Telephone assistance for smoking cessation: one year cost effectiveness estimations.

A randomised trial evaluated the American Cancer Society's telephone counselling service to assist smoking cessation. Counselling nearly doubles a smokers' odds of quitting and maintaining cessation for one year. The estimated cost for each case of maintained smoking cessation attributable to counselling availability is approximately 1300 dollars.

Characterization of crude oils using fluorescence lifetime data.

The average fluorescence lifetimes of nine North Sea crude oils with API gravities of between 20 and 51 were measured using a modular, filter based, instrument developed in-house. Two pulsed light emitting diode (LED) excitation sources (460 and 510 nm) were used to excite fluorescence, the lifetime of which was measured at a range of emission wavelengths. Fluorescence lifetimes were found to vary from 1.8 to 8.2 ns with confidence intervals of +/- 0.11 ns. The average lifetimes at all emission wavelengths were linearly correlated with API gravity and with aromatic concentration with the best results being obtained with the 460 nm excitation source. Predictive models with an accuracy of +/- 7.6 API degrees were generated using partial least-squares methods from average fluorescence lifetimes measured at an emission wavelength of 500 nm using 460 nm excitation. A better correlation was found between the aromatic concentration of the oils and the ratio of the average fluorescence lifetimes at measured at 550 and 650 nm using 460 nm excitation. This led to a quantitative model with an accuracy of +/- 5.4% for aromatic concentration.

Characterisation of an antibody coated microcantilever as a potential immuno-based biosensor.

In this study, we investigated the activity, stability, lifetime and re-usability of monoclonal antibodies to myoglobin covalently immobilised onto microfabricated cantilever surfaces. These sensing surfaces are of interest to us in the development of novel cantilever-based immunosensors. For such sensors the antibody layer represents the sensing element while the microcantilever acts as a mechanical transducer. A procedure for producing re-usable biological coatings has been tested with different independent techniques. An Enzyme Linked Immunosorbent Assay (ELISA) was used to determine the presence of an active antibody coating, and to monitor the lifetime and stability of the immobilised antibody. Through this analysis, the activity of the immobilised antibody layer was found to be more stable with the introduction of sucrose, as a stabilising agent. Sucrose was applied to the immobilised antibody layer after each regeneration step. The immobilised antibody was found to have a stable active lifetime for up to 7 weeks. Fluorescence microscopy was used to give information on the distribution of the coating on the gold and silicon nitride sides of the cantilever. Atomic Force Microscopy was used to determine the presence of the biological coating on the cantilever and to obtain information on the surface morphology of the biological element of the sensor. The combined results provide valuable information on the development of an optimised sensing element and demonstrate a set of methods to use for future sensor-to-sensor characterisation. Preliminary experimental results showing the antibody activity against myoglobin, detected with a microcantilever based sensor prototype confirmed the motivations and potentialities of the proposed immunosensing technique.

Epidemiology of lung cancer.

There are few relationships in the epidemiology of cancer between an exposure and disease that are as consistent as those observed between tobacco and lung cancer. The health consequences of tobacco use are not limited to lung cancer; the 1990 Surgeon General's Report described that the use of cigarettes was the leading cause of avoidable mortality in the United States, with about 434,000 preventable deaths per year. Although a majority of the adults in the United States are current or former smokers, smoking cessation and prevention efforts have been successful, although currently about one in four adults still smoke cigarettes. The decline in ever-smoking has reached a plateau in the past few years, however, and rates of teenage smoking have begun to increase. In 1997, smoking rates among high school students in the United States were 32% higher compared with 1991. As noted by Cinciripini et al, adult smokers who quit or die are being replaced by children who smoke. Until recently, lung cancer control efforts primarily have focused on smoking prevention in youth and cessation among adults, with little obvious potential for reducing deaths through early detection. With the recent publication of early results from the Early Lung Cancer Action Project showing remarkably more favorable screening performance compared with chest radiography, the potential to detect lung cancer early and save lives is being revisited. Ultimately, the preferred disease control strategy is the prevention of lung cancer through the elimination of tobacco use altogether, but for the foreseeable future a legacy of decades of tobacco use in a significant proportion of the US population means we are still challenged to develop public health strategies to reduce deaths and suffering from those destined to develop lung cancer.

Coast Guard exposure to gasoline, MTBE, and benzene vapors during inspection of tank barges.

A field study was conducted June through August 1996 in an attempt to quantify short-term exposure levels to Coast Guard personnel performing routine inspection activities aboard commercial tank barges carrying gasoline. Transfer and fleeting operations were monitored in the ports of Pittsburgh, Pa., Huntington, W.Va., Baton Rouge, La., and Galveston, Tex. A total of 43 personal and 68 area samples were analyzed for benzene and total hydrocarbons as gasoline ("gasoline"). Results can be summarized as follows: Personal exposure to benzene gave 15-min time-weighted-average (TWA) results ranging from <0.10 to 0.50 ppm. Area benzene levels ranged from <0.04 to 170 ppm. Personal monitoring for gasoline revealed a range of <2.0 to 590 mg/m3 with a GM of 23 mg/m3. Area sample results for gasoline ranged from 1.7 to 90,000 mg/m3. Twelve personal samples were collected for methyl-tert butyl ether (MTBE). Only two of these were above the limit of detection and had 15-min time-weighted averages of 22 ppm and 1.3 ppm. Eighteen MTBE area samples ranged in value from <3.0 to 38 ppm. Although none of the personal samples met or exceeded proposed or established short-term exposure standards, many of the area sampling results indicated that a significant risk of acute exposure exists in the vicinity of valves, pressure lines, and connections. This includes anticipated sources such as pressure vent valves as well as unexpected sources resulting from structural deficiencies onboard the vessels. These results further emphasize the value of safe work practices and proper vessel maintenance in controlling exposure to harmful chemicals.

Transfer of preventive health programs to physicians' practices through medical organizations.

BACKGROUND: Transferring new information to practicing physicians is a complex and often faulty process. Effective transfer is a challenging goal that requires a strategy for reaching large numbers of physicians throughout the country in a short time. However, methods for disseminating preventive health techniques such as smoking cessation have not been well organized. Smoking is the single most important preventable cause of premature mortality, so dissemination of research-based smoking-cessation techniques to physicians' practices is a priority for the National Cancer Institute (NCI). METHODS: NCI recruited national, professional medical organizations to collaborate in disseminating smoking-cessation techniques. The goal was to co-sponsor 50 Train-the-Trainer (TT) seminars that would prepare 2,000 professionals as volunteers to instruct their colleagues in smoking-cessation techniques. NCI provided all materials, faculty (nine professionals), advance logistics, CME credits, and follow-up. The co-sponsor organizations helped develop the training plan, promoted training among their members, enrolled professionals to be trained, and made logistical arrangements for the training sites. RESULTS: During the 4 years of the program, NCI recruited 11 national organizations as co-sponsors; conducted 53 TT seminars in 22 states and Washington, DC; and trained 2,098 professionals as smoking-cessation trainers, who practice nationwide. The many lessons learned provide the basis for recommendations that can assist others who want to work with professional organizations. CONCLUSION: The National Cancer Institute demonstrated that national organizations of medical professionals can help to disseminate effectively a research-based smoking-cessation program. Twelve recommendations are presented to help others disseminate preventive health techniques nationwide.

Public health approaches to tobacco use prevention and cessation in the U.S.

Tobacco has a long history of use in the U.S., and its serious health effects have been well-documented during the past half century, U.S. efforts to control tobacco use and tobacco-related morbidity and mortality have been reasonably successful over the past 25 years, during which time there has been a 34 percent reduction in adult smoking. Nevertheless, tobacco use remains a significant public health problem in the U.S., with more than 430,000 tobacco-related deaths per year and over one-fourth of the population continuing to smoke. Many organizations are involved in tobacco use control activities, the most broadly focused of which is the National Cancer Institute (NCI). As an example of the type of program needed to address the problem of tobacco use on a national scale, the NCI's public health research plan and activities are described and its emphasis on a data-based decision matrix in its approach to tobacco and cancer control research and applications of research is discussed. Finally, future approaches to tobacco use control in the U.S. are suggested.

Tobacco use among adolescents. Strategies for prevention.

Tobacco use is a major public health problem that has its onset during childhood and adolescence. To prevent the onset, physicians can reach children and their parents in their offices beginning in the prenatal period and continuing through adulthood. For pediatricians and other physicians who care for children, NCI recommends five office-based activities that begin with the letter A. The 5 As include anticipatory guidance, ask, advise, assist, and arrange follow-up visits. Elimination of tobacco use requires a comprehensive strategy that includes health professional interventions, policy changes, advertising restrictions, comprehensive school-based programs, community activities, and advocacy approaches. Physicians and health professionals have major roles to play in each of these interventions.

Improving the health of U.S. children: the need for early interventions in tobacco use.

Despite considerable progress, tobacco use continues to be a major public health problem in the United States, killing more U.S. citizens each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fires, and AIDS combined. There is cause for particular concern about smoking and other tobacco use by children. Although adolescent smoking declined in the late 1970s and early 1980s, the combination of a now-flat daily smoking prevalence rate among high school seniors, high smoking rates among high school dropouts, and increased use of smokeless tobacco argues for renewed efforts in tobacco use prevention. The greater risk associated with tobacco use at early ages suggests the need for comprehensive interventions (i.e., involving policy change, advertising restrictions, health professionals, and comprehensive school health education) before the prime age for tobacco use initiation (i.e., 12 to 14 years old), for repeated reinforcement of these interventions through adolescence, for innovative ways of reaching underserved--particularly high-risk and minority--youth with effective tobacco use prevention efforts, and for research to determine both the short-term and the long-term effectiveness of these approaches.

Youth tobacco use in the United States--problem, progress, goals, and potential solutions.

BACKGROUND: Efforts to control tobacco use and tobacco-related morbidity and mortality in the United States continue to be generally successful. In the quarter century since the publication of the first Surgeon General's Report on Tobacco and Health, adult smoking rates in the United States have been reduced by nearly 34%. Controlling tobacco use among our nation's youth, however, has not been as successful. Although there was considerable success in reducing adolescent tobacco use in the late 1970s and early 1980s, tobacco use among youth has remained essentially stable for the past decade. METHODS: The health and economic burden of tobacco use, current knowledge about youth tobacco use, and youth-related national tobacco reduction goals for the Year 2000 are reviewed. RESULTS: Analysis of the research of the past two decades clearly indicates that there is no "magic bullet" in existence or in sight for the reduction of tobacco use, either among youth or among adults. This does not mean that opportunities for significant advances through, for example, pharmacological therapies or the broad application of media or policy strategies should not continue to be explored, but that for the moment no single approach appears to work best. Rather, a comprehensive approach that applies multiple prevention and cessation strategies simultaneously appears to be most effective in tobacco use control. CONCLUSIONS: Among youth, the combination of tobacco control strategies that may work best includes those that involve the family, primary care physicians, and other health professionals such as nurses and dentists; programs that are carried out in schools and/or through the media; and societal approaches such as access and advertising restrictions and increased taxes.

The United States National Cancer Institute and the science of tobacco control research.

U.S. efforts to control tobacco use and tobacco-related morbidity and mortality have been reasonably successful over the past 3 decades, during which there has been a 34% reduction in adult smoking. Nevertheless, tobacco use remains a significant public health problem in the U.S., with more than 430,000 tobacco-related deaths per year and over one fourth of the population continuing to smoke. Many organizations are involved in tobacco-use control activities, the most broadly focused of which is that of the National Cancer Institute (NCI). The NCI's program is described and its emphasis on a data-based decision matrix in its approach to tobacco and cancer control research and applications of research is discussed. Finally, future approaches to tobacco-use control in the U.S. are suggested.

The clinician's role in promoting smoking cessation among clinic patients.

Like other chronic conditions, nicotine dependence offers both challenges and rewards to clinicians. The treatment of this condition frequently requires experience in pharmacology, behavioral science, and social aspects of medicine. Physicians are uniquely qualified to assist patients in their efforts to overcome the multifaceted condition of tobacco addiction. In providing this treatment, the clinical challenges are far outweighed by the benefit to patients who stop smoking. For many patients, smoking cessation is, by far, the most important step they can take to improve their health and increase their life span. Physicians who help patients accomplish this difficult goal provide a life-saving service. There is sufficient scientific evidence to guide physicians in their approach to smoking patients. Brief, systematic interventions have been shown to increase patient smoking cessation rates. The intervention can be described in four steps: ask about smoking, advise smokers to stop, assist those who want to stop, and arrange adequate follow-up. These interventions are used consistently when a smoking cessation program is adopted by an entire office practice. The components of this office-based program include defining staff roles, maintaining a smoke-free office, stocking appropriate materials, making use of the medical record to identify smokers and to remind staff to intervene, and monitoring patient progress. The potential public health impact of physician intervention with smoking patients is enormous. Even with very modest expectations of cessation rates, 100,000 physicians using effective intervention can produce over 3 million new ex-smokers in the United States each year. In conjunction with other community-based tobacco control efforts, this physician-lead effort will result in a marked reduction in the morbidity and mortality caused by smoking and, thus, control of "the most important public health issue of our time."

Laser safety primer outline for industrial/medical users.

Laser safety standards are detailed technical documents arising from the complexity of the different mechanisms, depending on the parameters of the laser beam, by which lasers interact with living tissue. As a result, their interpretation by non-expert laser users, who are concerned about safety issues, can cause many difficulties. Based on experience in advising industrial and medical laser users, we have developed a primer which (i) provides step-by-step guidance in the interpretation and use of the laser safety standards, and (ii) explains how to calculate the laser irradiance (on the retina or the skin) to which the user may be subjected in typical situations. A computer program has also been developed which, through a series of questions and answers, guides the user through the calculation of the maximum permissible exposure level and the nominal optical hazard distance for the application of interest. The overall package should be particularly useful to laser safety officers and users of lasers for research applications, as an independent check on safety calculations. It also provides a useful complement to the many worked examples in the laser safety standards.

Comprehensive approaches to tobacco use control.

This essay suggests approaches to two issues of importance to the future of tobacco use control research. First, there is need to identify those areas of tobacco use prevention and cessation research which have evolved to the point where additional investigation would only bring incremental gains. The reduction potential of this research should then be consolidated by applying existing, effective interventions widely and systematically. Conversely, there is need to identify those areas in which additional research is necessary. Second, the most logical way to reach agreement on those areas which are ready to move from research to applications-of-research is, with the co-operation and advice of the research community, through the large funding organizations which have supported this research over the past 2 decades. It is these organizations which, once the most effective intervention are identified, are capable of supporting the centrally-planned, consensus-driven, comprehensive approaches to tobacco use control which will be necessary to continued success in reducing tobacco-related morbidity and mortality in the industralized world and to begin addressing the growing problems of tobacco use in the developing world.