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In the past 20 years, public health initiatives on smoking cessation have increased substantially. Randomized trials indicate that pharmaceutical cessation aids can increase success by 50% among heavier smokers who seek help, and use of these aids has increased markedly. Quitlines provide a portal through which smokers can seek assistance to quit and are promoted by tobacco control programs. Randomized trials have demonstrated that telephone coaching following a quitline call can also increase quitting, and a combination of quitlines, pharmaceutical aids and physician monitoring can help heavier smokers to quit. While quit attempts have increased, widespread dissemination of these aids has not improved population success rates. Pharmaceutical marketing strategies may have reduced expectations of the difficulty of quitting, reducing success per attempt. Some policies actively discourage unassisted smoking cessation despite the documented high success rates of this approach. There is an urgent need to revisit public policy on smoking cessation.

ObjectiveResearch suggests that physical activity is associated with improved breast cancer survival, yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes. The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality.MethodsA total of 2,361 post-treatment breast cancer survivors (Stage I-III) enrolled in a randomized controlled trial of dietary change completed physical activity measures at baseline and one year. Physical activity variables (total, moderate-vigorous, and adherence to guidelines) were calculated for each time point. Median follow-up was 7.1 years. Outcomes were invasive breast cancer events and all-cause mortality.ResultsThose who were most active at baseline had a 53% lower mortality risk compared to the least active women (HR = 0.47; 95% CI: 0.26, 0.84; p = .01). Adherence to activity guidelines was associated with a 35% lower mortality risk (HR = 0.65, 95% CI: 0.47, 0.91; p < .01). Neither baseline nor 1-year change in activity was associated with additional breast cancer events.ConclusionsHigher baseline (post-treatment) physical activity was associated with improved survival. However, change in activity over the following year was not associated with outcomes. These data suggest that long-term physical activity levels are important for breast cancer prognosis.

PurposeNomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this study was to examine whether the predictions from a validated postoperative prostate cancer nomogram were associated with obesity.MethodsWe carried out a cross-sectional analysis of 1220 patients who underwent radical prostatectomy (RP) in southern California from 2000 to 2008. Progression-free probabilities (PFPs) were ascertained from the 10-year Kattan postoperative nomogram. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs).ResultsIn the present study, aggressive prostate cancer (Gleason ≥7), but not advanced stage, was associated with obesity (p = 0.01). After adjusting for age, black race, family history of prostate cancer and current smoking, an inverse association was observed for 10-year progression-free predictions (OR = 0.50; 95% CI = 0.28–0.90) and positive associations were observed for preoperative PSA levels (OR = 1.23; 95% CI = 1.01–1.50) and Gleason >7 (OR = 1.45; 95% CI = 1.11–1.90).ConclusionObese RP patients were more likely to have lower PFP values than non-obese patients, suggesting a higher risk of experiencing prostate cancer progression. Identifying men with potentially higher risks due to obesity may improve disease prognosis and treatment decision-making.

This is an exploratory, qualitative investigation of breast cancer survivors’ experiences with breastfeeding. Previous studies have focused on the physiology of lactation after surgery and treatment, but have not explored factors influencing breastfeeding decisions and behavior.We used purposeful sampling to identify 11 breast cancer survivors who had a child after their diagnosis and treatment. Participants were recruited from among those in the Women’s Healthy Eating and Living (WHEL) study and a Young Survival Coalition (YSC) affiliate. We conducted semi-structured, open-ended telephone interviews lasting 45–75 min. We used social cognitive theory (SCT) to structure questions regarding influences on breastfeeding behavior. We transcribed interviews and used cross-case, inductive analysis to identify themes.Ten of 11 participants initiated breastfeeding. The following main themes emerged: 1) Cautiously hopeful, 2) Exhausting to rely on one breast, 3) Motivated despite challenges, 4) Support and lack of support, and 5) Encouraging to others.Study participants were highly motivated to breastfeed but faced considerable challenges. Participants described problems that are not unique to women with breast cancer, but experienced these to a much greater degree because they relied mostly or entirely on one lactating breast. This study revealed a need for improved access to information and support and greater sensitivity to the obstacles faced by breast cancer survivors.Results of this qualitative analysis indicate that interventions to support the efforts of breast cancer survivors who are interested in breastfeeding are warranted. Additional research would aid in the development of such interventions.

ObjectiveTo assess the reported baseline dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study, a randomized plant-based dietary intervention clinical trial.DesignDietary data from 4 days repeated 24-hour recalls within 3 weeks included daily total intake of energy, protein, carbohydrates, cholesterol, total fat, monounsaturated fat, saturated fat, polyunsaturated fat, fruit/vegetable servings, carotenoids, alcohol, caffeine, and percentage of energy from protein, carbohydrates, alcohol, and fats.SubjectsOne hundred sixty-five Hispanic breast cancer survivors age-matched to 165 non-Hispanic white breast cancer survivors diagnosed with Stage I, II, or IIIA primary operable breast cancer.Statistical analysesTwo-sample t tests and Wilcoxon rank sum tests to compare dietary intake, and logistic and ordinal logistic regression analyses to examine the association between ethnicity, alcohol, and lycopene consumption, while controlling for place of birth, education, body mass index, and time since diagnosis.ResultsHispanics were more likely to be foreign-born (P

We examined the effect of dietary energy density change on body weight in participants of a randomized trial. Intervention participants markedly increased fruit and vegetable intake while reducing energy intake from fat. Participants were 2,718 breast cancer survivors, aged 26-74 yr, with baseline mean body mass index of 27.3 kg/m(2) (SD = 6.3). We assessed dietary intake by sets of four 24-h dietary recalls and validated with plasma carotenoid concentrations. Weight and height were measured at baseline, 1 yr, and 4 yr. Dietary energy density was calculated using food but excluding beverages. Intervention participants significantly reduced dietary energy density compared to controls and maintained it over 4 yr-both in cross-sectional (P < 0.0001) and longitudinal (Group x Time interaction, P < 0.0001) analyses. Total energy intake or physical activity did not vary between groups. The intervention group had a small but significant weight loss at 1 yr (Group x Time interaction, P < 0.0001), but no between-group weight difference was observed at 4 yr. Our study showed that reducing dietary energy density did not result in a reduction in total energy intake and suggests that this strategy alone is not sufficient. to promote long-term weight loss in a free-living population.

ObjectiveTo investigate the psychometric properties of the physical activity (PA) measure of the Women's Health Initiative (WHI).MethodsWomen diagnosed with breast cancer and enrolled in the Women's Healthy Eating and Living Study (average age 55 years) wore an accelerometer for 1 week and completed the 7-day Physical Activity Recall (PAR) and brief WHI measure.ResultsBoth self-reports correlated 0.73 with the accelerometer and had 100% sensitivity for meeting the current PA guideline, but specificity was significantly higher for the PAR.ConclusionsThe WHI measure had comparable validity, sensitivity, and measurement bias compared to the widely accepted PAR.

BackgroundThe criterion-related validity and measurement bias of the long form of the International Physical Activity Questionnaire (IPAQ) was compared to the 7-Day Physical Activity Recall (PAR).MethodsParticipants were women who have been diagnosed with breast cancer and enrolled in the ongoing Women's Healthy Eating and Living Study. Women (N = 159, average age 57 years) wore an accelerometer for one week and then completed the IPAQ or the PAR.ResultsThe validity correlation of the PAR was significantly higher (p < 0.001) than the IPAQ (0.73 vs. 0.33, respectively). The PAR and IPAQ overestimated total physical activity by 13% vs. 247%, respectively. The PAR had better sensitivity (p = 0.14) and specificity (p < .01) than the IPAQ (100% vs. 71% and 84% vs. 59%, respectively) in predicting attainment of the ACSM physical activity guideline.ConclusionThe PAR was superior to the IPAQ in terms of validity, measurement bias, and screening statistics.

To examine whether weight gain after diagnosis of breast cancer affects the risk of breast cancer recurrence. Patients included 3215 women diagnosed with early stage breast cancer (Stage I > 1 cm., II, and IIIA) who were enrolled either in an observational cohort of breast cancer survivors or were part of the comparison group of a dietary intervention trial to prevent breast cancer recurrence. We computed weight change from 1 year prior to diagnosis to study enrollment. Delayed entry Cox proportional hazards models were used to evaluate associations of categories of weight change with time to recurrence, controlling for known prognostic factors. Neither moderate (5-10%) nor large (> 10%) weight gain (HR 0.8, 95% CI, 0.6-1.1; HR 0.9, 95% CI, 0.7-1.2, respectively) after breast cancer diagnosis was associated with an increased risk of breast cancer recurrence in the early years post-diagnosis (median time of 73.7 months from diagnosis). Our research provides evidence that weight gain commonly seen in the first several years following a breast cancer diagnosis does not increase a woman's risk for breast cancer recurrence in the first 5-7 years post-diagnosis. However, this research does not address the effects of weight gain on overall survival or on the risk of other new cancers, other prognostic outcomes of concern to the breast cancer survivor.

Aim To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99). Design, setting and participants Cohorts of 12-15 -year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (1993-96, n = 1764; 1996-99, n = 2119). Measures We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. risk groups were defined using a mulBesides examining predictors individually, tivariate analysis. Findings Overall, transition to any smoking by follow-up occurred in 38.3 +/- 4.00% (% +/- 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 +/- 2.6%, in the 1996-99 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking. Conclusions The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Background: It is not clear whether the decline in African American adolescent smoking in the 1980s reflected a delay in age of onset of regular smoking initiation rather than success in preventing initiation completely. Purpose: The purpose of this study is to identify whether the marked reductions in African American adolescent smoking in the 1980s were offset by increased initiation in young adults. Methods: We combined data from the Tobacco Use Supplements of the 1992-1993, 1995-1996, and 1998-1999 Current Population Surveys (n = 512,258), and reconstructed year of smoking initiation and calculated age-specific incidence of initiation from 1970 to 1992. We then compared detailed age-specific rates of initiation for two 5-year periods selected to be before and after the documented large declines in African American adolescent smoking. Results: In the time period after marked declines in African American adolescent smoking (1987-1991), the incidence of initiation of regular smoking decreased for African Americans ages 14 to 16 and increased for ages 18 to 20. Such a delay was not as evident among non-Hispanic Whites. The delay that was slight in regular smoking initiation among African Americans relative to non-Hispanic Whites in 1975-79 had increased substantially by 1987-91. Conclusions: Reductions in African American adolescent smoking in the 1980s were offset by increased initiation among young adults ages 18 to 20 during this time period and suggest that the window for uptake of regular smoking shifted to older ages for African Americans more so than non-Hispanic Whites. Efforts to combat smoking should remain aggressive into young adulthood, when the tobacco industry's efforts to gain new smokers intensify.

AimsTo demonstrate that intentions predict long-term future levels of smoking, irrespective of level of past smoking experience. A growing body of research suggests that intentions about future smoking might play an important role in addition to the influence of past smoking experience on the likelihood of smoking in future.DesignUsing logistic regression analyses, we assessed the relationship between baseline smoking experience and a firm intention 'not to be smoking cigarettes 5 years from now' with four outcome measures of smoking at follow-up: 30-day smoking at a 3/4- and 5/6-year follow-up and current established smoking (self-described regular smokers or former smokers who had smoked in the past 30 days) at a 3/4- and 5/6-year follow-up.ParticipantsUS nationally representative samples of 12th graders who responded to the Monitoring the Future (MTF) survey from the years 1976 to 1993, inclusive. For these panels, we linked stage of smoking and intentions at 12th grade to follow-up measures of smoking collected at 3/4 years after baseline and 5/6 years after baseline.FindingsAnalysis of 3/4-year follow-up data (weighted n = 4544) and 5/6-year follow-up data (weighted n = 3885) for both definitions of smoking outcome indicated that there was a dose-response relationship between levels of baseline smoking experience and the likelihood of future smoking. In addition, independent of baseline smoking experience, there was a statistically significant protective effect for a firm intention not to smoke in five year's time on future smoking behavior.ConclusionsThe findings suggest that evaluative studies of tobacco control policies and programs might usefully employ smoking uptake categories that incorporate smoking intentions as early indicators of outcome.

Tobacco marketing contributes to adolescent smoking initiation, and the Master Settlement Agreement (MSA), therefore, included relevant restrictions. We analyzed data from large population surveys of Californians, conducted in 1992 (11,905 adults, ages 18 years and older), 1993 (5,531 adolescents, ages 12 to 17 years), and 1996 (6,252 adolescents, 18,616 adults) before the MSA, and in 1999 (6,090 adolescents, 14,729 adults) and 2002 (5,857 adolescents, 20,525 adults) following its implementation. Camel lost favorite-advertisement popularity after 1996, and between 1999 and 2002, there were large increases in the percentages declining to name a favorite advertisement. Ownership of tobacco promotional items declined from its peak in 1996. Furthermore, in 2002, close to 90% of adolescents and young adults reported seeing anti-tobacco messages on television in the past month, significantly higher than 1996. These trends indicate less receptivity to tobacco advertising and promotions following the MSA but leave room for additional restrictions to further reduce receptivity.

Tobacco marketing contributes to adolescent smoking initiation, and the Master Settlement Agreement (MSA), therefore, included relevant restrictions. We analyzed data from large population surveys of Californians, conducted in 1992 (11,905 adults, ages 18 years and older), 1993 (5,531 adolescents, ages 12 to 17 years), and 1996 (6,252 adolescents, 18,616 adults) before the MSA, and in 1999 (6,090 adolescents, 14,729 adults) and 2002 (5,857 adolescents, 20,525 adults) following its implementation. Camel lost favorite-advertisement popularity after 1996, and between 1999 and 2002, there were large increases in the percentages declining to name a favorite advertisement. Ownership of tobacco promotional items declined from its peak in 1996. Furthermore, in 2002, close to 90% of adolescents and young adults reported seeing anti-tobacco messages on television in the past month, significantly higher than 1996. These trends indicate less receptivity to tobacco advertising and promotions following the MSA but leave room for additional restrictions to further reduce receptivity.

This study used 1 longitudinal and 2 cross-sectional population surveys to compare stability of low-rate daily smokers (less than 5 cigarettes per day) with other daily smokers and occasional smokers. Few low-rate smokers maintained consumption level; 36% retained smoking status after 20 months, compared with 82% and 44% for regular daily and occasional smokers, respectively. In a dynamic process, established smokers quit smoking and/or modified (decreased or increased) consumption. Low-rate and occasional smokers quit at higher rates than regular daily smokers (odds ratios 3:1) but were replenished by new members, many converted from regular daily smokers. The overall trend is an increasing proportion of low-consumption smokers while smoking prevalence declines. The dynamic process his implications for tobacco control efforts and for addiction theory.

For the 1999 California Tobacco Surveys (CTS), Westat performed statistical tasks that included sample selection, weighting, and data collection. This volume of the report contains a description of the methodology used by Westat to do sample selection, weighting, and develop replicate weights for variance estimation purposes.

High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. Low–moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low–moderate intensity. These results support a powered trial investigating these interventions at a low–moderate intensity. [ABSTRACT FROM AUTHOR]