Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants.

AIMS: Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. METHODS AND RESULTS: After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8.7 years. CONCLUSION: The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a legacy effect. TRIAL REGISTRATION NUMBER: NCT00468923.

Comparison of Suicide Attempts/Behaviors Following Smoking Cessation Treatments Among Schizophrenic Smokers.

BACKGROUND: Smoking cessation may lead to depression in some smokers and result in increased risk of suicide. OBJECTIVE: To compare the risk of suicide attempts/behaviors associated with different smoking cessation medications among schizophrenic patients. METHODS: A retrospective cohort study was conducted using General Electric (GE) medical record database (1995-2011). The first day of being prescribed a smoking cessation medication defined as index date. Patients were followed up to one year from index date. Patients' suicide behaviors or attempts were identified through ICD-9 codes and E-codes. Cox proportional hazards model was applied to examine the association between smoking cessation medication and suicidal/self-injurious behaviors. RESULTS: Our cohort consisted of 3925 patients with diagnosis of schizophrenia or schizoaffective disorder who initiated cessation medication. Among them, 104 (2.65%) had suicide attempts or behavior within one-year follow up. However, statistically significant difference in the risk of suicide attempts/behaviors was not detected across cessation regimens in the Cox proportional hazard analysis. Only comorbidity index was found to be associated with suicide, which showed that higher Charlson comorbidity index was associated with higher risks of suicide behaviors within one year (HR=1.15, 95% CI=1.04-1.27). CONCLUSION: There were no significant differences in suicide attempts/behaviors with different cessation medications.

Comparative Effectiveness of Smoking Cessation Medications to Attenuate Weight Gain Following Cessation.

OBJECTIVE: To compare the postcessation weight gain following the use of different FDA-approved smoking cessation medications among obese smokers. METHODS: A retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006-2011). The cohort consisted of obese adult smokers newly initiating use of an FDA-approved smoking cessation medication (i.e., bupropion vs. varenicline). The outcome variable was weight change at 3, 6, or 12 months following the first prescription. Descriptive analyses and t-tests were conducted to assess the frequency distribution of sample characteristics and their association with the postcessation weight change. Multivariate linear regression models were carried out to compare the weight change among the FDA-approved smoking cessation medications and to identify predictors of weight change at 3, 6, and 12 months after assessing the model assumptions. RESULTS: The mean weight gain was 1.14 pounds (±17.26), 2.06 pounds (±18.46), and 3.06 pounds (±20.78) at 3-, 6-, and 12-month, respectively. Obese smokers who were prescribed varenicline had a mean weight gain of 1.18 pounds (±16.75), 2.14 pounds (±18.14), and 3.12 pounds (±20.89) for each follow up, while those who were prescribed bupropion had a mean weight gain of 0.23 pounds (±25.90), 0.22 pounds (±25.32), and 1.47 pounds (±17.50), respectively. Descriptive analysis showed that obese smokers taking bupropion had less weight gain than those taking varenicline at each follow up; however, this association was not statistically significant after accounting for all covariates. CONCLUSIONS: While patients using bupropion gained slightly less weight compared to those using varenicline, type of smoking cessation medication was not a significant predictor of weight change in the multivariate linear regression model.

Comparison of Diabetes Risk Following Smoking Cessation Treatment Using Varenicline Versus Bupropion Among Obese Smokers.

BACKGROUND: Recent literature suggests an initial increased risk of diabetes following smoking cessation. OBJECTIVES: To compare the risk of developing diabetes among obese smokers who tried to quit smoking using bupropion versus varenicline. METHODS: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (2006-2011). The cohort consisted of obese adult smokers without a diabetes diagnosis at baseline and newly initiating use of either bupropion or varenicline. This cohort was then followed for 1 year to observe the risk of developing diabetes. The relative risk of bupropion versus varenicline on developing diabetes was assessed using Cox Proportional Hazards regression model after controlling for covariates. RESULTS: The sample comprised of 78,002 obese smokers of which 1,937 (2.36%) developed diabetes during 1 year follow-up. Diabetes incidence rate was relatively comparable who used varenicline and bupropion (23.50 versus 25.80 per 1,000 person-years). Obese smokers who were prescribed bupropion had a statistically significant higher risk of developing diabetes during 1 year following cessation treatment than those who were prescribed varenicline. ([HR]: 1.58, 95% CI: 1.09-2.27) in the multivariate model. CONCLUSIONS/IMPORTANCE: Obese smokers who were prescribed bupropion might have a higher risk of developing diabetes during 1 year follow up compared to those who were prescribed varenicline. The clinical significance of the finding that bupropion had a higher risk of developing diabetes may need further investigation.

The social norms and beliefs of teenage male electronic cigarette use.

Electronic cigarettes (e-cigarettes) are novel, battery-operated inhalation devices that provide warm, vaporized nicotine, and often propylene glycol, to users without the inclusion of tobacco smoke. Because men, in general, are more likely to use cigarettes and illicit drugs than women, a qualitative study was undertaken to investigate the beliefs and perceived social norms regarding this issue among 47 teenage boys who self-identified themselves as current e-cigarette smokers. The majority of respondents reported that they used e-cigarettes because of expeditious consumption and concealment. Furthermore, the most common places respondents self-reported using e-cigarettes were everywhere, in school bathrooms, at home, and in school staircases. Interestingly, respondents stated that e-cigarettes are popular because they are accessible, healthier than tobacco cigarettes, and more aesthetically pleasing. Because of the growing popularity and uncertainty regarding the social and physical consequences of e-cigarettes, this study shows a need for additional research discovery.

Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk.

A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.

Cigarette smoking among Jordanian adults.

The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Beliefs and perceived norms concerning smoking cessation program recruitment among African American teen smokers: what appeals to youth and what turns them away.

A qualitative approach was used to investigate the beliefs and perceived norms about participation in smoking cessation programs among a sample of African American alternative school students (N = 53), aged 14 to 18 years old, in the United States who were current smokers. The authors found that the majority of participants felt that smoking cessation programs were not effective, caused smoking, or lacked activities. Both boys and girls believed that communication sources that provided direct messages in real situations were the best motivators or incentives for African American youth recruitment into smoking cessation programs. These findings support research that African Americans are more attentive to communications that involve direct personal stimuli. In addition, African Americans place heavy emphasis on source and message style to determine credibility of the intervention strategy.

Correlates of HIV knowledge and sexual risk behaviors among female military personnel.

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.

The association of drug use and post-traumatic stress reactions due to Hurricane Ike among Fifth Ward Houstonian youth.

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last week they tried to keep from thinking or talking about the hurricane or things that remind them of what happen were significantly more likely to use alcohol (p < .05), marijuana (p < .01), codeine cough syrup (p < .00), anti-energy drinks (p < .00), crystal methamphetamines (p < .00), and Viagra (p < .00). Unadjusted logistic regression showed that they also experienced over twice the odds of reporting past 30 day use of alcohol (OR = 2.57, 95% CI = .98, 6.8), marijuana (OR = 4.31, 95% CI = 1.2, 15.3), codeine cough syrup (OR = 5.22, 95% CI = 1.4, 19.5), and anti-energy drinks (OR = 3.27, 95% CI = 1.0, 1.4). Adjusted logistic regression revealed that male youth post-traumatic stress reaction is a significant predictor of marijuana use (OR = 4.1, 95% CI = 1.0, 16.5). This study shows the important link of higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters.

Substance use problems reported by historically Black college students: combined marijuana and alcohol use versus alcohol alone.

Using secondary data analysis,this study compares alcohol and other drug (AOD) problems experienced by African-American students attending a historically Black university who use alcohol only versus those who use alcohol plus marijuana. Results indicate that students who used marijuana plus alcohol experienced more AOD problems than their counterparts who used alcohol only. The current findings are similar to previous research with a majority White college student population.

The link between recent sexual abuse and drug use among African American male college students: it's not just a female problem in and around campus.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p < or = 0.001) and past 30 day (OR = 5.0, p < or = 0.001) drug use.

Codeine cough syrup use among African-American crack cocaine users.

While studies show evidence of a clear problem with the prevalence of crack cocaine and codeine cough syrup use separately, the relationship between these substances of abuse and concurrent polydrug use is unknown. In an attempt to ascertain beyond anecdotal evidence, the authors carried out a cross-sectional study among 482 African-American crack users to investigate the differences between those who were concurrently codeine cough syrup users and those who were not codeine cough syrup users in Houston, Texas. Logistic regression indicated that codeine use was significantly associated with lower participant age and lower education; codeine cough syrup users were significantly more likely than nonusers to not have a main sexual partner. In addition, codeine users had significantly higher odds of ever trading sex for money, marijuana use, and fry use. These findings are important in determining the "cultural novelties" relative to crack and codeine use among younger African Americans.

Prevalence of childhood sexual abuse among incarcerated males in county jail.

OBJECTIVE: The current study examined the prevalence and characteristics of childhood sexual abuse in a jailed-based population. METHODOLOGY: A retrospective, self-reported survey was administered over an 8-week period to a random sample of 100 men who were incarcerated in a county jail in Southeastern Texas. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors. RESULTS: Of the 100 male inmates who participated in this study, 59% reported experiencing some form of sexual abuse before puberty, and all such instances occurred before or at the age of 13 years. The first episode of childhood sexual abuse began at an average age of 9.6 years (SD = 2.4), and ended at an average age of 13.0 years (SD = 2.3). Kissing and touching without intercourse (64%) was the common pattern of sexual abuse experience reported. The total number of perpetrators was 165, with 10% male and 90% female. Friends (n = 72) and family (n = 56) were the most frequent perpetrators. CONCLUSION: Childhood sexual abuse may be more prevalent among inmates than among males in the general population. These results show a high percentage of inmates who report a history of childhood sexual abuse; this rate is higher than those reported by other studies for incarcerated males. The findings support the belief held by professionals in the criminal justice field that a significant number of incarcerated males may have been victims of sexual abuse.

Strategies to prevent HIV transmission among heterosexual African-American women.

BACKGROUND: African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. METHODS: Twenty five low income African American women, ages 18-29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and personal experience with someone who had contracted HIV. CONCLUSION: This study offers a foundation for further research that may be used to create culturally relevant HIV prevention programs for African-American women.

Use of interactive health communication to affect smoking intentions in middle school students: a pilot test of the "Headbutt" risk assessment program.

PURPOSE: Developing and disseminating innovative and effective approaches for smoking prevention among middle school children remains a public health priority. This pilot study evaluates the use of a Web-based tobacco prevention program, Headbutt, to change intentions of middle school children to smoke tobacco. METHODS: Headbutt was implemented with the use of a single-group pretest-posttest study design in sixth grade classes of nine middle schools in Texas (student n = 2227). The program assesses cognitive determinants of smoking and provides intervention feedback tailored to the child's responses. RESULTS: Headbutt significantly affected smoking intentions, prosmoking attitudes, self-efficacy expectations, and knowledge of negative consequences (all p < or = .001) measured with scales adopted from the Texas Tobacco Initiative Survey. Change in prosmoking attitudes had the greatest predictive effect on smoking intentions (p < .001). These results were moderated by ethnicity and age of students. CONCLUSION: Findings need to be interpreted in the light of study design limitations. However, strong associations between the Headbutt program and intention change suggests that a more rigorous effectiveness trial is indicated.

Strategies to prevent HIV transmission among heterosexual African-American men.

BACKGROUND: As part of qualitative research for developing a culturally sensitive and developmentally appropriate videotape-based HIV prevention intervention for heterosexual African- American men, six focus groups were conducted with thirty African-American men to determine their perceptions of AIDS as a threat to the African-American community, characteristics of past situations that have placed African Americans at risk for HIV infection, their personal high risk behaviors, and suggestions on how HIV intervention videotapes could be produced to achieve maximum levels of interest among African-American men in HIV training programs. METHODS: The groups took place at a low-income housing project in Houston, Texas, a major epicenter for HIV/AIDS. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The results revealed that low-income African-American men perceive HIV/AIDS as a threat to their community and they have placed themselves at risk of HIV infection based on unsafe sex practices, substance abuse, and lack of knowledge. They also cite lack of income to purchase condoms as a barrier to safe sex practice. They believe that HIV training programs should address these risk factors and that videotapes developed for prevention should offer a sensationalized look at the effects of HIV/AIDS on affected persons. They further believe that programs should be held in African-American communities and should include condoms to facilitate reduction of risk behaviors. CONCLUSIONS: The results indicate that the respondents taking part in this study believe that HIV and AIDS are continued threats to the African-American community because of sexual risk taking behavior, that is, failure to use condoms. Further, African-American men are having sex without condoms when having sex with women often when they are under the influence of alcohol or other mind-altering substances and they are having sex with men while incarcerated and become infected and once released resume unprotected sexual relations with women. According to the men, substance abuse is an important part of the problem of HIV in the African-American community. This is in keeping with research that shows that drug use, especially crack cocaine, is linked to sexual risk taking among African Americans and to increased likelihood of becoming infected with other sexually transmitted diseases (STDs) including HIV. Thus, interventions for men should address condom use, condom availability, skills for using condoms, eroticizing condoms and substance abuse prevention. Men in the present study also strongly recommended that HIV/AIDS videotaped messages should include footage of the sensational effects of the disease.