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Background: Health promotion efforts encourage smokers to quit and to use effective cessation treatments. Randomized controlled trials demonstrate that medications and behavioral treatments improve cessation rates, but retrospective surveys have been inconsistent. This study assessed frequency of quit attempts, use of treatments for cessation, and abstinence rates among treatment users and non-users. Methods: Data were analyzed from the 2003 Tobacco Use Special Cessation Supplement to the Current Population Survey. Participants included 29,537 U.S. smokers aged ≥18 years who smoked daily 12 months before the survey. Outcome measures included past-year quit attempts; use of behavioral, pharmacologic, and alternative treatments; receipt of social support; and abstinence for ≥4 weeks at time of survey. Results: Approximately 43.5% of smokers reported a quit attempt in the preceding year: 64.2% of attempters used no cessation treatments; 8.8% used behavioral treatment; 32.2% used medication; and 14.1% used more than one treatment. Social support was reported to have been received by 24.1%. More nicotine-dependent smokers were more likely to use medications (OR=3.58; 95% CI=3.04–4.20). At the time of the survey, 19.3% of attempters were abstinent ≥4 weeks. Smokers who sought treatment were less likely to be abstinent (OR=0.75; 95% CI=0.67–0.84), and those who sought multiple treatments were even less likely to be abstinent. Conclusions: Many U.S. smokers make quit attempts, but most do not use behavioral or pharmacologic treatments. More nicotine-dependent smokers were more likely to seek treatment. Smokers who sought treatment were less likely to report abstinence, probably due to biased self-selection and recall. Retrospective survey data are not well-suited to assess the effectiveness of treatment. [Copyright &y& Elsevier]

Objective: Our study evaluates the symptoms commonly attributed to adenomyosis in women undergoing the menopausal transition. We hypothesized that adenomyosis is more commonly seen in women with fibroids, pelvic pain, abnormal uterine bleeding, and in the presence of endometriosis., Design: Retrospective cohort., Setting: Multisite community-based study., Patient(s): Enrollees in the Study of Women's Health Across the Nation who had hysterectomies., Intervention(s): None., Main Outcome Measure(s): Relationship of adenomyosis to presenting symptoms and other patient characteristics., Result(s): Adenomyosis was found in 48% of 137 patients. Frequencies of presenting symptoms were similar in those with and without evidence of adenomyosis. The same prevalence of fibroids was seen in the presence or absence of adenomyosis: 37% versus 43%, endometriosis, 3% versus 5%, abnormal bleeding, 27% versus 33%, or chronic pelvic pain in the presence of fibroids 12% versus 17%., Conclusion(s): Adenomyosis is a common diagnosis seen in hysterectomized specimens from women undergoing the perimenopausal transition. Adenomyosis is equally common in women who also have fibroids, endometriosis, pelvic pain, or abnormal uterine bleeding, and women who do not. Therefore, adenomyosis is an incidental finding, not the source of the symptomatology. It appears not to be a "disease" per se but rather a normal variant.

Background: Trait negative affect has been implicated as a risk marker for cardiovascular disease, but the mechanisms underlying this association are uncertain., Purpose: Our aim was to examine associations between trait measures of anger, hostility, depression, and anxiety with endothelial dysfunction via brachial artery flow-mediated dilation (FMD), an early indicator of cardiovascular disease., Method: FMD was examined in 332 healthy older adults. Measures included Beck Anxiety and Depression Inventories, Cook-Medley Hostility Scale, and Spielberger State-Trait Anger Expression Inventory (Anger In, Anger Out, and Trait Anger)., Results: Mean age was 60.5 +/- 4.8 years; 83% of participants were Caucasian and 49% were female. FMD was greater in women compared to men (6.17% vs. 4.07%, p < 0.001). Women reported significantly greater Anxiety (p < 0.001), and men reported greater Hostility (p = 0.004). In separate multivariable linear regression models controlling for cardiovascular risk factors, plus current hormone therapy for women, smaller FMD was associated with higher Anger In for women (beta = -0.222, p = 0.04) and showed a trend with higher Hostility for men (beta = -0.082, p = 0.09)., Conclusion: Endothelial dysfunction, as indicated by less vasodilatation of the brachial artery, is positively associated with measures of hostility and anger suppression in healthy older adults. Thus, associations between negative affect and cardiovascular health may be apparent early in the disease process.

Context: Rates of bone loss across the menopause transition and factors associated with variation in menopausal bone loss are poorly understood., Objective: Our objective was to assess rates of bone loss at each stage of the transition and examine major factors that modify those rates., Design, Setting, and Participants: We conducted a longitudinal cohort study of 1902 African-American, Caucasian, Chinese, or Japanese women participating in The Study of Women's Health Across the Nation. Women were pre- or early perimenopausal at baseline., Outcome Measure: We assessed bone mineral density (BMD) of the lumbar spine and total hip across a maximum of six annual visits., Results: There was little change in BMD during the pre- or early perimenopause. BMD declined substantially in the late perimenopause, with an average loss of 0.018 and 0.010 g/cm2.yr from the spine and hip, respectively (P<0.001 for both). In the postmenopause, rates of loss from the spine and hip were 0.022 and 0.013 g/cm2.yr, respectively (P<0.001 for both). During the late peri- and postmenopause, bone loss was approximately 35-55% slower in women in the top vs. the bottom tertile of body weight. Apparent ethnic differences in rates of spine bone loss were largely explained by differences in body weight., Conclusions: Bone loss accelerates substantially in the late perimenopause and continues at a similar pace in the first postmenopausal years. Body weight is a major determinant of the rate of menopausal BMD loss, whereas ethnicity, per se, is not. Healthcare providers should consider this information when deciding when to screen women for osteoporosis.

Background: Behavioral and pharmacological treatments have been shown to improve smoking cessation rates, but treatments are under-utilized., Aims: To examine the demographic and smoking history characteristics associated with adoption of treatment for cessation., Design: Analysis of the 2003 tobacco use special cessation supplement to the current population survey., Participants: Representative sample of 12,027 U.S. daily smokers ages 18 and older who made a quit attempt in the past year., Measurements: Use of behavioral, pharmacological or alternative treatments for cessation; demographic variables (age, gender, ethnicity, education and income) and measures of nicotine dependence., Results: Females, Whites, older, more educated and wealthier smokers were more likely to adopt treatment in a quit attempt, as were more nicotine dependent smokers. Females were more likely than males to use behavioral treatments. Females and more educated smokers were more likely to combine behavioral and pharmacological treatment. Among those who used only one treatment, males, older and more nicotine dependent smokers were more likely to adopt pharmacological treatments., Conclusions: The majority of smokers make quit attempts without the benefit of proven behavioral or pharmacological treatments. Efforts are needed to increase use of smoking cessation treatments among all smokers, particularly combination treatment.

The random effects approach in meta-analysis due to DerSimonian and Laird is well established and used pervasively. It has been established by Brockwell and Gordon that this method, when used for confidence intervals, leads to coverage probabilities lower than the nominal value. A number of alternatives have been proposed, but these either have the defect of iterative and complicated calculation, or deficient coverage. In this paper we propose a new approach, which is simple to use, and has coverage probabilities better than the alternatives, based on extensive simulation. We call this approach the 'quantile approximation' method., (Copyright 2007 John Wiley & Sons, Ltd.)

Context: The relationship of reproductive hormones to vasomotor symptoms (VMS) has been incompletely explored, although an increase in such symptoms at midlife and their reduction with hormone therapy suggest a strong and direct relationship. Vasomotor symptoms are reported by 65-76% of women traversing the menopausal transition and are a primary reason for medical intervention during this life stage., Objective: The purpose of this report was to relate longitudinal serum concentrations of the reproductive hormones estradiol (E2), FSH, testosterone (T), dehydroepiandrosterone sulfate (DHEAS), and SHBG and the free hormone indices free E2 index (FEI) and free T index (FTI) with the occurrence of VMS in women traversing the menopausal transition., Design and Setting: The Study of Women's Health Across the Nation is a multisite, longitudinal, cohort study of the menopausal transition being conducted in community-based groups of women., Participants and Main Outcome Measures: At baseline, 3302 menstruating women who belonged to one of five ethnic/racial groups were recruited and followed up with annual visits. Frequencies of symptoms (hot flashes, night sweats) for the prior 2 wk and measures of other covariates as well as potentially confounding variables were self-reported in the annual interview. Serum was obtained annually, on d 2-5 of a spontaneous cycle in cycling women or within 90 d of the anniversary of the baseline study visit in noncycling women and assayed for FSH, E2, T, SHBG, and DHEAS. FTI and FEI were calculated. This analysis incorporated available longitudinal data from 3293 women, excluding information collected at or after first report of hormone therapy use or hysterectomy. Data were analyzed using longitudinal marginal logistic regression models and a partial proportional odds model., Results: After adjusting for age, body mass index, and other related covariates, VMS prevalence increased with higher (log)FSH concentrations, and the increase was greater when blood was drawn more than 5 d after menses began. FSH concentrations were positively associated with the frequency of either hot flashes or night sweats, and higher FSH concentrations were associated with greater odds of reporting more frequent symptoms. Vasomotor symptom prevalence decreased with higher (log)E2, (sqrt)SHBG, and (log)FEI but only when these hormone values were modeled independently of (log)FSH values and the specimens were obtained outside the d 2-5 window. When modeled simultaneously with (log)FSH, (log)E2, (sqrt)SHBG, and (log)FEI were no longer significantly associated with symptom prevalence. (Cubic root)T and (sqrt)DHEAS concentrations and (log)FTI were not associated with the prevalence of VMS., Conclusions: Annual serum FSH concentrations, but not E2, T, DHEAS, FTI, or FEI when collectively modeled longitudinally, are associated with both the prevalence and frequency of VMS in women at midlife.

Meta-analysis may be used to estimate an overall effect across a number of similar studies. A number of statistical techniques are currently used to combine individual study results. The simplest of these is based on a fixed effects model, which assumes the true effect is the same for all studies. A random effects model, however, allows the true effect to vary across studies, with the mean true effect the parameter of interest. We consider three methods currently used for estimation within the framework of a random effects model, and illustrate them by applying each method to a collection of six studies on the effect of aspirin after myocardial infarction. These methods are compared using estimated coverage probabilities of confidence intervals for the overall effect. The techniques considered all generally have coverages below the nominal level, and in particular it is shown that the commonly used DerSimonian and Laird method does not adequately reflect the error associated with parameter estimation, especially when the number of studies is small., (Copyright 2001 John Wiley & Sons, Ltd.)