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Biomedical subjects

R C Brownson

Publications and source records attributed to R C Brownson.

At least 73 records · Page 4Linked to original sources
PubMed1997

Environmental tobacco smoke: health effects and policies to reduce exposure.

The health hazards due to exposure to environmental tobacco smoke (ETS) are increasingly established. ETS contains thousands of chemicals including 43 known carcinogens. Known health effects of ETS exposure are lung cancer in nonsmokers, childhood disorders such as bronchitis, and perhaps, heart disease. Workplace exposure to ETS is widespread and is influenced strongly by the type of smoking policy in the workplace. To decrease ETS exposure, efforts to restrict public smoking have proliferated over the past decade. These restrictions have emanated from government as well as voluntary measures by various private industries. Bans on public smoking are effective in reducing nonsmokers' exposure to ETS. Workplace smoking bans also influence the intensity of smoking among employees and may increase quit smoking rates. In addition to the health benefits from smoke-free workplaces, there are likely cost savings to employers who implement such policies.

Cost-Benefit Analysis↗
PubMed1997

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities.

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.

Exercise↗
PubMed1997

Policy research for disease prevention: challenges and practical recommendations.

Policy approaches to health promotion and disease prevention hold great potential, as several community-based projects have illustrated. Policy interventions, despite their wide-spread use, frequently lack a systematic framework for implementation and evaluation. The authors propose a four-stage framework for the formation and evaluation of public health policy. The stages are identification of health risks and preventive options; intervention development; policy development; and policy enactment and assurance. A strong focus on evaluation is included within the framework. In addition, a series of practical implications and recommendations are given under the broad headings of evaluation issues and linkages. It is hoped that the issues described will lead to more systematic implementation and evaluation of public health policy measures.

Health Policy↗
PubMed1996

Avian exposure and risk of lung cancer in women in Missouri: population based case-control study.

OBJECTIVE: To investigate the association, previously reported in three European studies, between ownership of pet birds and the risk of lung cancer. DESIGN: A population based case-control study with a structured questionnaire administered by telephone. SETTING: Missouri, a midwestern state in the United States with a population of about 5 million. SUBJECTS: All newly diagnosed cases of primary lung cancer in women aged 30-84 years in Missouri from 1 January 1993 to 31 January 1994 reported to the state cancer registry were invited to participate (n = 652); and 629 population based controls. MAIN OUTCOME MEASURES: Odds ratios were computed in relation to whether or not the study subject ever kept pet birds, the type of bird kept, and several measures of intensity or duration of exposure. Odds ratios were adjusted for smoking. RESULTS: The odds ratio (95% confidence interval) for the development of lung cancer associated with keeping pet birds was 0.84 (0.65 to 1.09). The results were similar for the type of pet bird kept, the number of birds kept, the location of the bird in the house, and the duration of ownership. CONCLUSION: The keeping of pet birds carries no excess risk for the development of lung cancer.

Adult↗
PubMed1996

Hospital smoking bans and employee smoking behavior: Results of a national survey.

OBJECTIVE: To examine the impact of workplace smoking bans on smoking behavior of employees. PARTICIPANTS: A total of 1469 current or former smokers (intervention group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior. DESIGN: This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities. MAIN OUTCOME MEASURES: Postban quit ratio and progression along the stages-of-change continuum. METHODS: The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables. RESULTS: Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P<.001). Despite preban differences in smoking intensity, the overall difference in postban quit ratios remained significant even after multivariate adjustment for socioeconomic, demographic, and smoking intensity variables. For those sites that were 5 years postban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted. In all but 1 category, the intervention group was further along the stages-of-change continuum toward quitting smoking than the comparison group (P<.001). CONCLUSION: American hospitals' experiences with smoking bans, which directly affect more than 5 million workers, should be examined by other industries as a method of improving employee health. Workplace smoking bans could also be effective in saving lives, reducing health care costs, addressing safety concerns, and decreasing operating and maintenance expenses of employers.

Analysis of Variance↗
PubMed1996

Estimating the effect of dietary fat on the risk of lung cancer in nonsmoking women.

In 1992, approximately 13 000 lung cancers occurred in nonsmoking U.S. women but the cause of these highly fatal tumors is not well understood. As the rate of smoking declines in many developed countries, the interest in identifying lung cancer risk factors other than tobacco smoking is increasing. A population-based, case-control study of incident lung cancer among nonsmoking women in Missouri was conducted between 1986 and 1992 to assess the effect of a comprehensive list of potential risk factors. Dietary information on 429 case subjects and 1021 control subjects was obtained by personal interview, or next-of-kin interviews (36% and 64%, respectively) and the relationship of diet to lung cancer risk is the focus of this investigation. Odds ratios and population attributable risks (PAR) for dietary fat and dietary saturated fat were computed among lifetime nonsmokers and long-term ex-smokers. The mean age at lung cancer diagnosis was 71 years old, and nearly 50% of the lung cancers were histologically confirmed adenocarcinomas. Dietary intake of saturated fat was the leading identified cause of lung cancer among lifetime nonsmokers and former smokers in Missouri. The etiologic link between dietary saturated fat and lung cancer has not been examined in many other studies and the studies published to date are not completely consistent with the hypothesis so a cautious interpretation of the population attributable risks for these exposures is warranted. Nonetheless, a growing number of studies arising from around the world purport to show a link between fat, saturated fat and/or cholesterol or food groups containing relatively high amounts of these macronutrients (i.e. dairy products, eggs and/or red meat consumption) and lung cancer, and these recent studies add support to this hypothesis. If the results from Missouri are valid and applicable to other Americans, 23% of lung cancer cases among lifetime nonsmokers in the United States could be prevented if the saturated fat consumption of the upper half of saturated fat intake continuum could be reduced to the level consumed by the lower half. Even greater reductions in risk could be achieved if saturated fat consumption were reduced to even lower levels (i.e. 20th percentile of consumption as shown in this paper). However, additional etiologic research and evaluation is needed before specific dietary recommendations concerning fat and saturated fat and lung cancer prevention can be made.

Adult↗
PubMed1996

Changes in newspaper coverage of cardiovascular health issues in conjunction with a community-based intervention.

Numerous community-based prevention projects, with significant media components, have been conducted over the past decade. Multiple evaluation strategies have been used to document the effectiveness of these interventions, including intermediate measures of community impact such as assessment of media coverage. As part of the evaluation of a community-based intervention (the Bootheel Heart Health Project), dissemination of information on cardiovascular disease (CVD) was measured through a media content analysis of newspapers. Data were analyzed from 23 newspapers in six rural counties in southeastern Missouri for the period October 1988 through August 1993. An increase was observed in CVD-related coverage in the pre-intervention period (mean articles per month = 31.5) compared with the post-intervention period (mean articles per month = 50.7) (F = 10.2; P = 0.003). In supporting data from a separate randomized risk factor survey of 1510 residents in the same area, respondents reported hearing of heart health coalitions primarily through local newspapers. The current study documents increasing print media coverage of cardiovascular health issues in a high-risk, rural area and shows that media content analysis can be a useful evaluation tool in community-based interventions.

Cardiovascular Diseases↗
PubMed1996

Preventing cardiovascular disease through community-based risk reduction: the Bootheel Heart Health Project.

OBJECTIVES: The purpose of this study was to determine whether a community-based risk reduction project affected behavioral risk factors for cardiovascular disease. METHODS: Community-based activities (e.g., exercise groups, healthy cooking demonstrations, blood pressure and cholesterol screenings, and cardiovascular disease education) were conducted in six southeastern Missouri counties. Evaluation involved population-based, cross-sectional samples of adult residents of the state and the intervention region. Weighted prevalence estimates were calculated for self-reported physical inactivity, cigarette smoking, consumption of fruits and vegetables, overweight, and cholesterol screening. RESULTS: Physical inactivity decreased within the intervention region, that is, in communities where heart health coalitions were developed and among respondents who were aware of these coalitions. In addition, the prevalence rates for reports of cholesterol screening within the past 2 years were higher for respondents in areas with coalitions and among persons who were aware of the coalitions. CONCLUSIONS: Even with modest resources, community-based interventions show promise in reducing self-reported risk for cardiovascular disease within a relatively brief period.

Adolescent↗
PubMed1996

The future of cancer control research and translation.

The future holds great promise for translating advances in cancer control research to populations at risk-much is known about how to prevent cancer. Within the Institute of Medicines overall framework of assessment, policy development, and assurance, this article summarizes 10 cancer control priorities. Important themes include evaluation, cost-effectiveness analysis, shrinking the "latency period" between elucidation of preventive technologies and widespread application, coalition building, and development of adequate cancer control resources. Despite increased cancer control efforts among public health agencies over the past decade, little measurable progress has been made in reducing overall cancer mortality. A renewed commitment to controlling cancer is needed from health policy makers and even the public health community.

Decision Making, Computer-Assisted↗
PubMed1995

Smoking bans in US hospitals. Results of a national survey.

OBJECTIVE: To examine compliance and characteristics of hospitals with tobacco control standards enacted by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO). DESIGN AND SETTING: On-site national survey of hospitals as part of routine JCAHO accreditation visits. PARTICIPANTS: A total of 3327 US hospitals received site visits in 1992 and 1993 and were matched with American Hospital Association Annual Survey of Hospitals data. MAIN OUTCOME MEASURES: Compliance or noncompliance with tobacco control standards; location in a tobacco-producing state; and organizational characteristics, including provision of psychiatric/alcohol-chemical dependency services. RESULTS: Two years after implementation, 95.6% of hospitals met the new JCAHO smoking ban standard; 90.9% of hospitals were in compliance with a second smoking standard requiring development and use of medical criteria for physician-ordered exceptions to the ban. Hospitals in tobacco-producing states had higher-than-average rates of compliance when compared with hospitals in other states. Hospitals providing psychiatric and/or substance abuse services had lower-than-average rates of compliance. CONCLUSION: This first industry-wide smoking ban has been successful. However, hospitals should consider evaluating the use of medical exceptions to this policy.

Accreditation↗
PubMed1995

Lung cancer in nonsmoking women. Histology and survival patterns.

BACKGROUND: Despite the widespread view that important clinical and etiologic differences exist between histologic categories of lung cancer, few studies have examined the accuracy of hospital-reported pathologic diagnoses of lung cancer. METHODS: A review of pathologic material and an assessment of survival patterns were conducted in conjunction with a recently completed case-control study of lung cancer among nonsmoking women in Missouri. Using established protocols, tissue slides from tumors of 482 patients were reviewed by 3 pathologists. RESULTS: Adenocarcinoma was the most common histologic type among former smokers and lifetime nonsmokers. The overall agreement rate between the original and review diagnoses was 65.6%. The positive predictive value ranged from 0.33 for bronchioalveolar carcinomas to 0.84 for adenocarcinomas. Agreement rates for small, medium, and large hospitals were 63.1, 66.6, and 66.2%, respectively. Survival rates were highest for bronchioalveolar carcinoma and lowest for small cell carcinoma. CONCLUSION: Given the importance of lung cancer to public health and the need to examine risk by histologic type, these data indicate that pathologic review of registry-reported lung cancer cases may be an important component of large scale studies of etiology.

Adenocarcinoma↗
PubMed1995

Attributable risk of lung cancer in lifetime nonsmokers and long-term ex-smokers (Missouri, United States).

A population-based, case-control study of incident lung cancer among women in Missouri (United States) who were lifetime nonsmokers and long-term ex-smokers was conducted between 1986 and 1992. The study included 618 lung cancer cases and 1,402 population-based, age matched controls. Information on lung-cancer risk factors was obtained by interviewing cases, next-of-kin of cases (36 percent and 64 percent of the cases, respectively) and controls. Year-long radon measurements also were sought in every dwelling occupied for the previous five to 30 years. Population attributable risks (PAR) for specific risk factors were computed for all subjects, for lifetime nonsmokers, for long-term ex-smokers, by histologic cell type (i.e., adenocarcinoma cf nonadenocarcinoma) and for direct interviews with case (for living cases) and for next-of-kin interviews (for dead cases or cases too ill to complete an interview). The mean age at lung cancer diagnosis was 71 years, and nearly 50 percent of the lung cancers were histologically confirmed adenocarcinomas. Almost 40 percent of all lung cancers among lifetime nonsmokers and almost 50 percent of lung cancers among all subjects could be explained by the risk factors under study. Dietary intake of saturated fat and nonmalignant lung disease were the two leading identified risk factors for lung cancer among the lifetime nonsmokers, followed by environmental tobacco smoke, and occupational exposures to known carcinogens. A small nonsignificant risk was found for study subjects exposed to median domestic radon concentration of 4 pCi/l (25-year time-weight average).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Environmental and policy interventions to control tobacco use and prevent cardiovascular disease.

Despite its declining prevalence during the past few decades, tobacco use remains one of the most significant public health issues of the 1990s. Environmental and policy interventions are among the most cost-effective approaches to control tobacco use and prevent cardiovascular diseases. In this article, the authors review and offer to state and local health departments and other public health partners a summary of recommended policy and environmental interventions that have either reduced or show potential to reduce tobacco use. Priority recommendations include clean indoor air policies, restrictions on tobacco advertising and promotion, policies limiting youth access to tobacco, comprehensive school health programs, and excise taxes and other economic incentives. Many of these recommendations should be integrated with other health promotion interventions to also improve nutrition and physical activity. The authors also highlight several successful interventions and strategies used to establish policies at the state and local levels.

Adolescent↗
PubMed1994

Residential radon exposure and lung cancer among nonsmoking women.

BACKGROUND: Radon at sufficiently high concentrations is known to cause lung cancer among underground miners and in experimental laboratory animals. PURPOSE: Our aim was to determine whether indoor levels of radon are associated with a detectable increase in lung cancer. Nonsmoking women were selected because they offer the best opportunity to detect radon-related risk while minimizing the potentially confounding influences of cigarette smoking and occupation. METHODS: A population-based, case-control study of incident lung cancer was conducted in Missouri. A total of 538 non-smoking white women diagnosed with lung cancer between 1986 and 1992 and 1183 age-matched control subjects were identified from the Missouri Cancer Registry and from driver's license and Medicare listings, respectively. Information on lung cancer risk factors was obtained by telephone interview. Year-long radon measurements were sought in every dwelling occupied for the previous 5-30 years. RESULTS: Radon measurements covered 78% of the relevant residential period, and women reported being indoors for 84% of this time. The time-weighted average radon concentrations were exactly the same for case subjects and control subjects (1.82 pCi/L of air [pCi L-1]). Radon levels greater than 4 pCi L-1 were experienced by 6.5% of the case subjects and 6.8% of the control subjects. For all data combined, there was little evidence for a trend of lung cancer with increasing radon concentrations (two-tailed trend test, P = .99 continuous data analysis; P = .19 categorical data analysis). A positive dose-response trend was suggested for the adenocarcinoma cell type and among directly interviewed women (two-tailed trend test; P = .31 continuous data analysis; P = .04 categorical data analysis), but not for other histologies or among those who had surrogate interviews. CONCLUSIONS: The possibility of detecting a risk from indoor radon in this study was maximized by (a) including a large number of nonsmoking women with high indoor occupancy, (b) conducting a large number of radon measurements near the time of the diagnosis of cancer, and (c) controlling for known causes of lung cancer. However, an association between lung cancer and the exposure to domestic levels of radon was not convincingly demonstrated. IMPLICATIONS: The magnitude of the lung cancer risk from radon levels commonly found in U.S. dwellings appears low.

Adenocarcinoma↗
PubMed1994

Reliability of information on chronic disease risk factors collected in the Missouri Behavioral Risk Factor Surveillance System.

The Behavioral Risk Factor Surveillance System (BRFSS) is widely used by state health agencies to measure the prevalence of chronic disease risk factors. We completed a test-retest study to assess the reliability of the Missouri Behavioral Risk Factor Surveillance System. We conducted telephone reinterviews for 222 respondents of completed Behavioral Risk Factor Surveillance System interviews from March and April 1993. The second interview was completed between 6 and 30 days after the first interview. Agreement was high for sociodemographic variables (kappa values from 0.85 to 1.00). Reliability of information on chronic conditions and risk factors was also high, with kappa values from 0.82 for hypertension to 1.00 for current smoking status. Regarding cancer screening practices, reliability was lower for knowledge of the prostate-specific antigen test (kappa = 0.21) than for women's cancer screening practices (that is, the mammogram and Papanicolaou smear). Questions on attitudes toward environmental tobacco smoke showed lower reliability than did questions on individual actions to reduce exposure to environmental tobacco smoke.

Adolescent↗
PubMed1994

Diabetes-related end-stage renal disease in Missouri: trends and variations by age and race.

Diabetes-related end-stage renal disease (ESRD-DM) is a major source of morbidity and medical costs. The authors studied patterns of ESRD-DM in Missouri during the period 1985-1992. The incidence of ESRD-DM increased during this period, with the largest increase in older age groups. ESRD-DM is substantially more common among blacks than among whites. Enhanced efforts are needed to improve detection and control of diabetes and its complications, especially in high-risk populations.

Adult↗