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Biomedical subjects

Andrew Hyland

Publications and source records attributed to Andrew Hyland.

16 recordsLinked to original sources
PubMed2004

Obtaining DNA from a geographically dispersed cohort of current and former smokers: use of mail-based mouthwash collection and monetary incentives.

The feasibility of collecting DNA through the mail from a cohort of current and former smokers was assessed. Also examined was whether monetary incentives would increase response rates. A random sample of 300 subjects, stratified by 20 U.S. communities, was selected to participate. The sampling frame included the 6,726 people who were in both the Community Intervention Trial for Smoking Cessation (COMMIT) between 1988 and 1993 and the follow-up study in 2001, and who consented to being contacted again. Subjects were further randomized within communities to incentive arms of 10 US dollars, 2 US dollars, or 0 US dollars. A total of 110 usable samples were returned (37%), and the 10 US dollars incentive arm had the highest response (43%). Logistic regression revealed no significant predictors of sending a DNA sample, although in a larger study, similar-sized odds ratios would be statistically significant for subjects who received the 10 US dollars incentive and for those who were White, female, or college graduates or whose household incomes were more than 60,000 US dollars per year. The spectrophotometer-determined median DNA yield was 44.93 microg (range=4.00-425.86 microg). Assuming that 50 ng of DNA would be needed for polymerase chain reaction amplification to determine any given genotype, 80-8,517 runs would be attainable. Qualitative findings suggest several methodological improvements to boost response rates. Institutional review board requirements, which are standardized on the inpatient, clinical protocol model, stipulated that noninstitutionally based subjects needed a witness to initial and date every page as well as sign the consent form. This pilot study showed that this requirement could pose some challenges in population-based research.

Adult↗
PubMed2004

The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts.

A nine-membered panel of experts was asked to determine expert opinions of mortality risks associated with use of low-nitrosamine smokeless tobacco (LN-SLT) marketed for oral use. A modified Delphi approach was employed. For total mortality, the estimated median relative risks for individual users of LN-SLT were 9% and 5% of the risk associated with smoking for those ages 35 to 49 and > or =50 years, respectively. Median mortality risks relative to smoking were estimated to be 2% to 3% for lung cancer, 10% for heart disease, and 15% to 30% for oral cancer. Although individual estimates often varied between 0% and 50%, most panel members were confident or very confident of their estimates by the last round of consultation. In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of LN-SLT use. The risks of using LN-SLT products therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past. Importantly, the overall public health impact of LN-SLT will reflect use patterns, its marketing, and governmental regulation of tobacco products.

Adult↗
PubMed2003

Switching to lower tar cigarettes does not increase or decrease the likelihood of future quit attempts or cessation.

This study examined whether switching to low-tar cigarettes predicts future quit attempts or smoking cessation. Prior studies of whether switching to low-tar cigarettes increases or decreases cessation behavior have produced contradictory results. We believed a large, prospective population-based study was needed. Participants in the Community Intervention Trial for Smoking Cessation (COMMIT), who were smokers in 1989 and 1991 and provided their smoking status in a 1993 interview, provided product code information so that the tar categories of their cigarettes could be identified. Smokers' brands were classified as ultralight (0-6 mg tar), light (7-15 mg tar), and regular (16+ mg tar). The main predictor measure was switching to a lower tar yield category: 8% of baseline light smokers and 19% of baseline regular smokers switched to a lower yield product between 1989 and 1991. The main outcome measures were attempts to quit and successful 6-month cessation. Despite greater desire to quit among switchers, switching down was not associated with increased or decreased number of attempts to quit or the likelihood of future cessation. No evidence of differential effects was found for subgroups of smokers, including those who did and did not believe that low-tar cigarettes are safer. The data show that switching to a low-tar cigarette does not appear to increase or decrease the likelihood of future cessation, though motivation to stop smoking may be associated with switching.

Adult↗
PubMed2003

Nurse practitioners' knowledge, practice and attitudes about tobacco cessation & lung cancer screening.

PURPOSE: To determine nurse practitioners' (NPs') knowledge, practice, and attitudes about tobacco cessation counseling and lung cancer early detection. DATA SOURCE: A descriptive, cross-sectional survey design was used to examine NPs' approaches to primary and secondary prevention of tobacco use among patients in western New York. CONCLUSIONS: Among the 175 respondents, NPs appropriately counseled tobacco users on tobacco cessation. However, there was limited understanding of first-line pharmacological agents used for tobacco cessation and of how to manage treatment for a patient at high risk for lung cancer. IMPLICATIONS FOR PRACTICE: These findings suggest the need to implement professional educational programs aimed at conveying not only the importance of tobacco cessation counseling but also information on the most effective first-line pharmacological agents and appropriate management options for patients at increased risk of developing lung cancer.

Adult↗
PubMed2003

Is the prevalence of youth smoking affected by efforts to increase retailer compliance with a minors' access law?

This study correlated measures of youth smoking behavior with community-level indicators of retailer compliance with a minors' tobacco access law. The study was carried out between 1992 and 1996 in 12 communities in Erie County, New York. Retailer compliance was assessed by having adolescents attempt to purchase tobacco products in licensed tobacco-selling outlets in fall 1994 and fall 1995 after implementation of an aggressive enforcement program. Communities were grouped in two ways: (a) those that did or did not increase retailer compliance rates by 200% or more between 1994 and 1995 and (b) those that did or did not achieve an 80% retailer compliance rate in 1995. School-based surveys conducted in 1992 and 1996 assessed the tobacco use behaviors of ninth-grade public school students. Between 1994 and 1995, retailer compliance increased in all 12 communities by an average of 155%. In 1995, six of the 12 communities achieved retailer compliance rates in excess of 80%. Indicators of youth smoking behavior did not vary significantly between communities that increased their retailer compliance rates by more or less than 200%. The prevalence of past 30-day smoking remained stable between 1992 and 1996 in the six communities that achieved a retailer compliance rate of at least 80% and increased slightly in the remaining communities. The prevalence of frequent smoking decreased between 1992 and 1996 in the communities that achieved a retailer compliance rate of at least 80% and increased slightly in the six communities that failed to achieve this rate. Achieving a high rate of retailer compliance with a minors' access law appears to have caused youths to rely more on noncommercial sources of cigarettes and may have had a small effect on adolescent smoking prevalence, especially frequent smoking.

Adolescent↗
PubMed2002

Provider case volume and outcome in the evaluation and treatment of patients with mammogram-detected breast carcinoma.

BACKGROUND: Practice volume may affect the outcome of patients with breast carcinoma. Defining factors that influence the relation of volume and outcome for the diagnosis and treatment of breast carcinoma is important, because breast carcinoma is common, and care is decentralized. METHODS: Community-wide diagnosis and treatment of mammogram-detected breast carcinoma was examined using claims data from a single insurer representing 25% of the regional population. Among 1001 mammogram-directed breast biopsies, the rate of breast carcinoma diagnosed by stereotactic core needle biopsy (SCNB) or excisional biopsy with needle localization (EBNL) and the rate at which breast-conserving surgery (BCS) was used were analyzed. Outcome and practice volume were examined for surgeons, radiologists, and medical centers. RESULTS: Two hundred twenty-four tumors were diagnosed by EBNL (604 diagnoses) and SCNB (397 tumors), for a 22.4% positive biopsy rate. The median number of procedures per physician was one. Positive biopsy rates for radiologists, surgeons, and medical centers did not correlate with practice volume. Positive biopsy rates for high-volume physician providers and medical centers ranged from 9% to 46%. The BCS rate was 45% and 64% for surgeons treating one or more than one claim, respectively. Tumor stage and surgeon case volume were the only independent predictors of BCS (P < 0.05). CONCLUSIONS: There is wide variation in diagnosis and treatment outcomes for patients with mammogram-detected breast carcinoma. Overall, practice volume was correlated with the use of BCS but not with the rate of positive biopsy. A wide variation in the positive biopsy rate among high-volume providers and medical centers suggests that volume of practice is not a surrogate for quality in the diagnosis of breast carcinoma.

Biopsy↗
PubMed2002

Prognostic significance of molecular genetic aberrations on chromosome segment 11p15.5 in non-small-cell lung cancer.

PURPOSE: The assessment of prognosis and decisions on treatment for patients with non-small-cell lung cancer (NSCLC) are determined on the basis of disease stage and performance status. NSCLC frequently manifests loss of heterozygosity (LOH) at chromosome segment 11p15.5. Whether LOH at 11p15.5 is an independent prognostic variable has yet to be determined. PATIENTS AND METHODS: We developed five novel markers, which can be assessed by polymerase chain reaction and restriction enzyme digestion. LOH at 11p15.5 was assessed in 193 patients who underwent surgical resection for pathologic stage I and II of the disease. RESULTS: LOH at 11p15.5 was associated with poor survival (P =.021). Multivariate logistic regression analysis showed that after disease stage, performance status, weight loss, sex, age at diagnosis, and smoking history were controlled for, patients with LOH were two times more likely to die than those without LOH (relative risk [RR] = 2.01, P =.021). Cox regression analysis with disease stage and LOH revealed that the survival of patients with stage I disease and LOH was similar to the survival of patients with stage II disease, and it was significantly worse than the survival of stage I patients without LOH (RR = 2.38, P =.038). CONCLUSION: LOH in a 310-kb region on chromosome segment 11p15.5 that includes the gene for the regulatory subunit of the enzyme ribonucleotide reductase is highly predictive of poor survival from NSCLC. The future utility of analysis of the allelic status of this region may involve treatment decisions, such as the use of neoadjuvant and adjuvant chemotherapy for patients with stage I disease.

Carcinoma, Non-Small-Cell Lung↗
PubMed2002

The effect of a smoke-free law on restaurant business in South Australia.

BACKGROUND: Despite evidence to the contrary from overseas research, the introduction of smoke-free legislation in South Australia (SA), which required all restaurants to go smoke-free in January 1999, sparked concerns among the hospitality industry about loss of restaurant business. This study aimed to determine whether the law had a detrimental impact on restaurant business in SA. METHODS: Using time series analysis, we compared the ratio of monthly restaurant turnover from restaurants and cafés in SA to (a) total retail tumover in SA (minus restaurants) for the years 1991 to 2001 and (b) Australian restaurant tumover (minus SA, Westem Australia and the Australian Capital Territory) for the years 1991-2000. RESULTS: There was no decline in the ratio of (a) SA restaurant turnover to SA retail turnover or (b) SA restaurant tumover to Australian restaurant turnover. CONCLUSION: The introduction of a smoke-free law applying to restaurants in SA did not adversely affect restaurant business in SA.

Commerce↗
PubMed2002

Evaluation of smoke-free dining in South Australia: support and compliance among the community and restaurateurs.

OBJECTIVES: To evaluate the impact of smoke-free dining legislation introduced in South Australia on 4 January 1999. Specifically, to determine changes in public support and support among the restaurant and cafe industry; to determine changes to self-reported experiences of dining out; and to assess compliance with the legislation. METHODS: A series of independent, representative, cross-sectional surveys were undertaken over time. Study 1: 3000+ South Australians, aged 15 and over, were interviewed about opinions of the legislation and about dining out, in an annual household survey in October-November in 1997, 1998 and 1999. Study 2: 500+ owners and managers of public dining venues were interviewed about their opinions about and experiences of the legislation in face-to-face surveys in May-June 1999 and July 2000. RESULTS: Study 1: Public support for smoke-free dining increased from 73.4% in 1997 to 84.2% in 1999. In 1999, 60.2% reported the ban had made dining out more enjoyable and 35.1% indicated no difference. Study 2: 88.2-92.3% of restaurants were complying with the legislation at five months and 95.7-99.6% at 18 months. In 2000, 82% of restaurateurs reported that they had spent no money in order to implement the law. CONCLUSIONS AND IMPLICATIONS: Smoke-free dining in South Australia is popular and has resulted in increased perceived enjoyment for patrons. The legislative change has apparently been adhered to by both the majority of restaurateurs and customers, and was inexpensive for restaurateurs to implement. Smoke-free dining legislation can be implemented with confidence.

Attitude to Health↗
PubMedDate not supplied

Cigarette purchasing behaviors when prices are high.

The objective of this study was to assess the cigarette purchase patterns of smokers in Erie and Niagara Counties following recent increases in the state excise tax for cigarettes. Data were collected with telephone interviews of a sample of 1,548 randomly selected people in Erie and Niagara Counties between October 2002 and March 2003. Purchase patterns were assessed for the 908 smokers in the sample who responded to questions about cigarette purchasing patterns. Thirty-three percent reported that their usual source of cigarettes is from a small store, large store, pharmacy, or vending machine, while 67% reported that their usual source is from an Indian reservation. Only one smoker reported the Internet was a usual source of cigarettes. The average price paid per pack was $4.80 in a small store and $1.91 on an Indian reservation. Price influences smoking behavior; however, the majority of smokers are taking advantage of readily available venues where less expensive, untaxed cigarettes are sold. This may undermine the public health benefit of higher prices and cause lost revenue to state and local governments.

Adult↗
PubMedDate not supplied

Avoidance of smoky establishments: findings from Erie and Niagara Counties in New York.

The objective of this study was to determine the extent to which people avoid smoky restaurants, bars, bowling alleys, casinos, and bingo halls because of secondhand smoke. Data were collected with telephone interviews of a sample of 1,548 randomly selected adults in Erie and Niagara Counties between October 2002 and March 2003. Most nonsmokers (71%) reported that they are bothered by secondhand smoke. Thirty-four percent of nonsmokers and 10% of smokers responded that they had avoided patronizing a smoky establishment in the past 12 months. The places that were most often avoided were restaurants (17%), bars or taverns (13%), and bingo halls (9%).

Adolescent↗
PubMedDate not supplied

Which population-based interventions would motivate smokers to think seriously about stopping smoking?

OBJECTIVE: To describe what smokers say about the impact of different population-based interventions to motivate them to think seriously about stopping smoking. METHODS: A random-digit dialed cross-sectional telephone survey of adult current cigarette smokers was conducted in Erie and Niagara counties, New York, in October through November 2002. A total of 815 smokers were asked which of eight interventions would motivate them to think seriously about stopping smoking in the next 6 months. RESULTS: The offer of free nicotine patches/gum (53%) and cash incentives (49%) were the most frequently mentioned interventions that smokers said would get them to think seriously about stopping smoking. The degree of motivation to stop smoking was the most consistent and strongest predictor of how respondents answered the question about the influence of the various intervention options. CONCLUSION: Communities need to offer a wide array of interventions that are likely to appeal to different subgroups of smokers in order to have a population-wide impact on smoking behavior.

Adolescent↗