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Biomedical subjects

Elizabeth A Gilpin

Publications and source records attributed to Elizabeth A Gilpin.

At least 19 recordsLinked to original sources
PubMed2006

Trends in smoking among Hispanic women in California: Relationship to English language use.

BACKGROUND: Research has shown that Hispanic women who speak mostly English have higher smoking rates than those who speak mostly another language. It is unknown how differences in smoking by English language use among adult Hispanic women in California have changed in recent years. METHODS: We compared current daily (100 or more cigarettes in lifetime, now smokes daily) and current nondaily (100 or more cigarettes in lifetime, now smokes some days) smoking prevalence for adult Hispanic women by English language use at home from population-based, random-digit-dialed California Tobacco Surveys in 1996 (n = 1406, 74% response rate [RR]); 1999 (n = 1379, 69% RR), and 2002 (n = 2912, 64% RR). RESULTS: Current smoking prevalence was at least twice as high among those who speak mostly English compared to those who speak mostly another language in every survey year (1996: 14.7% vs 6.1%; 1999: 14.6% vs 6.1%; 2002: 11.7% vs 4.9%) with the ratio staying constant (2.4:1). There was a decline in current nondaily smoking among those who speak mostly English by 2002 (1996 and 1999 prevalence: approximately 6%, 2002: approximately 4%), but no declines in current daily smoking for either language-use group. CONCLUSIONS: There has been no reduction in the English-language-use gap in smoking among Hispanic women in California. There has been a significant decline in current nondaily smoking prevalence among women who speak mostly English, but no significant reduction in current daily smoking for either language-use group. It appears that not much progress has been made in California in reducing daily smoking prevalence among Hispanic women at the population level. Smoking prevention and cessation efforts among Hispanic women remain a priority.

Acculturation↗
PubMed2006

Comparative validation of the IPAQ and the 7-Day PAR among women diagnosed with breast cancer.

BACKGROUND: The criterion-related validity and measurement bias of the long form of the International Physical Activity Questionnaire (IPAQ) was compared to the 7-Day Physical Activity Recall (PAR). METHODS: Participants were women who have been diagnosed with breast cancer and enrolled in the ongoing Women's Healthy Eating and Living Study. Women (N = 159, average age 57 years) wore an accelerometer for one week and then completed the IPAQ or the PAR. RESULTS: The validity correlation of the PAR was significantly higher (p < 0.001) than the IPAQ (0.73 vs. 0.33, respectively). The PAR and IPAQ overestimated total physical activity by 13% vs. 247%, respectively. The PAR had better sensitivity (p = 0.14) and specificity (p < .01) than the IPAQ (100% vs. 71% and 84% vs. 59%, respectively) in predicting attainment of the ACSM physical activity guideline. CONCLUSION: The PAR was superior to the IPAQ in terms of validity, measurement bias, and screening statistics.

Journal Article↗
PubMed2006

Cigarette promotional offers: who takes advantage?

BACKGROUND: Promotional offers on cigarettes (e.g., dollar-off, multipack discounts) composed the largest share of tobacco industry marketing expenditures, totaling $8.9 billion, or 72% of the total budget in 2002. Internal industry documents indicate that young adults, potential quitters, and other price-sensitive groups are the targets of these marketing tactics. How effective they are in actually reaching these groups in the general population of smokers has not yet been investigated. METHODS: Data were from 4618 current smokers responding to the large, random-digit-dialed population-based 2002 California Tobacco Survey. The characteristics were identified of smokers who reported that they used these offers "every time I see one." RESULTS: Thirty-five percent of smokers used promotional offers every time they saw one. Multivariate analyses identified young adults, women, African Americans, those with higher daily cigarette consumption, and those worried about cigarette costs as more likely to use promotional offers at every opportunity. Smokers most committed to quitting were no more likely to use promotional offers than those with no intention to quit. Cigarette brand was highly correlated with age and race/ethnicity, and therefore was not included in the multivariate analysis. Those who smoked menthol cigarettes and Camels, more often young adults and African Americans, were much more likely than those of other brands to use promotional offers. CONCLUSIONS: With the exception of smokers intending to quit, cigarette promotional offers are effectively reaching most industry-targeted groups. Importantly, young adults, who have the greatest long-term customer potential, are responding.

Adolescent↗
PubMed2006

Responsiveness of homocysteine concentrations to food and supplemental folate intakes in smokers and never-smokers enrolled in a diet intervention trial.

We investigated circulating homocysteine concentrations in relation to smoking, folate intake (from food and supplements), serum folate concentrations, and other dietary variables. The present study is part of a parent trial assessing the effects of increasing vegetable, fruit, and fiber intakes and reducing the percentage of energy obtained from fat on breast cancer recurrence in 3,088 women previously diagnosed with breast cancer. Of the 121 smokers enrolled in the parent trial, 85 were available at baseline for the present study and were randomly matched to 85 never-smokers on baseline folate intake, age, and intervention status. Follow-up data were available on 53 smokers (22 intervention and 31 comparison) and 56 never-smokers (24 intervention and 32 comparison). No significant differences in circulating homocysteine and folate concentrations were observed between smokers and never-smokers at baseline. For smokers, significant decreases in circulating homocysteine and significant increases in folate concentrations (p < .05) from baseline to 12 months were observed in the comparison group. For never-smokers, significant decreases in circulating homocysteine and significant increases in folate concentrations were observed in the intervention and comparison groups (p < .05). In the multivariate analysis, changes in serum folate concentration and supplemental folic acid were significantly associated with change in plasma homocysteine concentrations (p < .05). These findings show that increasing supplemental folic acid can reduce homocysteine concentrations, which may have implications for lowering cardiovascular disease risk for smokers and never-smokers.

Adult↗
PubMed2006

Population effectiveness of pharmaceutical aids for smoking cessation: what is associated with increased success?

Although nicotine replacement therapy (NRT) has shown efficacy in randomized controlled trials, population effectiveness has appeared to diminish after it became available over the counter. The present study examined the population effectiveness of bupropion. It also examined whether population effectiveness of pharmaceutical-aid use in general (NRT, bupropion, or both) might be influenced by environmental factors: Having a smoke-free home (possible indication of motivation to quit) or no other smoker in the household. Data from the large population-based cross-sectional 1999 and 2002 California Tobacco Surveys were combined to improve statistical power for subgroup analyses of duration of abstinence following the most recent quit attempt in the past year. Moderate-to-heavy daily smokers (at least 15 cigarettes/day) a year prior to the survey (N = 2,640) were the main focus. A Cox proportional-hazards analysis suggested that bupropion was effective, perhaps even in the longer term. Further analyses identified significant interactions on abstinence duration between having a smoke-free home and any pharmaceutical-aid use (NRT, bupropion, or both), and between having a smoke-free home and no other smoker in the household. Although pharmaceutical aids may have had a slight short-term benefit if the home was not smoke free, they appeared particularly effective if the home was smoke free, both in the short and longer term. The California population experience supports the policy that programs subsidizing pharmaceutical aids to help smokers quit (particularly bupropion, if appropriate) should target highly motivated smokers who have already taken a behavioral action, such as implementing a smoke-free home.

Bupropion↗
PubMed2006

What contributed to the major decline in per capita cigarette consumption during California's comprehensive tobacco control programme?

OBJECTIVES: California experienced a notable decline in per capita cigarette consumption during its comprehensive tobacco control programme. This study examines what proportion of the decline occurred from: (1) fewer ever smokers in the population, (2) more ever smokers quitting, and (3) current smokers smoking less. DESIGN, SUBJECTS: Per capita cigarette consumption computed from cigarette sales and from adult respondents to the large, cross-sectional, population-based California Tobacco Surveys of 1990 (n = 24,296), 1996 (n = 18,616) and 2002 (n = 20,525) were examined for similar trends. MAIN OUTCOME MEASURE: Changes (period 1: 1990-1996; period 2: 1996-2002) in per capita cigarette consumption from self-reported survey data were partitioned for the entire population and for demographic subgroups into the three components mentioned above. RESULTS: In periods 1 and 2, most of the decline in per capita cigarette consumption for the population as a whole was from current smokers smoking less followed by a reduction in ever smokers. The decline from smokers smoking less was particularly evident among young adults (18-29 years) in period 1. While the portion of the decline due to quitting in the entire population in period 1 was negligible, in period 2 it accounted for 22% of the total per capita decline. The decline from quitting in period 2 was mostly observed among women. CONCLUSIONS: Rather than near-term benefits from smokers quitting, population health benefits from reduced per capita cigarette consumption will likely occur over the longer term from fewer people becoming ever smokers, and more less-addicted smokers eventually quitting successfully.

Adolescent↗
PubMed2005

The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: estimates of a panel of experts.

OBJECTIVE: To predict the impact on tobacco use in the US of a "harm reduction" policy that requires that the smokeless tobacco product meet low nitrosamine standards, but could be marketed with a warning label consistent with the evidence of relative health risks. METHODS: Low nitrosamine smokeless tobacco (LN-SLT) and cigarette use are predicted by a panel of experts using a modified Delphi approach. We specify a thought experiment to isolate the changes that would occur after the new LN-SLT policy was implemented. RESULTS: The panel predicted that the new policy would accelerate a decrease in smoking prevalence from 1.3 to 3.1 percentage points over 5 years compared to the current SLT product policy, with greater effects on males than females. Introduction of the new product was also predicted to result in modest additional use of SLT overall, with the greatest increases among males who initiated tobacco use under the new policy. CONCLUSION: An overall consensus was reached that the introduction of a new LN-SLT product under strict regulations would increase SLT use, but reduce overall smoking prevalence. This reduction would likely yield substantial health benefits, but uncertainties surround the role of marketing and other tobacco control policies.

Adolescent↗
PubMed2005

Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking.

Real cigarette prices in the US increased from the early 1980s to early 1990s. Holding all else equal, adolescent initiation of regular smoking should have declined during this period. Using national population-based surveys (n = 336 343) conducted in the 1990s, we present trends (early 1960s to mid-1990s) in the initiation of regular smoking among 14-17-year-old adolescents and 18-21-year-old young adults. We also present trends in consumer-price-index-adjusted cigarette price and tobacco-industry expenditures for price-subsidizing promotions. We relate price and price-subsidizing tobacco industry expenditures to trends in initiation in the two age groups, using autoregressive integrated moving average models (ARIMA). From the model results, we conclude that price-subsidizing promotions may provide the tobacco industry with an effective way to segment the market. That is, they effectively offer lower prices to population subgroups that are more price-sensitive (e.g. young smokers not yet addicted), countering the depressing effect of general price increases on smoking. Thus, we find that the relationship of cigarette price to smoking behavior is more complex than previously described.

Adolescent↗
PubMed2005

The role of curiosity in smoking initiation.

CONTEXT: Although advertising theories have long viewed curiosity as an intermediate goal to encouraging consumption of a product among previous nonusers, this variable is rarely discussed in psychological theories and its role in smoking uptake has not been addressed adequately. DESIGN AND SETTING: Using a longitudinal design, in 1999, we reinterviewed 12- to 15-year-old adolescent never smokers (N=2119; 970 committed never smokers, 1199 susceptible never smokers) 3 years after they responded to a population survey on tobacco use in California. RESULTS: Logistic regression showed curiosity and susceptibility to smoke were independently associated with increased future smoking in all never smokers. Committed never smokers reporting curiosity were more likely to become susceptible by follow-up than those not curious. A multivariate analysis of committed never smokers from the cross-sectional survey identified best friends who smoke and receptivity to tobacco advertising and promotions as associated with curiosity. CONCLUSIONS: Curiosity may be a critical precursor to smoking. Future research on smoking initiation should examine curiosity and investigate factors influencing it.

Adolescent↗
PubMed2005

How do smokers control their cigarette expenditures?

When faced with high cigarette prices, smokers can potentially control cigarette expenditures by limiting consumption or seeking cheaper cigarettes. The present study examined both these options and whether the use of price-minimizing strategies (the second option) could counteract a further price increase without smokers having to reduce consumption. Data for 5,109 smokers who purchased manufactured cigarettes were from the 2002 cross-sectional, population-based, random-digit-dialed California Tobacco Survey. We used logistic regression to examine which smokers used consumption-limiting or price-minimizing strategies, and multiple linear regression to determine how much price-minimizing strategies reduced the average price paid per pack. Overall, 32.3% of California smokers said they limited consumption and 74.1% used at least one of the five price-minimizing strategies identified: choosing cheaper retail outlets (61.1%), using promotional offers (35.2%), choosing cheaper brands (28.7%), purchasing by the carton (27.7%), and using low-tax or nontaxed sources (6.3%). Different groups of smokers used different strategies. Except for the use of promotional offers, all price-minimizing strategies significantly reduced the price paid per pack. Carton purchasers saved 1.01 US dollars/pack, and those buying from low-tax or nontaxed sources saved 1.23 US dollars/pack. However, pack buyers were reluctant to purchase cartons, mostly because they thought they might smoke too much, or because they considered the upfront cost unaffordable. The average California smoker could potentially save 0.33-0.66 US dollars/pack or 6.00-12.00 US dollars/month by using other price-minimizing strategies. Reducing consumption by 3 cigarettes/day could save a smoker 18.00 US dollars/month. Whereas price-minimizing strategies appeared to save money, cutting consumption could save even more. Thus further substantial tax increases would likely have the desired effect.

Adult↗
PubMed2005

What fraction of young adults are at risk for future smoking, and who are they?

Recent evidence indicates that higher smoking rates among young adults in the United States may be related in part to increased initiation during young adulthood. The tobacco industry, restricted from overtly targeting adolescents, appears to be focusing on young adults. Thus it is important to estimate the percentage and identify the characteristics of the young adult population (aged 18-29 years) at risk for future smoking. This group would include all current established smokers (smoked at least 100 cigarettes in their lifetime), current experimenters, former established smokers, and former experimenters at risk for smoking again, as well as never-smokers who do not rule out future smoking. Using data from the population-based 2002 California Tobacco Survey (N = 9,364 young adults aged 18-29 years), we designated groups of young adults at risk and identified factors associated with risk. Altogether, 86.7+/-1.5% of current and former established smokers were at risk for future smoking, and 59.6+/-4.3% of former established smokers were at risk. Over half (52.2+/-2.0%) of all experimenters but only 9.0+/-1.2% of never-smokers were at risk. Overall, 43.0+/-1.2% of the young adult population was at risk. Although different demographic and other factors were associated with risk among former established smokers, experimenters, and never-smokers, three factors were consistently associated in each group: Younger age, not having a smoke-free home, and going to bars and clubs. We conclude that the group of young adults at risk for future smoking is sizable and presents a fertile target for tobacco industry efforts to promote smoking. Counter-efforts might include promotion of smoke-free environments.

Adolescent↗
PubMed2005

How have smoking risk factors changed with recent declines in California adolescent smoking?

AIM: To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99). DESIGN, SETTING AND PARTICIPANTS: Cohorts of 12-15-year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (1993-96, n = 1764; 1996-99, n = 2119). MEASURES: We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. Besides examining predictors individually, risk groups were defined using a multivariate analysis. FINDINGS: Overall, transition to any smoking by follow-up occurred in 38.3 +/- 4.0% (% +/- 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 +/- 2.6% in the 1996-99 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking. CONCLUSIONS: The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Adolescent↗
PubMed2005

African-American women's perceptions of their most serious health problems.

African Americans experience a disproportionate burden of illness. According to the Centers for Disease Control and Prevention (CDC), heart disease, cancer, cerebrovascular disease and diabetes are the most common causes of mortality among African Americans. Data were gathered from 1,055 African-American women to gain their perspectives of the most serious health problems affecting African-American women and their related knowledge, attitudes and health promoting behaviors. Women listed CDC's top four causes of mortality as their top four most serious health threats. Cancer was reported as a serious health threat by 81% of the participants, whereas heart disease, the most common cause of mortality and a disease amenable to prevention and early intervention, was mentioned by only 31% of the women. Diabetes was reported by 59% of the women and cerebrovascular disease by 52%. As the Health Belief and other theoretical models would predict, awareness of the seriousness of these four disease groups among African-American women was associated with a greater likelihood of adherence for several of the recommended behaviors. Many opportunities exist for raising women's awareness of these four diseases and linking women's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Adult↗
PubMed2005

Why does adult African-American smoking prevalence in California remain higher than for non-Hispanic whites?

OBJECTIVES: To explain why, contrary to national trends, adult California African-American (AA) smoking prevalence remains higher than for non-Hispanic Whites (W) and to explore how future rates might change. METHODS: Data from the random-digit-dialed California Tobacco Surveys from 1990 to 2002 (N=16,000-21,000) allowed for the examination of differences in current smoking prevalence, ever smoking (uptake), and successful smoking cessation over time by race/ethnicity and age group. RESULTS: African-American (AA) adolescent (12-17 years) smoking prevalence was lower than Ws through 1996, but similar thereafter because of marked declines for Ws. After 1990, AA young adult (18-29 years) smoking prevalence was consistently 25% lower than Ws', and no evidence of delayed AA smoking initiation was seen. However, among older age groups (30-44 years and 45+ years), AA smoking prevalence was much higher, yielding higher overall adult (18+ years) prevalence. While ever smoking (uptake) was generally lower among AAs, successful cessation (5+ years) was much lower among AA adults, especially older age groups. CONCLUSIONS: Continued higher adult California AA smoking prevalence results from less successful quitting in older age groups. Increased successful cessation is critical for reducing near-term prevalence. Long-term forecasting is difficult because both AA and W adolescents now smoke at comparably low rates.

Adolescent↗
PubMed2004

Do the majority of Asian-American and African-American smokers start as adults?

BACKGROUND: Identifying ethnic differences in the age of smoking onset from nationally representative data can lead to improved targeted prevention programs and policies to combat smoking in ethnic communities. METHODS: Analyzing data from the Tobacco Use Supplements of the U.S. Census Bureau's Current Population Surveys throughout the 1990s, differences in the age of regular smoking onset among Asians/Pacific Islanders (A/PI), African Americans (AA), Hispanics/Latinos (H/L) and non-Hispanic whites (WH) are reported. Data on people aged 26 to 50 years at the time of the survey interview (n =130,356; mean age=38.4 years; 47.9% male; 1.9% A/PI, 7.8% AA, 5.2% H/L, and 85.1% WH) were examined. RESULTS: Results indicate significant ethnic disparities in when people start smoking, among A/PIs in particular, and AAs and H/Ls to a lesser degree, who initiate regular smoking at later ages than do WHs. The majority of A/PIs and AAs initiated smoking as young adults, with almost half (47.8%) of A/PIs who were ever regular smokers starting between ages 18 and 21, compared with 39.8% of AAs, 37.5% of H/Ls, and 36.7% of WHs. CONCLUSIONS: These findings indicate significant ethnic disparities in relation to when people start smoking, with the majority of A/PIs and AAs initiating as young adults. The findings suggest that prevention strategies should begin at a young age and continue throughout young adulthood, especially among ethnic minority populations. Further consideration of the different influences on later initiation in ethnic minorities may lead to suggestions to improve current smoking-prevention programs aimed at adolescents and young adults.

Adolescent↗
PubMed2004

Consequences of declining survey response rates for smoking prevalence estimates.

BACKGROUND: Response rates have been declining in statewide tobacco surveys. This study investigated whether there was associated evidence of increasing bias in smoking prevalence estimates. METHODS: Demographic characteristics of respondents to tobacco surveys in Massachusetts and California were compared to population data in the early 1990s, when response rates were high, and in more recent years, when response rates were lower. State estimates of smoking prevalence at three times were compared with estimates from the Current Population Survey Tobacco Use Supplement (CPS-TUS), conducted by the U.S. Census Bureau. RESULTS: Under- and over-representation of population subgroups has not changed as response rates have declined. Smoking prevalence estimates from state surveys remain relatively close to the state-specific CPS-TUS estimates. CONCLUSIONS: There is no evidence that declining response rates have resulted in less accurate or biased estimates of smoking behavior.

Bias↗
PubMed2004

Does adolescent perception of difficulty in getting cigarettes deter experimentation?

BACKGROUND: Considerable controversy surrounds tobacco control emphasis on youth-access-to-tobacco laws, as there is limited evidence that such enforcement reduces youth smoking. In California, access-law enforcement increased substantially in 1996 compared to earlier in the decade. METHODS: Two longitudinal cohorts of adolescent never smokers from the large, population-based California Tobacco Surveys of 1993 and 1996 were followed-up 3 years later (1993-1996 [n = 1764] and 1996-1999 [n = 2119]). We examined transition to any smoking by follow-up with adolescent perception that cigarettes are easy or hard to get, during periods with less and more access law enforcement. RESULTS: Transition to any smoking by follow-up among 12- to 15-year-old never smokers was identical in the 1993-1996 cohort, regardless of whether they perceived cigarettes as hard or easy to get (about 38%), but was lower in the 1996-1999 cohort for those who perceived that cigarettes were hard (25.9%) vs. easy (36.1%) to get. This differential effect was confirmed in multivariate analyses that adjusted for demographics, cohort, and other known predictors of adolescent smoking. CONCLUSIONS: Increased enforcement of access laws may help protect young adolescents from experimenting with cigarettes by strengthening societal anti-tobacco norms. Such enforcement appears warranted as part of a comprehensive tobacco control program.

Adolescent↗