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Biomedical subjects

K M Emmons

Publications and source records attributed to K M Emmons.

At least 37 records · Page 2Linked to original sources
PubMed2000

Behavioral risk factors among women presenting for genetic testing.

Considerable research attention has been given to the impact of genetic testing on psychological outcomes. Participation in genetic testing also may impact on health behaviors that increase the risk of cancer and other chronic diseases. The purpose of this study is to describe behavioral cancer risk factors of women who requested genetic testing for breast and ovarian cancer susceptibility (BRCA1, BRCA2). Before participation in a genetic testing program, 119 women completed a series of questionnaires designed to assess their health behaviors, perception of risk, and depressive symptomatology. Eight percent of participants were current smokers, 27% did not engage in at least moderate exercise, 46% did not regularly protect themselves from the sun, 39% did not consume at least five servings of fruits and vegetables per day, and 9% drank at least one alcoholic beverage per day. Poisson regression analysis revealed that age was the only predictor of behavioral risk profiles, with older women having fewer cancer risk behaviors. These patients who presented for genetic testing generally had better health behaviors than the general population. However, given their possible high-risk status, these patients should consider further improving their preventable cancer risk factors and, in particular, their diet, sun protection, and physical activity levels. Inclusion of behavioral risk factor counseling in the context of the genetic testing process may be an important opportunity to reach this at-risk population.

Adult↗
PubMed1999

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.

Adult↗
PubMed1999

The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking.

Worksites are a key channel for delivery of interventions designed to reduce chronic disease among adult populations. Although some evaluations of worksite physical-activity interventions have been conducted, to date very few randomized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion. This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessments as part of their worksites' participation in The Working Healthy Project (WHP), a multiple risk factor intervention implemented in 26 manufacturing worksites. In this study, a randomized matched-pair design was used. Fifty-one percent (n = 2,761) of the employees who completed the baseline assessment also completed the interim survey. Eighty-three percent of those who completed the interim assessment also completed the final survey. The WHP intervention targeted smoking, nutrition, and physical activity. At baseline, 38% of the sample reported engaging in regular exercise, and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day, 7.9 grams of fiber per 1000 kilocalories, and 35.4% calories from fat per day; 28% of the sample were smokers. By the time of both the interim (intervention midpoint) and final (end of intervention) assessments, participants in the intervention condition had significantly increased their exercise behavior, compared with the control condition. There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment, compared with the control condition. No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation. These results suggest that among a cohort of participants in a worksite health promotion study, there were significant health behavior changes across two risk factors over time. These data suggest that further investigation of multiple risk factor worksite health promotion is warranted, particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce.

Adult↗
PubMed1999

Smoking cessation and tobacco control: an overview.

Cigarette smoking is an intractable public health problem and the single largest risk factor for a variety of malignancies, including lung cancer. Worldwide, about 3 million people die each year of smoking-related disease, and this is expected to increase to > 10 million deaths per year. The Agency for Health Care Policy and Research has published a clinical practice guideline detailing available outcome data for various smoking cessation strategies. In particular, it has been recommended that all patients be screened for smoking status on every health-care visit, and that all patients who smoke be strongly advised to quit and offered assistance to do so. Health-care providers play a vital role in the effort to reduce the prevalence of smoking by delivering smoking cessation advice, supporting community-based efforts to control tobacco, and becoming involved in the tobacco control debate.

Counseling↗
PubMed1998

Factors influencing nutrition education for patients with low literacy skills.

Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center-based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients' social networks; appear in a visually based, interactive format; and be culturally appropriate.

Adult↗
PubMed1998

Environmental tobacco smoke: association with cardiovascular function at rest and during stress.

Chronic exposure to environmental tobacco smoke (ETS) contributes to cardiovascular disease morbidity and mortality, and ETS alters cardiovascular performance during exercise stress. However, no study has examined whether those with ETS exposure have altered cardiovascular functioning during psychological stress, relative to those with no substantial ETS exposure. Seventy-eight healthy, nonsmoking adult men with either high levels of current ETS exposure at home and work or no current or significant lifetime ETS exposure were tested in a stress reactivity protocol. Blood pressure and heart rate were monitored during rest and during two psychological stressors. Those with high ETS exposure had significantly elevated heart rate and blood pressure at baseline, relative to those with no exposure. The groups did not differ on their cardiovascular stress responses. These data suggest that chronic ETS exposure is associated with altered cardiovascular functioning at rest, but not during stress. Results are discussed with regard to the role of ETS on the development of heart disease among nonsmokers.

Journal Article↗
PubMed1998

Predictors of smoking among US college students.

OBJECTIVES: This study explored predictors of smoking among a large, representative national sample of students enrolled in American 4-year colleges. METHODS: A sample of undergraduate students, randomly selected from 140 colleges, was sent a detailed questionnaire that included questions about smoking status. RESULTS: The 30-day smoking prevalence was 22.3%; 25% of the participants were former smokers. Multivariate analyses suggested that, among college students, men are less likely to smoke than women. In addition, high-risk behaviors (e.g., marijuana use) and lifestyle choices (e.g., nonparticipation in athletics) increased the likelihood of being a smoker. CONCLUSIONS: This study's findings have important implications for health education and promotion among college populations.

Adult↗
PubMed1997

Tobacco control: a brief review of its history and prospects for the future.

Smoking prevalence among American adults is at its lowest point in the last 30 years, and there is unprecedented popular support for tobacco control measures. The financial resources to carry on the battle for tobacco control are still heavily stacked in favor of the industry, which by current estimates is worth $45 billion, including $6 billion spent each year on advertising and promotion alone. Nonetheless, industry executives must realize that, even if they can win individual battles, they are losing the war. This article has discussed key events in the history of tobacco control, as well as some of the most innovative strategies currently being used for tobacco control. Although it is important that tobacco control efforts be disseminated widely and through novel channels, the challenge facing public health advocates in the next several decades will be to anticipate the industry's response to key initiatives, as well as to launch organized and strategic counterattacks against efforts to dissuade acceptance of such initiatives. The history of tobacco control demonstrates that public health advocacy resources should be strategically focused in precisely the areas in which the industry feels most vulnerable (e.g., nicotine addiction, regulation of nicotine, environmental tobacco smoke), rather than in areas in which the industry maintains a vocal presence for the purposes of public relations (e.g., youth access). Through its lobbying efforts and financial clout, the tobacco industry has played a key role in the development of public health policy. Although it is no secret that the tobacco industry regularly makes campaign contributions to both Republicans and Democrats, the impact of these donations on public policy making have only recently begun to be quantified and documented. Moore et al found that the more tobacco money a politician received, the less likely he or she was to support tobacco control legislation. Similar distortional effects of tobacco money have been demonstrated at the state level. The political expenditure of 12 tobacco firms increased 10-fold in California after the implementation of Proposition 99 in California--from $790,050 in the 1985-1986 election, to $7,615,091 in the 1991-1992 election. In an analysis of the behavior of the California legislature between 1991 and 1992, a statistically significant relationship was found between members' receipt of tobacco money and their likelihood of opposing tobacco control measures. Tobacco control advocates as well as health professionals in general have an important role to play in holding their legislators accountable for developing public health policy that reflects the concerns of their constituencies, not of the tobacco lobby. Public health advocates should pay particular attention to the recent regulations placed on cigarettes as a key tobacco control strategy for the next several decades. For the first time in the history of the United States, a President has introduced legislation that will allow a governmental agency to regulate tobacco. The FDA has faced relentless attacks by the tobacco industry, and it will continue to be a target. Public health advocates and health care providers have a critical role to play in the FDA's efforts to bring this issue to fruition. If the public health community fails to support this initiative and create an active and forceful opposition to the industry's efforts to derail it, it is likely that the impact on tobacco control efforts will be resounding and far-reaching.

Adult↗
PubMed1995

Distribution of smokers by stage in three representative samples.

OBJECTIVES: A key variable for the design of individual and public health interventions for smoking cessation is Stage of Change, a variable which employs past behavior and behavioral intention to characterize an individual's readiness to change. Reactively recruited samples distort estimates of the stage distribution in the population because such samples attract a disproportionate number of late-stage participants. Three representative samples are described which provide accurate estimates of the stage distribution in the population. These samples are of adequate size to permit within-sample comparisons with respect to sex, age, Hispanic or non-Hispanic origin, race, and education level. The implications of using stage distribution as a tool for planning intervention is discussed. METHOD: The first sample of 4,144 smokers was from the state of Rhode Island and involved a random-digit-dial survey. The second sample of 9,534 smokers was from the state of California and involved a stratified random-digit-dial survey. The third sample of 4,785 smokers was from a total of 114 worksites located in four different geographic locations. RESULTS: The stage distributions were approximately identical across the three samples, with approximately 40% of the sample in Precontemplation, 40% in Contemplation, and 20% in Preparation. The stage distribution was generally stable across age groups with the exception of the 65 years and older group. Education level did affect the stage distribution with the proportion of the sample in Precontemplation decreasing as education level increased. In all three samples, minor differences in stage distribution were related to Hispanic origin and race, but the pattern was not consistent across the samples. CONCLUSIONS: The pattern of stage distribution has important implications for the design of interventions. Existing interventions are most appropriate for the Preparation stage, but the majority of the three samples were in the first two stages, resulting in a likely mismatch between the smoker and the intervention. The stability of distribution across age suggests that interventions that are appropriately matched to stage can be applied across all age groups. The differences found with respect to education, Hispanic origin, and race can serve as a guide to the tailoring of intervention materials.

Adult↗
PubMed1995

Dietary intake and exposure to environmental tobacco smoke in a worksite population.

OBJECTIVES: Nonsmokers who live with smokers have poorer dietary habits than those who live in nonsmoking households. This relationship may be due to shared lifestyle patterns by spouses and family members. However, in order to fully understand the nature of this relationship, it is also important to examine the association between diet and exposure to environmental tobacco smoke (ETS) at the workplace. Further, blue collar workers' patterns of exposure to ETS both at work and at home have not been studied. The goal of this study is to examine the dietary intake of manufacturing workers as it relates to exposure to ETS at work and at home. METHODS: The Working Well Trial surveyed 10,833 nonsmokers about a variety of health behaviors, including smoking, dietary behaviors, and ETS exposure. RESULTS: Nonsmokers who had ETS exposure in their household had significantly lower intake of all target micronutrients, compared to those without household exposure. Exposure to ETS at the workplace was associated with lower intakes of vitamin C and fruits and vegetables, but not the other micronutrients examined. CONCLUSIONS: Exposure to ETS was associated with poorer dietary habits. Household exposure was a stronger predictor of intake than was workplace exposure. Because of the antagonistic effects of many components of a healthful diet in relation to the harmful effects of tobacco smoke, these findings have relevance larger than either ETS exposure or diet considered singly.

Adult↗
PubMed1994

An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure.

To evaluate the relationship between self-reported exposure to environmental tobacco smoke and saliva cotinine concentrations, we studied 186 nonsmokers. Each participant completed an exposure questionnaire, kept a daily exposure diary for 7 days, and provided a saliva sample for cotinine analysis. Salivary cotinine concentrations were measured using gas chromatography/mass spectrometry. Of the volunteers, 30% lived with one or more smokers, and 84% were regularly exposed to smokers at work. Eighty-three percent of the volunteers had detectable saliva cotinine concentrations (> or = 0.5 ng/ml) (median = 1.1; range = 0.5-7.4 ng/ml). Cotinine concentrations were related to exposure in the household and at the workplace. Volunteers who lived with smokers had significantly higher cotinine levels (median = 1.0; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-4.7 ng/ml). Volunteers who reported regular exposure at work had higher cotinine levels (median = 0.8; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-3.0 ng/ml). Cotinine concentrations were predicted by a regression equation that included the number of smokers at home and work and the number of minutes of exposure recorded in the daily diary (r2 = 0.29).

Adolescent↗
PubMed1994

Mechanisms in multiple risk factor interventions: smoking, physical activity, and dietary fat intake among manufacturing workers. Working Well Research Group.

BACKGROUND: Individuals who have multiple poor health behaviors account for a disproportionately large percentage of the preventable U.S. health care cost burden. Understanding the relationships between multiple risk factors is important for the design of both individual and public health interventions. There have been few efforts to examine the co-occurrence of psychosocial and motivational mechanisms that mediate smoking, dietary fat intake, and physical activity in a defined population of blue collar workers. METHODS: The sample comprised 1,559 manufacturing workers who participated in a self-help physical activity intervention and who completed a computerized assessment battery about their smoking, dietary fat intake, physical activity, and demographic characteristics. RESULTS: Twenty-six percent of the sample were smokers, 51% did not exercise regularly, and 35% consumed more than an estimated 40% of calories per day from fat. Almost half of the sample was in the later stages of readiness for physical activity and dietary fat intake, compared with only 3% for smoking. Only 12% of the smokers had smoking as their only risk factor. Smokers were significantly more likely to engage in poor dietary and physical activity behaviors, compared with nonsmokers. The relationship among smoking status and the other risk factors was apparent both in terms of dietary fat and physical activity behaviors, as well as mediators such as motivation for change. Lower dietary fat intake was associated with an absence of the other two risk factors. CONCLUSIONS: The results suggest that there are important mediating mechanisms both within and among workers with one or more risk factors. Smokers are a particularly important target for health promotion interventions, and it may be possible to make initial contact with them through other health programs at the worksite. The role of other lifestyle changes as a gateway to smoking cessation has not yet been explored, but may have potential for reaching smokers who are very low in their motivational readiness to change. The implications of these findings for research and the design of multiple risk factor interventions are discussed.

Adult↗
PubMed1994

Smoking at home: the impact of smoking cessation on nonsmokers' exposure to environmental tobacco smoke.

Nonsmokers who live with smokers are at increased risk for chronic disease. This study evaluated the impact of eliminating smoking in the home on nonsmokers' environmental tobacco smoke (ETS) exposure. Nonsmokers participated in measurements of their ETS exposure before and after the smoker in their home quit smoking. A matched comparison group of nonsmokers from nonsmoking homes was also included. ETS exposure was assessed using passive nicotine monitors, an exposure diary, and a questionnaire. Nonsmokers from smoking homes had significantly higher exposure to ETS than those from nonsmoking homes. There was a 60% reduction in nicotine levels following smoking cessation by the household smoker. However, there were still detectable levels of nicotine measured at posttest. These results have important implications for individual risk reduction and public health policy.

Case-Control Studies↗
PubMed1994

Recruitment of work sites to a health promotion research trial. Implications for generalizability.

The characteristics of companies that either accepted or declined participation in a 5-year randomized trial of a multirisk factor health promotion intervention were compared to investigate potential limitations on the generalizability of research findings. A representative sample of 151 manufacturing work sites in the northeast was recruited to participate. Sixty-four of the companies were determined to be eligible and 10 others, which refused to have an administrator interviewed, were presumed to be eligible. Of this group, 27 companies agreed to participate. Work force demographics, shift structure, and prior history of health promotion offerings were not significantly different in the two groups. However, participating companies employed fewer workers and had a more favorable financial outlook than did companies that declined to participate. Implications of these findings for research on work site health promotion are discussed.

Health Promotion↗