The role of physicians in combatting the growing health crisis of tobacco-induced death and disease in the People's Republic of China.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
T F Pechacek
Publications and source records attributed to T F Pechacek.
Changes in adult cigarette smoking in the Minnesota Heart Health Program.
OBJECTIVES: The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes. METHODS: Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, self-help materials, telephone support, and home correspondence programs. RESULTS: Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross-sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities. CONCLUSIONS: The findings suggest that community education may be unlikely to exceed dramatic secular reductions in smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however.
Adult↗
Promoting smoking cessation at the workplace. Results of a randomized controlled intervention study.
This paper presents results from a preliminary short-term work-site intervention study aimed at smoking cessation. The 3-month intervention included consultation for employers on the adoption of a nonsmoking policy, training for nonsmokers to provide assistance to smokers attempting to quit, and cessation classes for smokers. Eight work sites from Bloomington, Minnesota were recruited to the study and randomly assigned to an intervention or comparison condition after a baseline survey of all employees. To assess the effect of the intervention, smokers were surveyed 1 and 6 months after the intervention was completed. At the 1-month follow-up, the overall quit rate in the intervention group was 12% compared to 5% in the control group (P < .05). At the 6-month follow-up, 12% of smokers in the intervention group reported quitting, compared to 9% in the control group (P < .05). Co-worker support for quitting was higher in the intervention group compared to the comparison group. Cessation was highest overall among smokers whose co-workers frequently asked them not to smoke and among those who worked with a high proportion of nonsmokers. These results indicate that a short-term, multifaceted smoking cessation program implemented in work sites can affect smoking cessation rates as well as the work-site norms about smoking.
Follow-Up Studies↗
Aspects of statistical design for the Community Intervention Trial for Smoking Cessation (COMMIT).
We present statistical considerations for the design of the Community Intervention Trial for Smoking Cessation (COMMIT). One outcome measurement, the quit rate in randomly selected cohorts of smokers, is compared with another outcome measurement, the decrease in smoking prevalence, in terms of statistical efficiency and interpretability. The COMMIT study uses both types of outcome measurements. The merits of pair-matching the communities are considered, and sample size calculations take into account heterogeneity among pair-matched communities. In addition to significance tests based on the permutational (randomization) distribution, we also describe approaches for covariate adjustment. The COMMIT design includes 11 pair-matched communities, which should provide good power to detect a 10% or greater difference in quit rates between the intervention and control communities in cohorts of heavy smokers and in cohorts of light or moderate smokers. The power is only moderate to detect intervention effects on the decreases in overall smoking prevalence or in the prevalence of heavy smoking.
Bias↗
Smoking-attributable cancer mortality in 1991: is lung cancer now the leading cause of death among smokers in the United States?
Findings from the new American Cancer Society prospective study of 1.2 million men and women indicate that mortality risks among smokers have increased substantially for most of the eight major cancer sites causally associated with cigarette smoking. Lung cancer risk for male smokers doubled, while the risk for females increased more than fourfold. On the basis of the new American Cancer Society relative risks, we project that cigarette smoking alone will contribute to slightly more than 157,000 of the 514,000 total cancer deaths expected to occur in the United States in 1991. Overall, smoking directly contributes to 21.5% of all cancer deaths in women but 45% of all cancer deaths in men. It would also appear that lung cancer has now displaced coronary heart disease as the single leading cause of excess mortality among smokers in the United States.
Aged↗
Needs and recommendations for behavior research in the prevention and early detection of cancer.
Because life-style patterns affect many cancer risks, research on health-risk behavior and behavior change is critical to cancer prevention. This report recommends priorities for the next decade of psychosocial research on cancer prevention and detection. The leading priority for future research is to fill gaps in basic knowledge left by the rush to intervention and outcome studies. Such research must be theoretically driven and should aim to develop broad principles applicable to diverse health behaviors. Studies that include relevant process data on various stages of behavior change are considered more desirable than simple outcome studies. Epidemiologic investigations should be expanded to include measures of relevant behaviors, so that their impact on clinical outcomes might be established. More research is needed on lay perception of health risks and on individual and health-system barriers to effective cancer prevention and detection. Studies that address the needs of minority and underprivileged populations are crucial. Funding agencies' narrow categorical mandates impede interdisciplinary research on multiple risk factors and their interactions; these boundaries must be relaxed to promote such approaches. Funding agencies should also consider basic research as a long-term investment towards the development of effective interventions.
Health Behavior↗
A comparison of self-help approaches to smoking cessation.
The current study evaluated the effectiveness of widely used self-help materials for quitting smoking. Five hundred and seventy smokers volunteered during a baseline survey to participate in the evaluation. After random assignment, 200 were mailed National Cancer Institute (NCI) "Quit for Good" materials, 200 the Minnesota "Quit and Win" program, and the remaining 170 were assigned to a nonintervention control condition. Results at 7-month follow-up failed to indicate treatment effects either for abstinence or for reported quit attempts. A number of smokers quit prior to the mailing of self-help materials, suggesting that a telephone prompt in itself may have been an important stimulus to cessation. Overall abstinence at follow-up was 10%. Contrary to expectation, successful participants were less likely to use a number of specific preparation strategies for quitting. The results are instructive in providing a large-scale assessment of self-help materials in a population of smokers that was not specifically seeking treatment.
Adult↗
A comparison of smoking patterns in the People's Republic of China with the United States. An impending health catastrophe in the middle kingdom.
Half of the global increase in tobacco use from 1976 to 1986 occurred in the People's Republic of China. In 1984, the first national smoking survey was conducted in China, involving over a half-million subjects. Sixty-one percent of Chinese males over age 15 smoke, with higher rates in all occupational groups than for corresponding groups in the United States. Current smoking patterns in China are similar to those in the United States during the 1950s, and these patterns forecast a steadily increasing epidemic of smoking-related deaths. It is estimated that by 2025, two million Chinese men will die annually from smoking. Foreign tobacco companies are mounting massive production and advertising campaigns in China. Government health education programs lack funds to counter these influences with sustained and comprehensive educational and interventional campaigns. To avert an impending national health catastrophe, China must launch a comprehensive smoking-control initiative aimed at public education, cessation, and legislation and policy.
Adolescent↗
Physician-initiated smoking cessation program: the National Cancer Institute trials.
Explore the source record for details and available documents.
Clinical Trials as Topic↗
Toward a tobacco-free society.
Explore the source record for details and available documents.
Adolescent↗
Tobacco use trends and control strategies in the United States.
The future of U.S. smoking control efforts and for all countries lies in strengthening existing cooperative relationships among smoking control advocates (Coalitions on Smoking or Health) and facilitating linkages among others who have not previously worked together. In this way with numerous Governmental and Non-Governmental organizations converging on the single issue of reducing prevalence, a multiplicative effect is possible. With it comes the realization of a smoke-free U.S. society by the year 2000.
Adult↗
Differences in smoking cessation strategies between men and women.
This descriptive research was designed to identify differences in smoking cessation strategies between men and women in a cross-sectional population sample of current smokers in the upper Midwest. Data on the number of previous quit attempts, the success and persistence in quit attempts, future intentions to change smoking habits, and strategies planned for cessation were obtained from 1669 smokers. Log-linear analyses controlling for age and the number of cigarettes smoked revealed significant gender differences. Men and women appear to approach smoking cessation differently. Women were more tentative and less committed to quitting smoking entirely. Women were also less successful in sustaining smoking cessation attempts for longer than one week. Efficacy expectations and differential attributions for failure were suggested as possible explanations for the results, however further research will be necessary to confirm or disconfirm these hypotheses.
Adult↗
Implementing nonsmoking policies in the private sector and assessing their effects.
Nonsmoking policies are being implemented increasingly in worksites across the country. This cross-sectional study examined attitudes toward worksite nonsmoking policies and worksite norms about smoking and cessation. Data were collected by telephone interview from 711 smokers and recent ex-smokers employed in seven worksites in Bloomington, Minnesota, in 1986. The findings indicated widespread support for nonsmoking policies even among smokers. Support for nonsmoking policies was especially high among respondents interested in quitting smoking, those concerned about the health effects of smoking, those reporting high coworker support for prior cessation attempts, and those working with a high proportion of nonsmokers. Support for nonsmoking policies was also correlated with smoking cessation in the 18 months prior to the survey. The clustering of these social norms is indicative of a worksite "culture" that may either support nonsmoking or inhibit cessation.
Attitude↗
Predictors of non-adoption of cigarette smoking following experimentation.
The Childhood Antecedents of Smoking Study (CASS) investigated patterns of cigarette smoking among junior and senior high school students in an upper midwest school district. Four biannual school-based surveys were conducted over two years. A cohort of 72 smokers was identified and followed to determine who continued smoking and who quit. Discriminant analysis was used to study social, psychological, and environmental factors predictive of quitting smoking. Compared to continuing smokers, quitters reported having fewer friends and siblings who smoked, they were less likely to view the cigarette smoker's image as positive, and lived in families where parental involvement with teenagers was high (based on the reports of parents). These results are consistent with the view that social influences are strong determinants of patterns of adolescent smoking behaviour.
Adolescent↗
Attitudes toward smoking cessation among men and women.
Recent reports indicate that women are less successful than men in their attempts to quit smoking. Sex differences in attitudes toward smoking cessation were examined cross-sectionally in a sample of 447 smokers randomly selected from employees of 10 diverse Minnesota worksites and interviewed in early 1984. No sex differences were found in the percentage of smokers who had tried to quit at least once in the past; indeed, over four of five respondents reported prior attempts to quit. Yet compared to women, men were more interested in quitting. Women were less likely than men to perceive the health benefits of quitting and expressed more concern about weight gain and job pressures related to quitting. No significant sex differences were found in prior use of formal cessation services, which had been used by about one-fourth of these respondents. Yet compared to men, women appeared to rely on informal sources of support, such as encouragement from co-workers. These findings underline the importance of intervention programs targeting women and suggest strategies that might enhance the effectiveness of such programs oriented toward women.
Adult↗
Smoking patterns among social contacts of smokers, ex-smokers, and never smokers: the Doctors Helping Smokers Study.
Smoking status of spouses/partners and other social contacts was examined among 5,241 adults who had recently visited a family physician. Associations between smoking status and proportion of social contacts who smoke among men and women of three different age groups were assessed by analysis of covariance, with age and education as covariates. The proportion of smoking contacts was found to be greatest for smokers, less for ex-smokers, and least for never smokers. Comparison of data across four types of social contacts by smoking groups suggests that, in general, the social contacts of ex-smokers more strongly resemble those of never smokers than those of current smokers. The results suggest that smokers desiring to become nonsmokers need to enlarge their social group to include more nonsmoking contacts, as well as to learn and use coping strategies to prevent relapse in the presence of smokers.
Adolescent↗
New Roads: assessing and treating psychological dependence.
The "New Roads" approach provides a practical tool for explaining and assessing dimensions of psychological dependence. It connects common triggers for relapse and the effects that the client intends to achieve through substance use. Among its clinical applications are (a) preventive education, (b) assessing high risk situations, (c) tracing pathways of psychological dependence, and (d) devising alternative coping strategies. This simple technique is compatible with a wide range of treatment settings, goals, and approaches.
Adaptation, Psychological↗
Prevalence of tobacco dependence and withdrawal.
In a sample of 1,006 middle-aged male smokers drawn from the general population, 90% (N = 905) fulfilled DSM-III criteria and 36% (N = 362) fulfilled Fagerstrom's criteria for tobacco dependence. Among the 875 who had stopped smoking in the past for at least 24 hours, 21% (N = 184) fulfilled DSM-III criteria and 46% (N = 403) fulfilled the authors' own criteria for tobacco withdrawal. Concordance of results among the criteria for diagnosing tobacco dependence and withdrawal was low. These results suggest that the DSM-III criteria for tobacco dependence are overinclusive and that there is little consensus among the definitions of tobacco dependence and withdrawal.
Humans↗