Triathlon training for women breast cancer survivors: feasibility and initial efficacy.

ᅟ: Exercise can improve quality of life (QOL) in breast cancer survivors. In contrast to many group or home-based exercise programs, little is known about the effectiveness of goal-oriented recreational activities. PURPOSE: The purpose of this study was to evaluate a clinically overseen team triathlon training program on improving physiological and psychosocial health-related measures in female breast cancer survivors. METHODS: Twenty-three participants (age = 48 (8), BMI = 25 (1), mean (SE)) were recruited from a 14-week sprint triathlon (800-m swim, 20-km bike, 5-km run) team training program for women breast cancer survivors (4 (3) years post-surgery, chemo-, or radiation-therapy). Training included two supervised group and three home-based individual sessions per week. Pre- and post-training outcomes included isokinetic knee extensor strength (60, 180, and 300° s-1), 6-min walk test (6MWT), maximal oxygen uptake (VO2 max), QOL (Functional Assessment of Cancer Therapy -Breast (FACT-B)), and barriers to exercise. Outcomes were also obtained 6 months post except for VO2 max. Significance was set at p < 0.05. RESULTS: Data are mean (SD) from 21 complete data sets. Knee extensor peak torque significantly improved only at 300° s-1 (pre 40.3(8.5) ftlb; post 45.2(8.4); p = 0.001). 6MWT significantly improved (pre 632.8(62.1) m; post 657.4(53.2); p = 0.014) as did VO2 max (pre 31.3(5.8) ml kg-1 min-1; post 35.9(5.8); p < 0.001). FACT-B also improved (pre 114(12); post 122(13); p = 0.004), including the FACT-G total score, social well-being, and breast cancer subscales while barriers to exercise decreased (pre 54(12); post 36(9); p < 0.001). Strength, 6MWT, and barriers to exercise remained improved after 6 months. CONCLUSIONS: Team triathlon training in breast cancer survivors can increase aerobic capacity and improve QOL which may contribute to healthier lifestyles in breast cancer survivors.

Restaurant volatility and the Iowa City, Iowa, smoke-free restaurant ordinance.

PURPOSE: To determine the economic impact of the Iowa City, Iowa, smoke-free restaurant ordinance (IC-SFRO) using an immediate and novel approach. DESIGN: In this retrospective study, food permit licensure served as the measure to assess the IC-SFRO impact. The Iowa City experience provided an excellent experimental setting, as the ordinance was enacted March 1, 2002, and repealed May 7, 2003, because of preemption. SETTING: The city of Coralville served as a natural control, as it is contiguous to Iowa City, has similar population demographics, and has never enacted a smoke-free restaurant ordinance. MEASURES: Food permit licensure data for all Iowa City and Coralville restaurants were obtained from the Johnson County Health Department. ANALYSIS: Differences in restaurant volatility were assessed using Fisher's exact probability test. RESULTS: The number of restaurants increased in both Iowa City and Coralville throughout the ordinance period. The ratio of the total number of restaurants in Iowa City to the total number of restaurants in the Iowa City-Coralville metropolitan area remained stable. The proportion of restaurants for each city did not differ significantly during the preordinance, ordinance, and postordinance periods. CONCLUSION: The IC-SFRO did not adversely impact the restaurant industry in terms of restaurant closures. The Iowa legislature was urged to draft evidence-based legislation, such as amending preemption of the IC-SFRO, to protect and promote the health of its communities.

Fax referrals, academic detailing, and tobacco quitline use: a randomized trial.

BACKGROUND: Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy. PURPOSE: To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit. DESIGN: Participants were randomized to one of two intervention conditions. SETTING/PARTICIPANTS: Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month. INTERVENTIONS: One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD). MAIN OUTCOME MEASURES: Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009. RESULTS: Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010. CONCLUSIONS: Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing. TRIAL REGISTRATION: This study is registered at Clinicaltrials.gov NCT00989755.

Tobacco withdrawal components and their relations with cessation success.

RATIONALE: Tobacco withdrawal is a key factor in smoking relapse, but important questions about the withdrawal phenomenon remain. OBJECTIVES: This research was intended to provide information about two core components of withdrawal (negative affect and craving): (1) how various withdrawal symptom profile dimensions (e.g., mean level, volatility, extreme values) differ between negative affect and craving; and (2) how these dimensions relate to cessation outcome. METHODS: Adult smokers (N = 1,504) in a double-blind randomized placebo-controlled smoking cessation trial provided real-time withdrawal symptom data four times per day for 4 weeks (2 weeks pre-quit and 2 weeks post-quit) via palmtop computers. Cessation outcome was biochemically confirmed 8-week point-prevalence abstinence. RESULTS: Examination of craving and negative affect dimensions following a cessation attempt revealed that craving symptoms differed from negative affect symptoms, with higher means, greater variability, and a greater incidence of extreme peaks. Regression analyses revealed that abstinence was associated with lower mean levels of both craving and negative affect and fewer incidences of extreme craving peaks. In a multivariate model, the increase in mean craving and negative affect scores each uniquely predicted relapse. CONCLUSIONS: Real-time reports revealed different patterns of abstinence-related negative affect and craving and that dimensions of both predict cessation outcome, suggesting that negative affect and craving dimensions each has motivational significance. This underscores the complexity of withdrawal as a determinant of relapse and the need to measure its distinct components and dimensions.

Creating a perfect storm to increase consumer demand for Wisconsin's Tobacco Quitline.

BACKGROUND: Telephone quitlines are a clinically proven and cost-effective population-wide tobacco-dependence treatment, and this option is now available in all 50 states. Yet, only 1% of the smoking population accesses these services annually. This report describes a series of policy, programmatic, and communication initiatives recently implemented in Wisconsin that resulted in a dramatic increase in consumer demand for the Wisconsin Tobacco Quitline (WTQL). INTERVENTION: In 2007, the Wisconsin legislature voted to increase the state cigarette excise tax rate by $1.00, from $0.77/pack to $1.77/pack effective January 1, 2008. In preparation for the tax increase, the Wisconsin Tobacco Prevention and Control Program, the University of Wisconsin Center for Tobacco Research and Intervention, which manages the WTQL, and the state's quitline service provider, Free & Clear, Inc., collaborated to enhance quitline knowledge, availability, and services with the goal of increasing consumer demand for services. The enhancements included for the first time, a free 2-week supply of over-the-counter nicotine replacement medication for tobacco users who agreed to receive multi-session quitline counseling. A successful statewide earned media campaign intensified the impact of these activities, which were timed to coincide with temporal smoking-cessation behavioral patterns (i.e., New Year's resolutions). RESULTS: As a result, the WTQL fielded a record 27,000 calls during the first 3 months of 2008, reaching nearly 3% of adult Wisconsin smokers. CONCLUSIONS: This experience demonstrates that consumer demand for quitline services can be markedly enhanced through policy and communication initiatives to increase the population reach of this evidence-based treatment.