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Biomedical subjects

John P Pierce

Publications and source records attributed to John P Pierce.

13 recordsLinked to original sources
PubMed2003

Measuring dietary change in a diet intervention trial: comparing food frequency questionnaire and dietary recalls.

Measurement of dietary change was assessed in a systematic quota subsample (n = 397) of women recruited into the Women's Healthy Eating and Living Study between 1996 and 1998, a multicenter, randomized dietary intervention trial among breast cancer survivors. Women from the intervention and comparison arms completed the Arizona Food Frequency Questionnaire (AFFQ) and 24-hour dietary recalls at baseline (prerandomization) and at year 1 (postrandomization). Both dietary measurement methods demonstrated significant changes in intake of key intervention-associated nutrients at year 1 in the intervention group subjects compared with minimal or no change in the comparison group subjects. The reliability of the AFFQ and recalls was measured in the comparison group and showed correlations of 0.63 and 0.43, respectively. Both instruments captured differences in dietary intake associated with the diet intervention. These results demonstrate the utility of using a multimode, multimethod approach (AFFQ and 24-hour dietary recalls) to measure differences in self-reported dietary intake over time as shown in this dietary intervention trial being conducted among breast cancer survivors.

Adult↗
PubMed2003

Concurrent use of tobacco products by California adolescents.

BACKGROUND: To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age. METHODS: Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use. RESULTS: Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use. CONCLUSIONS: Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Adolescent↗
PubMed2002

Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation.

CONTEXT: Successful smoking cessation is a major public health goal. In controlled clinical trials, nicotine replacement therapy (NRT) and the antidepressant bupropion have been shown to significantly increase cessation rates only for moderate to heavy smokers (> or = 15 cigarettes/d). Nicotine replacement therapy is heavily promoted to the general population by both the pharmaceutical industry and tobacco control advocates. OBJECTIVE: To examine trends in smoking cessation, pharmaceutical cessation aid use, and success in cessation in the general California population. DESIGN, SETTING, AND PARTICIPANTS: The large population-based California Tobacco Surveys of 1992, 1996, and 1999, including 5247 (71.3% response rate), 9725 (72.9% response rate), and 6412 (68.4% response rate) respondents, respectively. MAIN OUTCOME MEASURES: Rates of cessation attempts (> or = 1 day) among smokers in the last year, use of pharmaceutical aids (mostly over-the-counter products since 1996), and cessation success. RESULTS: Between 1992 and 1999, cessation attempts among California smokers increased 61.4% (from 38.1% to 61.5%), and NRT use among quitters increased 50.5% (from 9.3% to 14.0%). A total of 17.2% of quitters used NRT, an antidepressant, or both as an aid to cessation in 1999. In 1996 and 1999, the median duration of aid use (14 days) was much less than recommended, and only about 20% of users had adjuvant one-on-one or group behavioral counseling. Use of NRT increased short-term cessation success in moderate to heavy smokers in each survey year. However, a long-term cessation advantage was only observed before NRT became widely available over-the-counter (August 1996). In 1999, no advantage for pharmaceutical aid users was observed in either the short or long term for the nearly 60% of California smokers classified as light smokers (<15 cigarettes/d). CONCLUSION: Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.

Adult↗
PubMed2002

Increased fruit, vegetable and fiber intake and lower fat intake reported among women previously treated for invasive breast cancer.

OBJECTIVE: To describe the dietary intake patterns of women before and after breast cancer diagnosis. SUBJECTS AND SETTING: 3,084 women (age range 27 to 70 years) who had been treated for early-stage breast cancer, who were free of recurrent disease, and who were willing to complete study questionnaires. DESIGN: A descriptive analysis of baseline demographic and lifestyle questionnaire data, including reported dietary intake data from women who have had breast cancer participating in a randomized, controlled dietary intervention trial. Outcomes include dietary intakes of high- and low-fat foods, fruits and vegetables, and whole grains. STATISTICAL ANALYSIS PERFORMED: Analyses included frequency of intake of selected food items, chi2 analysis to determine associations between reported intakes and demographic and personal characteristics, and logistic regression to assess odds of making more healthful changes. RESULTS: Women who have had breast cancer reported higher fruit, vegetable, and fiber-rich food intakes (58%, 60%, 38% more, respectively) and lower intakes of high-fat foods, including fast foods, after diagnosis. Those older than age 60 years were more likely to report no change in intake, including red meat (41%), vegetables (51%), and whole grains (62%). Odds ratios (OR) for more healthful diet choices varied by age and time since diagnosis. The longer the time since diagnosis the more likely women selected low-fat (vs high-fat) foods (OR 1.56, 95% confidence interval [CI] 1.16-2.09 for 3 to 4 years vs <1 year after diagnosis) and reduced added fats (OR 1.47, 95% CI 1.17-1.84 for 3 to 4 years vs <1 year after diagnosis). APPLICATIONS: Women who have had breast cancer report more healthful diet habits after diagnosis. Through nutrition education and counseling, dietetics professionals may be able to promote healthful and evidence-based eating habits among women previously treated for breast cancer.

Adult↗
PubMed2002

A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study.

The Women's Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.

Adult↗
PubMed2002

Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking?

OBJECTIVE: The tobacco industry contends that parenting practices, not marketing practices, are critical to youth smoking. Our objective was to examine whether tobacco-industry marketing practices undermine the protective effect of recommended authoritative parenting against adolescent smoking. DESIGN AND SETTING: Receptivity to tobacco advertising and promotions was assessed in 1996 from a representative sample of California adolescent never-smokers aged 12 to 14 years. A follow-up survey of 1641 of these adolescents was conducted in 1999 that included measures of the key components of authoritative parenting: parental responsiveness, monitoring, and limit setting. MAIN OUTCOME MEASURE: Smoking initiation in adolescents. RESULTS: Adolescents in families with more-authoritative parents were half as likely to smoke by follow-up as adolescents in families with less-authoritative parents (20% vs 41%, p <0.0001). In families with more-authoritative parents, adolescents who were highly receptive to tobacco-industry advertising and promotions were significantly more likely to smoke (odds ratio=3.52, 95% confidence interval =1.10-11.23), compared to those who were minimally receptive. This effect was not significant in adolescents in families with less-authoritative parents. The overall attributable risk (adjusted for exposure to peer smokers) of smoking from tobacco-industry advertising and promotions was 25%. However, an estimated 40% of adolescent smoking in families with more-authoritative parents was attributable to tobacco-industry advertising and promotions; this was five times the attributable risk seen in families with less-authoritative parents (8%). CONCLUSION: The promotion of smoking by the tobacco industry appears to undermine the capability of authoritative parenting to prevent adolescents from starting to smoke.

Adolescent↗
PubMed2002

Demographic differences in patterns in the incidence of smoking cessation: United States 1950-1990.

PURPOSE: Current measures of successful quitting are insensitive to changes induced by tobacco control activities. We evaluated whether changes in the incidence of successful quitting, a new measure of cessation, can inform policy makers how population subgroups responded. METHODS: Smokers from National Health Interview Surveys (NHIS) (1965 through 1992, n = 140,199) were used to determine the number of current smokers eligible to quit at the beginning of each year from 1950 through 1990. Incidence of quitting, computed for different demographic subgroups, was the ratio of those newly successfully quit each year to those eligible to quit. RESULTS: Overall, incidence increased over fivefold, from < 1% in 1950 to a still low 5% in 1990. When the health risks of smoking were first disseminated, middle-aged men had the highest quitting incidence. Gender differences in younger smokers occurred following the beginning of the public health campaign of the mid 1960s, as the dangers of smoking to the fetus were documented. Younger adult smokers appeared to increase quitting markedly in the 1970s, around the beginning of the nonsmokers' rights movement. Quitting patterns in middle-aged African Americans were similar to whites, although at much reduced levels. Younger African Americans had low quitting incidence until 1989. Incidence differed by educational attainment; regardless of age, during the 1970s and 1980s, those with some college increased their quitting incidence markedly. CONCLUSION: Incidence of quitting is a sensitive indicator of relatively short-term changes in successful quitting in population subgroups and should facilitate evaluation efforts.

Adult↗
PubMed2002

The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers.

Harm reduction for continuing smokers has been suggested as a public health priority. We evaluated whether tobacco control programs might reduce cigarette consumption among current smokers through strategies aimed primarily at protecting nonsmokers from secondhand smoke (SHS). Data were from adult (18+ years) respondents to multiple (1990, 1992, 1996, 1999), large, cross-sectional, population-based surveys of smoking behavior, conducted to evaluate the California Tobacco Control Program. Adult daily smoking prevalence decreased from 15.9 +/-0.4%(+/-95% confidence interval) of the California adult population in 1990 to 13.0 +/-0.3% in 1999. Concurrently, moderate-to-heavy daily smoking (>or= 15 cigarettes/day) decreased from 10.3 +/-0.4% in 1990 to 7.4 +/-0.3% in 1999, and heavy daily smoking (>or= 25 cigarettes/day) from 3.4 +/- 0.2% in 1990 to 1.9 +/- 0.1% in 1999. Decreased daily smoking was observed in all demographic subgroups except young adults. Among college graduates, the daily smoking prevalence in 1999 was 6.4 +/- 0.4%, a level previously observed only among U.S. physicians. In 1999, nearly 30% of current smokers did not smoke daily, and more than 60% said they now smoked less than previously. In 1999, self-reported cigarette consumption was inversely related to believing SHS is harmful to nonsmokers, having a smoke-free workplace, and living in a smoke-free home. In California, tobacco control strategies that educated the population about SHS and resulted in smoking restrictions may have led continuing smokers to smoke less, which should reduce the harm from smoking to the public health in the long term.

Adolescent↗
PubMed2002

Does tobacco industry marketing of 'light' cigarettes give smokers a rationale for postponing quitting?

The objective of this analysis was to examine further whether tobacco industry marketing using the labels light and ultra-light is perceived by smokers as a health claim. Smokers might view low tar/nicotine brands of cigarettes as a means to reduce the harm to their health from smoking and postpone quitting. Data were from smokers responding to a large, population-based survey of Californians' smoking behavior, conducted in 1996 (8,582 current smokers). Sixty percent of smokers thought the labels light and ultra-light referred to low tar/nicotine cigarettes, or otherwise implied a health claim. This percentage was higher for smokers of low tar/nicotine brands. Among smokers of regular brands, the more highly addicted, those who were trying unsuccessfully to quit, those who had cut consumption or thought about it, and those with health concerns were more likely to have considered switching. While some of these characteristics also were associated with smokers of low tar/nicotine brands, the associations were not as numerous or as strong. We conclude that some smokers appear to view low tar/nicotine brands as one short-term strategy to reduce the harm to their health from smoking without quitting. By implying reduced tar or nicotine exposure, tobacco industry marketing using the labels light and ultra-light is misleading smokers. The use of such labels should be regulated.

Adolescent↗
PubMed2002

Clean indoor air: advances in California, 1990-1999.

OBJECTIVES: This study assessed progress in achieving clean indoor air in California. METHODS: Data were from large, cross-sectional population-based surveys (1990-1999). RESULTS: Indoor workers reporting smoke-free workplaces increased from 35.0% (95% confidence interval [CI] = 33.7, 36.3) in 1990 to 93.4% (95% CI = 92.6, 94.2) in 1999. Exposure of nonsmoking indoor workers to secondhand tobacco smoke decreased from 29.0% (95% CI = 27.2, 30.8) to 15.6% (95% CI = 14.1, 17.1). Adults with smoke-free homes increased from 37.6 % (95% CI = 35.1, 40.1) in 1992 to 73.7% (95% CI = 73.2, 74.2) in 1999; nearly half of smokers in 1999 had smoke-free homes. In 1999, 82.2% (95% CI = 81.5, 82.9) of children and adolescents (0-17 years) had smoke-free homes, up from 38.0% (95% CI = 35.1, 40.9) in 1992. CONCLUSIONS: California's advances highlight an important opportunity for tobacco control.

Adolescent↗