrease tobacco use, appropriately treat atrial fibrillation, educate the public about stroke warning signs, and improve and standardize the neurocritical care of stroke patients. Yet, it is sobering that the actual number of strokes continues to increase as the population ages because the incidence of stroke increases markedly with age. Stroke remains the second leading cause of death worldwide and one of the leading causes of disability worldwide. That is why the ASA/AHA is partnering with the World Stroke Organization and World Health Organization to take best practices and apply them worldwide. We have accomplished much but have more to do. The International Stroke Conference Scientific Sessions and Pre-conference meetings in Nashville was a great success with 4341 attendees, the largest number of attendees ever. The quality of the …

The Phenomenological, Social Network, Social Norms, and Economic Context of Substance Use and HIV Prevention and Treatment: A Poverty of Meanings

The Phenomenological, Social Network, Social Norms, and Economic Context of Substance Use and HIV Prevention and Treatment: A Poverty of Meanings

Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control

Countries have agreed on reduction targets for tobacco smoking stipulated in the WHO global monitoring framework, for achievement by 2025. In an analysis of data for tobacco smoking prevalence from nationally representative survey data, we aimed to provide comprehensive estimates of recent trends in tobacco smoking, projections for future tobacco smoking, and country-level estimates of probabilities of achieving tobacco smoking targets. We used a Bayesian hierarchical meta-regression modelling approach using data from the WHO Comprehensive Information Systems for Tobacco Control to assess trends from 1990 to 2010 and made projections up to 2025 for current tobacco smoking, daily tobacco smoking, current cigarette smoking, and daily cigarette smoking for 173 countries for men and 178 countries for women. Modelling was implemented in Python with DisMod-MR and PyMC. We estimated trends in country-specific prevalence of tobacco use, projections for future tobacco use, and probabilities for decreased tobacco use, increased tobacco use, and achievement of targets for tobacco control from posterior distributions. During the most recent decade (2000-10), the prevalence of tobacco smoking in men fell in 125 (72%) countries, and in women fell in 156 (88%) countries. If these trends continue, only 37 (21%) countries are on track to achieve their targets for men and 88 (49%) are on track for women, and there would be an estimated 1·1 billion current tobacco smokers (95% credible interval 700 million to 1·6 billion) in 2025. Rapid increases are predicted in Africa for men and in the eastern Mediterranean for both men and women, suggesting the need for enhanced measures for tobacco control in these regions. Our findings show that striking between-country disparities in tobacco use would persist in 2025, with many countries not on track to achieve tobacco control targets and several low-income and middle-income countries at risk of worsening tobacco epidemics if these trends remain unchanged. Immediate, effective, and sustained action is necessary to attain and maintain desirable trajectories for tobacco control and achieve global convergence towards elimination of tobacco use. Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports and Technology, Japan; Department of Health, Australia; Bloomberg Philanthropies.

Cluster-Randomized Trial of Clinical Pharmacist Tobacco Cessation Counseling Among Patients with Cardiovascular Disease.

Optimal management of patients with cardiovascular disease (CVD) includes evaluation of risk factors using a team-based approach. Tobacco use often receives less attention than other CVD risk factors; therefore, utilization of nonphysician health care providers may be valuable in addressing tobacco use. The purpose of this trial was to assess the impact of brief, structured, telephone tobacco cessation counseling (BST) delivered by clinical pharmacists on tobacco cessation attempts compared to usual care. The BST consisted of 1 to 5 minutes discussing 3 key counseling points, including a recommendation to quit and education about cessation aids. This was a cluster-randomized trial of tobacco-using patients with CVD who were enrolled in a clinical pharmacist-managed, physician-directed, CVD disease state management service. Clinical pharmacists were randomized to provide usual care (control) or BST (intervention) to their tobacco-using patients during a 4-month period. Patients were surveyed 3 months later to assess their tobacco cessation attempts, use of tobacco cessation aids, and self-reported cessation. One hundred twenty patients were enrolled. Subjects were predominately white males, aged ≥65 years, with a history of myocardial infarction. One hundred and four subjects completed the follow-up survey. No differences were detected between the 36.2% and 38.6% of control and intervention subjects, respectively, reporting a tobacco cessation attempt (P=0.804) or in the other outcomes (all P>0.05). A BST delivered by clinical pharmacists may not adequately affect patient motivation enough to increase tobacco cessation attempts in tobacco-dependent patients with CVD. Future research is needed to evaluate other team-based strategies that can decrease tobacco use in patients with CVD.

Life in the big city: building a culture of health.

Life in the big city: building a culture of health.

Communities putting prevention to work: Local evaluation of community-based strategies designed to make healthy living easier

This introduction is an overview of the articles presented in this supplement that describe implementation and evaluation activities conducted as part of the Centers for Disease Control and Prevention's (CDC's) Communities Putting Prevention to Work (CPPW) initiative. CPPW was one of the largest federal investments ever to combat chronic diseases in the United States. CPPW supported high-impact, jurisdiction-wide policy, systems, and environmental changes to improve health by increasing access to physical activity and healthy foods, and by decreasing tobacco use and exposure to secondhand smoke. The articles included in this supplement describe implementation and evaluation efforts of strategies implemented as part of CPPW by local awardees. This supplement is intended to guide the evidence base for public health interventions on the basis of jurisdiction-wide policy and environmental-level improvements and to encourage rigorous evaluation of the public health interventions.

A longitudinal examination of the interrelationship of multiple health behaviors.

Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation. To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis. In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery. Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes. Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously.

Cancer-Related News from the CDC

Cancer-Related News from the CDC

Smoking and mental illness in the US population

ObjectivesThose with any psychiatric diagnosis have substantially greater rates of smoking and are less likely to quit smoking than those with no diagnosis. Using nationally representative data, we sought to...

Tobacco Usage among Males in Rural Tamil Nadu, India: A Cross-sectional Study

Background: Knowing the prevalence of tobacco use and the socio-demographic profile of users might prove useful in further strengthening the information, education, communication and regulatory activities, thereby decreasing tobacco use. The objective was to study the prevalence and pattern of tobacco use among men aged 18 years and above in rural area of Tamil Nadu. Methods: A cross sectional study was performed among 714 males aged 18 years and above in Vadagarai village of Tamil Nadu during 2010 and interviewed with a pretested questionnaire. Systematic random sampling was used to select the participants. Results: Prevalence of smoking was found to be 36.7%. Cigarette smoking was more common than beedi and smokeless tobacco. Conclusion: Strict enforcement of anti-tobacco legislation and awareness measures targeting ill-effects of tobacco can be intensified to reduce tobacco related morbidity and mortality.

Noncombustible Tobacco Product Advertising: How Companies Are Selling the New Face of Tobacco

With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. Over 3 months, almost $20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (~$8 million) and snus (~$10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs.