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Biomedical subjects

J B Unger

Publications and source records attributed to J B Unger.

At least 19 recordsLinked to original sources
PubMed2006

Definitive and palliative radiotherapy for cervix cancer in the elderly.

The elderly population is increasing in number. Aggressive therapeutic intervention in this patient group may not always be possible because of age, the presence of co-morbidity, and poor functional status. Hence, individualized management of cervix cancer (CC) in the elderly is often practiced. Because of the preceding consideration, the cases of 79 women 65 years of age and older with CC treated with radiation over the last 20 years were reviewed. The cases were classified into two groups--those who were aggressively irradiated (group 1: 43 patients) and those managed less intensively for palliation (group 2: 36 patients). Local tumor control, complications, and survival were assessed. There were fewer extremely aged (> or = 75 years of age) women (p = 0.006) with advanced stage disease (p = 0.012) in group 1 than in group 2. Also, group 1 women experienced fewer treatment failures (p < 0.0003) and more of them were alive and well at last follow-up (p < 0.005) than those from group 2. The median survival periods for groups 1 and 2 were 60 months and 11 months, respectively (p < 0.0001); the corresponding 5-year crude survival rates were 54% and 19%, respectively (p = 0.002). Two women required remedial surgery for bowel obstruction/perforation after irradiation, and one patient sustained chronic radiation cystitis.

Aged↗
PubMed2003

Cancer of the cervix with endometrial extension treated by radiotherapy: a retrospective case-control study.

BACKGROUND: Studies determining prognosis of cancer of the cervix with endometrial extension (CCEE) in a case-control fashion are scant. METHODS: A case-control retrospective study of 20 women with CCEE and 16 patients with cervical cancer not extending to the endometrium (CCNEE) treated by radiation was undertaken. The patient groups were matched for age, disease stage, the presence of bulky/barrel-shaped tumor in the cervix, intercurrent illness, total radiation dose, and hemoglobin level. The overall mean follow-up was 54 months (range 8 to 218 months). RESULTS: The numerical rates of local and systemic failure as well as 5-year survival were worse for patients with CCEE versus CCNEE. However, the observed differences were not statistically significant. CONCLUSION: Involvement of the endometrium by cancer of the cervix seems to confer a worse outcome among cervical cancer patients treated by radiation alone.

Adult↗
PubMed2001

Hazard of smoking initiation by age among adolescents in Wuhan, China.

BACKGROUND: Knowledge about age of smoking initiation among adolescents in China is helpful for exploring cultural differences in adolescent smoking behavior and informative for global tobacco control. However, little has been documented on this issue. METHOD: Adolescents (6,473) attending grades 7, 8, and 9 completed the baseline survey of a longitudinal, randomized smoking prevention trial. Data were collected in classrooms with a paper-and-pencil questionnaire. A survival model was used in the statistical analysis. RESULTS: The hazard of smoking initiation for boys showed a pattern previously observed in the United States: very low (<2%) before 7 years of age, increasing rapidly after age 10, and peaking at 14-15 years of age. The hazard for girls was below or around 1% until 12 years of age before it increased. The hazard levels were similar for adolescents both in urban and in rural areas, but higher for those in grade 7 than in grades 8 and 9. CONCLUSIONS: Chinese boys in Wuhan, China, experienced a hazard pattern of smoking initiation by age similar to those observed in the United States, while Chinese girls there experienced a rather low risk of smoking initiation. The hazard pattern suggests that the best time for smoking prevention is between 10 and 15 years of age. Adolescents in lower grades are at higher risk of early smoking initiation, suggesting a potential cohort effect in adolescent smoking initiation in Wuhan, China.

Adolescent↗
PubMed2001

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial.

BACKGROUND: This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China. METHODS: Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke). RESULTS: Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05). CONCLUSIONS: Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

Adolescent↗
PubMed2001

Ethnic variation in peer influences on adolescent smoking.

Previous research has indicated that the influence of peers on adolescent smoking may differ across ethnic groups. Although many studies have focused on African Americans, Hispanics, and Whites, few studies have included Asian Americans, Pacific Islanders, and multi-ethnic adolescents as distinct groups. Using data from a statewide sample of 5870 eighth-grade adolescents in California, this study examined ethnic differences in the association between peer influence variables and smoking behavior and susceptibility. Informational peer influence (best friends' smoking behavior) and normative peer influence (prevalence estimates of peer smoking) were investigated. We hypothesized that informational peer influences would be stronger among Whites (whose families originate primarily from the individualistic cultures of the USA and Western Europe) than among Asian Americans, Pacific Islanders, Hispanics, and African Americans (whose families originate primarily from collectivist cultures). Conversely, we hypothesized that normative peer influences would be stronger among ethnic minority adolescents from collectivist cultural backgrounds than among Whites. Consistent with previous studies, friends' smoking and prevalence estimates of peer smoking were risk factors for past 30-day smoking and susceptibility to smoking across ethnic groups. The influence of friends' smoking behavior was stronger among Whites than among several other groups: Pacific Islanders, African Americans, and Hispanic/Latinos. The influence of prevalence estimates of peer smoking was stronger among Whites than among multiethnic adolescents. Results indicate that cultural factors may play a role in peer influences on smoking initiation. Smoking prevention interventions for adolescents should address the differences in peer influences across ethnic groups.

Adolescent↗
PubMed2001

Peer influences and susceptibility to smoking among California adolescents.

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996-97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N=2681) and ever-smokers (N=4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking.

Adolescent↗
PubMed2001

Are adolescents attempting to buy cigarettes on the internet?

OBJECTIVE: To assess the prevalence of, and demographic and smoking behaviour correlates of, attempting to purchase cigarettes via the internet among adolescent current smokers. METHODS: A representative sample of 17 181 10th and 12th grade California students completed a written questionnaire on tobacco related attitudes and behaviour during the 1999-2000 school year. Logistic regression analyses were used to determine the variables associated with attempting to purchase cigarettes on the internet. RESULTS: Among youth under 18 years of age who were current smokers (n = 1689), 2.2% (95% confidence interval 1.5% to 2.9%) reported attempting to purchase cigarettes on the internet. Attempted internet purchases were more likely among younger respondents, males, frequent smokers, and respondents reporting lower perceived availability of tobacco products from retail and social sources. CONCLUSIONS: Few adolescent smokers in California surveyed during the 1999-2000 school year had attempted to obtain cigarettes from the internet. As internet access increases, future studies should examine whether internet cigarette vendors sell to minors and whether adolescents are purchasing cigarettes on the internet.

Adolescent↗
PubMed2000

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents.

PURPOSE: To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility. METHODS: An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues. RESULTS: The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age. CONCLUSIONS: The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.

Adolescent↗
PubMed2000

Perceived consequences of teenage childbearing among adolescent girls in an urban sample.

PURPOSE: The purpose of this study was to examine the perceived positive consequences of teenage childbearing among female adolescents, and to determine whether perceived consequences of teenage childbearing are associated with other attitudes and sexual risk behaviors. METHODS: The sample consisted of 584 female students attending three urban high schools in Los Angeles, California. The respondents' mean age was 15.8 years, and 72% were Hispanic/Latina. Respondents completed a paper-and-pencil survey assessing their attitudes and risk behaviors relevant to teenage pregnancy. Multiple regression and logistic regression analyses were used to examine the associations between perceived consequences of teenage childbearing and demographic variables, educational variables, parental characteristics, psychosocial variables, attitudes, and sexual behavior. RESULTS: Higher scores on a scale of perceived positive consequences of teenage childbearing were associated with increased risk of sexual intercourse and unprotected sexual intercourse. Higher scores on this scale were found among girls who were Latinas, were non-U.S. natives, had low levels of expected educational attainment, had low parental monitoring, had good communication with parents, and wished to have many children. CONCLUSION: Potential strategies for preventing adolescent pregnancy include educating girls about the difficulties of teenage childbearing, countering their positive illusions about the expected benefits, and teaching them more adaptive ways to meet their emotional needs.

Adolescent↗
PubMed2000

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms.

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.

Adolescent↗
PubMed2000

Ethnic differences in adolescent smoking prevalence in California: are multi-ethnic youth at higher risk?

OBJECTIVE: Although ethnic differences in adolescent smoking have been well documented, smoking among multi-ethnic adolescents has received little research attention. This study examined smoking prevalence and tobacco related psychosocial risk factors among multi-ethnic adolescents in California, as compared with white, African American, Asian American, and Hispanic adolescents. DESIGN: This study used a cross sectional design. Data were obtained from the independent evaluation of the California Tobacco Control, Prevention, and Education Program. SETTING: Students completed a paper-and-pencil survey in their classrooms. SUBJECTS: Data were collected from a stratified random sample of 5072 eighth grade students (age 13-14 years) in California during the 1996-97 school year. The data were weighted by school enrollment in analyses to make the estimates representative of the population of California students attending public schools. MAIN OUTCOME MEASURES: Outcome variables included self reported smoking prevalence, susceptibility to smoking, access to tobacco, and related attitudes, beliefs, and behaviours. Ethnicity was assessed with a self reported, "check all that apply" question. RESULTS: Results indicated that multi-ethnic adolescents were at higher risk than single-ethnic adolescents on several variables, including 30 day cigarette smoking prevalence, lifetime smokeless tobacco use, buying cigarettes, receiving cigarette offers, and expected friends' reaction if the respondent smoked. For several other variables (lifetime cigarette smoking prevalence, susceptibility to smoking, and number of friends who smoked), Hispanic adolescents were at higher risk than all other ethnic groups including multi-ethnic adolescents. Although susceptibility to smoking was highest among Hispanics, multi-ethnic adolescents scored significantly higher on susceptibility than the three other single-ethnic groups. CONCLUSIONS: Multi-ethnic adolescents may be at increased risk for smoking and may have easier access to cigarettes. Culturally targeted smoking prevention interventions for adolescents should address the unique social challenges faced by multi-ethnic adolescents that may increase their risk for smoking.

Adolescent↗
PubMed1999

Hazards of smoking initiation among Asian American and non-Asian adolescents in California: a survival model analysis.

BACKGROUND: Information about the risk of smoking initiation among whites, African Americans, and Latino Americans has provided an important information base for smoking prevention programs among adolescents from these ethnic backgrounds. Unfortunately, there is a lack of such information for Asian Americans, a fast-growing ethnic minority group with much internal diversity. METHOD: This study used cross-sectional data from 20,482 subjects 12-17 years of age, randomly sampled in California, to describe and compare the risk of smoking initiation for adolescents by age among Asian American and other non-Asian ethnic groups, using survival analysis. Computer-aided telephone interview techniques were used in data collection. RESULT: The risk of early smoking initiation among Asian American adolescents is about a third of that of Caucasians. However, the risk among Asian Americans continues to increase throughout adolescence, while the same risk among Caucasians and African Americans plateaus around 14-15 years of age. Significant differences in the levels and patterns of smoking initiation among Asian American subgroups were observed, with Chinese Americans showing the lowest risk of smoking initiation and Filipino Americans the highest, Japanese and Korean Americans being in-between. CONCLUSION: Asian American adolescents may be especially at risk of smoking initiation later in adolescence, even though they are at lower risk early in adolescence. Smoking prevention programs for Asian Americans should continue throughout adolescence and early adulthood.

Adolescent↗
PubMed1999

Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams.

OBJECTIVES: The purpose of this study was to compare the surgical outcomes of women with moderately enlarged uteri undergoing vaginal hysterectomy with those of women with uteri of normal size undergoing vaginal hysterectomy. A secondary objective was to investigate the roles of uterine morcellation and laparoscopically assisted vaginal hysterectomy in the treatment of these women. STUDY DESIGN: Thirty consecutive women during a 2-year period with uterine enlargement to a weight of between 200 and 700 g underwent vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy limited to lysis of adhesions or adnexectomy. These patients with uterine enlargement (group 1) were compared with 160 women with uteri weighing <200 g who also underwent vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy during the same interval (group 2). The 2 groups were compared for total complications, operative time, hospital stay, perioperative hemoglobin concentration change, and use of vaginal uterine morcellation and laparoscopically assisted vaginal hysterectomy. RESULTS: Operative time for vaginal hysterectomy was significantly longer for women in group 1 than for women in group 2 (66.6 +/- 26.2 minutes vs 53.0 +/- 25.5 minutes, P =.008). There was a linear relationship between uterine weight and operative time: Operative time = 47.156 + 0.056 x Uterine weight (r = 0.20, F = 7.66, degrees of freedom 1, 188, P = .006). Vaginal morcellation of the uterus was needed in 80.0% of the women in group 1 and in 10.0% of the women in group 2 (P < .001). Two women in group 1 (6.7%) and 9 women (5.6%) in group 2 had laparoscopically assisted procedures for lysis of adhesions, adnexectomy, or both, unrelated to uterine size (P =.69). There were no significant differences between the 2 groups with respect to perioperative hemoglobin concentration change or hospital stay. Finally, the rates of major surgical complications were similar in the 2 groups (3.3% in group 1 vs 4.3% in group 2, P > .99, 95% confidence interval -8.1% to 5.9%). CONCLUSIONS: Although vaginal hysterectomy requires a modest increase in operative time, it is as safe and effective for the woman with a moderately enlarged uterus as for the woman with a uterus of normal size. Vaginal uterine morcellation is the key to a successful operation and obviates the need for either abdominal or laparoscopically assisted hysterectomy solely to deal with moderate uterine enlargement.

Adult↗
PubMed1999

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.

PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.

Adolescent↗
PubMed1999

Smoking patterns of Asian-American youth in California and their relationship with acculturation.

PURPOSE: To examine patterns of smoking behavior among subgroups of Asian-American youth in California and their relationship with acculturation status. METHODS: Data were from the 1990-1996 California Tobacco Survey and the California Youth Tobacco Survey, which assessed smoking-related attitudes and behaviors among California youth in grades 7-12. Among the 20,482 respondents, 1,810 were Asian-Americans. Variables assessed included lifetime smoking prevalence, 30-day smoking prevalence, and age of smoking onset. Acculturation status was assessed with measures of English usage, language spoken at home, and age at immigration to the United States. RESULTS: Of the 1,810 Asian-Americans (52% male), 19% were Chinese, 33% Filipino, 8% Japanese, 13% Korean, and 26% other Asian-Americans. Lifetime smoking prevalence was 16.1% for Asians and 26.1% for non-Asians. The 30-day smoking rate was 6.9% for Asians and 14.2% for non-Asians. Subgroup-specific analyses revealed differences in lifetime smoking prevalence (18.9% for Filipinos, 17.3% for Japanese, 16.3 % for Koreans, 11.0% for Chinese, and 13.7% for other Asian-Americans) and 30-day smoking rate (8.6% for Filipinos, 8.3% for Koreans, 7.4% for Japanese, 2.8% for Chinese, and 7.2% for other Asian-Americans). Gender differences in lifetime smoking prevalence varied by Asian subgroup; smoking prevalence was higher among males than among females for Chinese and Koreans, but smoking prevalence was higher among females than among males for Japanese and other Asians. The average age of smoking onset was 12.9 years for Asians and 12.8 years for non-Asians. Age of smoking onset differed among Asian-American subgroups but did not differ by gender. In addition, smoking behaviors of the Asian respondents were significantly associated with their acculturation status. CONCLUSIONS: Asian-American youth have relatively lower smoking rates and later age of smoking onset than non-Asian youth in California. In addition, subgroups of Asian-American youth vary widely in their smoking behavior. High levels of acculturation among Asian-American youth are associated with higher smoking prevalence rates and earlier age of smoking onset.

Acculturation↗