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Biomedical subjects

M C Fiore

Publications and source records attributed to M C Fiore.

69 records · Page 4Linked to original sources
PubMed1990

Quitting smoking in the United States in 1986.

In an analysis of recent behavior with regard to quitting smoking, detailed histories were obtained on a representative sample of 5,623 Americans who had smoked in the year preceding the 1986 Adult Use of Tobacco Survey. An estimated 55.8 million Americans smoked regularly for some period during the year prior to the survey. Approximately one third (34.8%) quit for at least a day during the year prior to the survey, 28.3% quit for at least 7 days during the year prior to the survey, and 16.2% were still not smoking at the time of the survey. Of those who quit for a day, 54% had relapsed by the time of the survey. Demographic characteristics, such as age, sex, race, marital status, and education, were evaluated as predictors of making a major attempt to quit for 7 days or more. Among those who had made a major attempt, a similar analysis was done predicting success in maintaining cessation for 3 months or more. Ordinal logistic regression analyses showed that younger age and higher education predicted a major attempt to quit. There was only one group who differed markedly from all others: those who were younger and were more highly educated. Older age and being white predicted those who abstained for 3 months or longer.

Adolescent↗
PubMed1990

Cigarette smoking: the clinician's role in cessation, prevention, and public health.

Cigarette smoking is the most important preventable cause of illness and death in the United States, responsible for 390,000, or one sixth, of all deaths. Although smoking prevalence has decreased among adults, from 40% in 1965 to 29% in 1987, 49 million Americans continue to smoke. Smoking rates have declined at a slower rate among blacks, women, young people, and the less educated, groups that must be targeted for tobacco use prevention interventions. The clinician is uniquely positioned to reduce the enormous health toll from cigarette smoking. As a first step, physicians are urged to assess tobacco use during every patient visit by making smoking status a new vital sign. Although 85% of all smokers quit on their own, physicians can greatly facilitate this process. A brief intervention for physicians to help their smoking patients quit, based on a program of the National Cancer Institute, is presented. This program includes asking about smoking status during every clinic visit, advising all smoking patients to quit, assisting smokers by setting a quit date and using nicotine gum, if appropriate, and arranging follow-up with smokers who try to quit. Cessation rates of 5% to 25%, sustained for at least 1 year, are consistent with a successful, physician-mediated intervention program. Physicians are also urged to prevent smoking initiation among adolescents, particularly young girls and those not aspiring to attend college. Physicians can also reduce the enormous toll of tobacco use by acting at the public health and public policy levels. Recording tobacco use as a contributing or the underlying cause on death certificates, if appropriate, will assist in public health surveillance. Also, clinicians are urged to work at the organizational, community, and governmental levels to promote tobacco-free environments.

Health Policy↗
PubMed1990

Trends in smoking by age and sex, United States, 1974-1987: the implications for disease impact.

Using data from the 1974-1987 National Health Interview Surveys, we report trends in current smoking prevalence and quit ratios (the proportion of those who have ever smoked who no longer smoke) for men and women in the age groups 20-24, 25-44, 45-64, and 65 years and older. Current smoking prevalence decreased linearly for men in all age subgroups except 65 and older and for women ages 25-44 and 45-64 years only. The quit ratios increased linearly within each age/sex subgroup except for men and women ages 20-24 years. Overall, there were about 1.4 million fewer male smokers and over 1 million more female smokers in 1987 than there were in 1974. Between 1974 and 1987, the population ages 25-44 years increased by approximately 47%, and the population 65 years and older increased by approximately 34%. As a result, between 1974 and 1987, the actual number of smokers increased among men ages 25-44 years (8% increase), women ages 25-44 years (15% increase), and women ages 65 years and older (50% increase). These data suggest that even with favorable recent changes in the overall smoking prevalence of the U.S. population, the disease impact of smoking will increase for decades, especially among women. This scenario will be mitigated if increased attention is given to cessation among women in general and to the post-World War II generation of both male and female smokers.

Adult↗
PubMed1989

Trends in cigarette smoking in the United States. The changing influence of gender and race.

Trends in the prevalence, initiation, and cessation of cigarette smoking are reported for the US population using weighted and age-standardized data from seven National Health Interview Surveys (1974 to 1985). The decline in prevalence was linear, with the prevalence for men decreasing at 0.91 percentage points per year to 33.5% in 1985 and the prevalence for women decreasing at 0.33 percentage points per year to 27.6% in 1985. For whites the rate of decline (percentage points per year) was 0.57, to 29.4% in 1985, and for blacks the decline was 0.67, to 35.6% in 1985. Smoking cessation increased among all gender-race groups from 1974 to 1985, with the yearly rate of increase (in percentage points per year) about equivalent for blacks (0.75) and whites (0.77), while it was higher in women (0.90) than in men (0.67). Smoking initiation decreased among young men (-1.03), while it remained about the same in young women (+0.11). Initiation decreased at a more rapid rate in blacks (-1.02) than in whites (-0.35). We conclude that smoking prevalence is decreasing across all race-gender groups, although at a slower rate for women than men, and that differences in initiation, more than cessation, are primarily responsible for the converging of smoking prevalence rates among men and women.

Adult↗
PubMed1989

Trends in cigarette smoking in the United States. Educational differences are increasing.

National trends in smoking prevalence by educational category from 1974 through 1985 show that education has replaced gender as the major sociodemographic predictor of smoking status. Smoking prevalence has declined across all educational groups but the decline has occurred five times faster among the higher educated compared with the less educated. From 1974 to 1985, smoking prevalence among persons with less than a high school diploma declined to 34.2% (0.19 percentage points per year) whereas prevalence for persons with four years or more of college education declined to 18.4% (0.91 percentage points per year). Smoking cessation activity increased across all educational groups, but the rate of increase among the higher educated was twice that of lower-educated groups. Initiation of smoking among more-educated men decreased rapidly to 15% in 1985 but leveled off by 1987. Until 1985, less-educated young females were the only group in which smoking initiation was increasing. However, in 1987 a sudden and large decline in initiation among less-educated females occurred. The apparent recent changes in initiation patterns by educational level suggest that the converging of smoking prevalence between the genders may not continue. The large and widening educational gap in smoking suggests that health promotion priorities need to be reassessed.

Adult↗
PubMed1989

Trends in cigarette smoking in the United States. Projections to the year 2000.

Data from National Health Interview Surveys from 1974 through 1985 are used to project cigarette smoking prevalence to the year 2000. Smoking prevalence in the United States has declined at a linear rate since 1974. If this trend continues, in the year 2000, 22% of the adult population (40 million Americans) will be smokers. By the year 2000, the major inequalities in prevalence will occur among educational categories. At least 30% of those who have not proceeded beyond a high school education will be smokers, whereas less than 10% of college graduates will smoke. Among the other sociodemographic subgroups, smoking prevalence is expected to decrease by the year 2000 to 20% among men, to 23% among women, to 25% among blacks, and to 21% among whites. Between 1974 and 1985, approximately 1.3 million persons per year became former smokers, indicating considerable success in public health efforts to encourage people to stop smoking. However, in the early 1980s, approximately 1 million new young persons per year were recruited to the ranks of regular smokers. This is equivalent to about 3000 new smokers each day. Public health efforts need to focus more on preventing young people from starting to smoke, and such prevention efforts should particularly target less educated socioeconomic groups.

Adult↗
PubMed1989

The reliability of self-reported cigarette consumption in the United States.

To investigate the possibility that self-reported smoking is not a valid measure for assessing trends in smoking prevalence, we compared total self-reported cigarette consumption with the adjusted consumption data from cigarette excise taxes as reported by the US Department of Agriculture (USDA) for the period 1974 through 1985. Self-reported consumption was calculated by using data from the National Health Interview Surveys (NHIS) for adults and from the National Household Surveys on Drug Abuse for adolescents. For this period, the average ratio of self-reported cigarette consumption to the USDA estimate of consumption was 0.72 (range = 0.69 to 0.78). There was no statistical difference in this consumption ratio from year to year, indicating no apparent increase in the underreporting of cigarette smoking in these surveys. We conclude that cross-sectional surveys of self-reported smoking status remain a reliable surveillance tool for monitoring changes in population smoking behavior.

Adolescent↗
PubMed1989

Smokeless tobacco use in the United States: the adult use of tobacco surveys.

Prevalence of smokeless tobacco use is reported for adults aged 21 years and older in the Adult Use of Tobacco Surveys, 1964-1986. Data from the 1986 survey on prevalence, beliefs, ages of initiation, and demographic correlates of use by males aged 17 years and older are also reported. The prevalence of smokeless tobacco use declined slightly among persons aged 21 and older between 1966 and 1986. However, 5.2% of the males aged 17 and older used smokeless tobacco in 1986, and prevalence was highest among those 17 to 19 years old (8.2%). The median age of initiation for both products was 19 years. Smokeless tobacco use was most common among white men who were 1) living in the southeastern United States, 2) unemployed, and 3) in blue-collar or service/labor employment. Most users (77.4%) and nonusers (83.4%) believe that smokeless tobacco is a health hazard. Many current users (39.1%) had attempted to quit. Some current (6.4%) and former smokers (7.0%) have used smokeless tobacco as an aid to smoking cessation. National survey data such as these permit the identification of high-risk groups, so that interventions against smokeless tobacco use may be specifically targeted.

Adolescent↗
PubMed1986

Chronic exposure to aldicarb-contaminated groundwater and human immune function.

Aldicarb, a carbamate pesticide, has been a known groundwater contaminant in Wisconsin since 1981. To assess the effects of chronic ingestion of low-level aldicarb-contaminated groundwater (less than 61 ppb) on the immune function of humans, we identified 50 women, ages 18 to 70, with no known underlying reason for immunodysfunction. Twenty-three of these women (exposed group) consumed groundwater with detectable levels of aldicarb, and 27 (unexposed group) consumed water from a source with no detectable levels of aldicarb. Data were collected on each woman's health status, immune function, and fluid intake. Exposed women as compared with unexposed women showed an elevated stimulation assay response to the antigen Candida (P less than 0.02, t test). The exposed group had increased numbers of T8 cells (P less than 0.05, t test), an increased percentage of total lymphocytes as T8 cells (P less than 0.02, t test), and a decreased ratio of T4:T8 cells (P less than 0.02, t test). Our results suggest an association between consumption of aldicarb-contaminated groundwater and abnormalities in T-cell subsets in women with otherwise intact immune systems.

Adolescent↗
PubMedDate not supplied

Transdermal nicotine replacement for hospitalized patients: a randomized clinical trial.

BACKGROUND: This study was undertaken to assess the safety and efficacy of a treatment involving brief counseling and the nicotine patch among hospital inpatients and to identify variables associated with long-term smoking cessation following hospitalization. METHODS: One hundred eighty-five patients were randomly assigned to one of three smoking cessation interventions: (1) A Minimal Care (MC) condition, consisting of a brief physician-delivered motivational message to stop smoking, (2) a Counseling + Active Nicotine Patch (CAP) condition in which patients received the motivational message, a 6-week supply of nicotine patches, and extended bedside and telephone counseling, and (3) a Counseling + Placebo Patch (CPP) condition identical to the CAP condition except the supplied patches contained no nicotine. RESULTS: At 6-month follow-up, abstinence rates for the three treatments were 4.9, 6.5, and 9.7% for the MC, CPP, and CAP treatments, respectively. These differences were not statistically significant. Patients admitted for respiratory disease were more likely to quit than patients with any other diagnosis. The nicotine patch was well tolerated by hospital inpatients. CONCLUSIONS: The initiation of nicotine patch therapy during hospitalization appears to be safe when used among patients carrying a wide range of diagnoses. Our study provided no evidence of the superiority of nicotine patches versus placebo, but this does not preclude the possibility that future research using larger samples might detect differences between patch groups. Hospital interventions for smoking cessation may be most effective among patients hospitalized for a smoking-related illness such as respiratory disease.

Administration, Cutaneous↗
PubMedDate not supplied

Tobacco and alcohol abuse: clinical opportunities for effective intervention.

No behaviors are more costly to the United States from a health or economic perspective than tobacco and alcohol use. One of the primary strategies available to mitigate this exacting toll is to identify and clinically treat the 25% of adults in America who smoke and the 20% of adults who drink alcohol above recommended limits. During the last two decades, researchers have identified a series of brief clinical interventions that can markedly reduce alcohol and tobacco use and significantly decrease the health burdens resulting from such use. This review outlines office-based clinical interventions and the organizational policies that support these interventions that have been shown to decrease tobacco and alcohol use.

Adult↗
PubMedDate not supplied

Smoking cessation services offered by health insurance plans for Wisconsin state employees.

Health insurance plans for state of Wisconsin employees were surveyed regarding the smoking cessation benefits offered to their members. Seven of the 25 plans (28%) cover some form of cessation treatment. Those plans that cover smoking cessation services differ substantially in the scope of benefits, and some have limitations and exclusions. These results suggest that smokers in Wisconsin are offered only limited insurance coverage for effective smoking cessation treatments.

Humans↗
PubMedDate not supplied

Methods used to quit smoking in the United States. Do cessation programs help?

Using data from the 1986 Adult Use of Tobacco Survey, we analyzed smoking-cessation methods used by adult smokers in the United States who tried to quit. About 90% of successful quitters and 80% of unsuccessful quitters used individual methods of smoking cessation rather than organized programs. Most of these smokers who quit on their own used a "cold turkey" approach. Multivariate analysis showed that women, middle-aged persons, more educated persons, persons who had made more quit-smoking attempts, and, particularly, heavier smokers were most likely to use a cessation program. Daily cigarette consumption, however, did not predict whether persons would succeed or fail during their attempts to quit smoking. Rather, the cessation method used was the strongest predictor of success. Among smokers who had attempted cessation within the previous 10 years, 47.5% of persons who tried to quit on their own were successful whereas only 23.6% of persons who used cessation programs succeeded. We conclude that cessation programs serve a small, but important, population of smokers that includes heavier smokers, those most at risk for tobacco-related morbidity and mortality.

Adolescent↗
PubMedDate not supplied

The effectiveness of the nicotine patch for smoking cessation. A meta-analysis.

OBJECTIVE: To estimate the overall efficacy and optimal use of the nicotine patch for treating tobacco dependence. DATA SOURCES: Nicotine patch efficacy studies published through September 1993, identified through MEDLINE, Psychological Abstracts, and Food and Drug Administration new drug applications. STUDY SELECTION: Double-blind, placebo-controlled nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (eg, coronary artery disease). DATA EXTRACTION: Pooled abstinence rates and combined odds ratios (ORs) at end of treatment and 6-month follow-up were examined overall and in terms of patch type (16-hour vs 24-hour), patch treatment duration, dosage reduction (weaning), counseling format (individual vs group), and intensity of adjuvant behavioral counseling. DATA SYNTHESIS: Across 17 studies (n = 5098 patients) meeting inclusion criteria, overall abstinence rates for the active patch were 27% (vs 13% for placebo) at the end of treatment and 22% (vs 9% for placebo) at 6 months. The combined ORs for efficacy of active patch vs placebo patch were 2.6 at the end of treatment and 3.0 at 6 months. The active patch was superior to the placebo patch regardless of patch type (16-hour vs 24-hour), patch treatment duration, weaning, counseling format, or counseling intensity. The 16-hour and 24-hour patches appeared equally efficacious, and extending treatment beyond 8 weeks did not appear to increase efficacy. The pooled abstinence data showed that intensive behavioral counseling had a reliable but modest positive impact on quit rates. CONCLUSIONS: The nicotine patch is an effective aid to quitting smoking across different patch-use strategies. Active patch subjects were more than twice as likely to quit smoking as individuals wearing a placebo patch, and this effect was present at both high and low intensities of counseling. The nicotine patch is an effective smoking cessation aid and has the potential to improve public health significantly.

Administration, Topical↗