The toxic-tobacco law: "appropriate remedial action".

Tobacco products, despite being lethal and addictive, are highly attractive and accessible to children at hundreds of thousands of retail outlets. The proposed Toxic-Tobacco Law (the Law) will end this access by prohibiting U.S. corporations from making, marketing, or importing tobacco products. The Law will go into effect twenty years after enactment, giving all stake-holders (e.g., farmers) time to adjust. After this adjustment period, adults will be "free" to import tobacco products for personal use. Unlike Prohibition, which sought to stop Americans from consuming alcohol, the Toxic-Tobacco Law does not seek to restrict consumption by adults. The purpose of this law is to end the massive presence of tobacco products in American society in order to prevent the addiction of children to tobacco and its devastating health consequences (e.g., lung cancer). The U.S. Congress, under the "commerce clause" of the Constitution, has the authority to pass the Toxic-Tobacco Law.

Predictors of weight increases over 7 years in fire fighters and paramedics.

BACKGROUND: Excess body weight among adults is associated with increased risk of disease. Therefore, we sought predictors of weight gain that might be used to prevent increases in weight. METHODS: Participants were 438 male fire service personnel, 20-58 years of age, who filled out a questionnaire in 1984 and were weighed in 1984 and 1991. RESULTS: Sixty-five percent gained > or = 5 lb, 42.1% gained > or = 10 lb, and 26.1% gained > or = 15 lb. Unmarried fire fighters gained 11.7 lb; those married or living as married gained 7.0 lb (P < 0.001). Black non-Hispanics increased by 15.7 lb, white Hispanics by 8.9 lb, and white non-hispanics by 6.7 lb (P < 0.001). New ex-smokers gained 13.0 lb; all other fire fighters gained 7.7 lb (P < 0.004). Fire fighters who reported eating "faster" at the station than elsewhere gained 9.9 lb compared with 6.8 lb for all others (P < 0.006). Those worried over financial security gained 11.2 lb versus nonworriers who gained 7.4 lb (P < 0.005). CONCLUSION: Prevention programs will reach fire fighters likely to gain the most weight if aimed at those who are unmarried, younger, black, recent ex-smokers, fast eaters, and experiencing certain stressful life events.

Response rates to six recruitment mailing formats and two messages about a nutrition program for women 50-79 years old.

Recruiting participants for large prevention trials is time consuming and costly. In order to test various recruitment techniques, we conducted two studies of response rates to recruitment mailings for the Women's Health Trial. The potential participants, 50- to 79-year-old women, were requested to return an enclosed postcard to learn more about the trial. In the first study, we sent at random either a short or a long message to a group of University of Miami personnel (N = 862) and a Dade County cohort (N = 2964). More university women responded to the short message than to the long message (22.4% vs 16.4%, p = 0.024). Similarly, more of the Dade County cohort replied to the short message than to the long one (12.1% vs 9.6%, p = 0.027). The long message listed details of the intervention (e.g., modifying recipes) that some women may have used to decide they were not interested in participating. In the second study, we examined response rates to two different ways of addressing the mailing, i.e., handwritten envelopes and machine-printed labels; we also evaluated three methods for delivering the short message: (1) formal invitation, (2) business letter with an inside name and address of the recipient, and (3) business letter without the recipient's name and address. Response rates were similar between the methods of addressing envelopes and among the three vehicles for the message, suggesting that the least costly method of mailing should be used.

Effectiveness of self-help smoking cessation guides for firefighters.

Most smokers would prefer to quit smoking on their own. However, among specific blue-collar occupations it is not known whether self-help techniques will be effective or even used to help smokers quit smoking. In this study we evaluated the effectiveness of a self-help smoking cessation guide designed specifically for firefighters (FF) and compared it with the American Lung Association (ALA) guide designed for the general public. We hypothesized that a shorter guide (FF), written in the jargon of the fire service, and formatted as a workbook would be more effective. One hundred five firefighters randomly received either the ALA or FF guide after having an annual physical examination. Twelve percent of the ALA group and 11% of the FF group quit smoking after the physical examination but before receiving the guides. We found no relationship between the specific guide that the firefighters received and subsequent smoking status. Few firefighters reported filling out pages of the ALA guide (11.9%) or the FF guide (17.8%). For smokers who have not reached the active stage of quitting smoking, guides may not be a factor in quitting. Screening smokers to determine their "stage of change" at the physical examination may increase the effectiveness of self-help guides.

Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group.

Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. Change in smoking status (quitters vs nonquitters) was not independently associated with change in diastolic blood pressure or the subsequent use of antihypertensive medication for smokers who were normotensive at entry. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.01), although the groups had similar baseline diastolic blood pressure levels. Weight gain subsequent to cessation probably contributed to this excess incidence of hypertension in quitters. Stepped-care antihypertensive therapy lowered diastolic blood pressure similarly for hypertensive quitters and nonquitters. Weight increases of 6 lb or more by the 72-month visit occurred in 47% of quitters vs 25% of nonquitters (P less than 0.01); quitters did not differ from nonquitters in their change in total kilocalories from baseline to the 72-month visit. Quitters who gained 6 lb or more tended to be less obese at baseline, be less physically active, and smoke more cigarettes per day than those who did not gain this amount. Finally, quitters relative to nonquitters experienced an adjusted increase of 2.4 mg/dl high-density lipoprotein cholesterol, but no difference in total or low-density lipoprotein cholesterol. The implications for intervention are discussed as they relate to the common, but not inevitable, increase in weight subsequent to cessation.

Road to a smoke-free fire service for Florida: policies and progress.

In 1986 the Professional Fire Fighters of Florida (PFFF), a labor organization of 11,000 members, passed an unprecedented resolution to create a "smoke-free fire service." The PFFF's commitment arose from its (i) concern for the health of fire fighters, (ii) need to address the issue of smoking to protect the fire fighters' "Heart and Lung Law," and (iii) attempt to avert criticism of its proposed presumptive "Cancer Bill." In 1987 the PFFF gained support for its resolution from a council representing chiefs, fire instructors and inspectors, and volunteer fire fighters. Prior to the "smoke-free" resolution, one fire department in Florida required that new fire fighters be non-smokers. Since the resolution passed, 14 departments added this requirement. In 1989 the PFFF succeeded in getting a landmark bill passed requiring that new fire fighters be non-users of tobacco for at least one year prior to application. Important implications of the PFFF's efforts to create a "smoke-free fire service" are also discussed.

The effects of a worksite health promotion program on the wives of fire fighters.

One method of increasing the cost-effectiveness of worksite health promotion programs is to develop programs that also have an impact on risk factors of family members and friends of the employees. In this study, 41 wives of fire fighters were interviewed concerning changes the fire fighters and they had made in their health habits--exercise, weight, and consumption of fats, fruits/vegetables, and cereal/whole grain breads--in the previous year. Thirty-two were wives of fire fighters who had received a worksite health promotion program and nine were wives of fire fighters who had not yet received the program. Findings of our exploratory study strongly suggest that wives of fire fighters who received information were more aware of the program (93% vs 56%), had greater exposure to the written diet plan (72% vs 11%) and guide to high fat foods (72% vs 0%) than controls. Furthermore, the intervention led to changes in the fire fighters' health habits that were reported by the wives. No significant changes in the wives' health habits occurred as a result of the intervention, although the changes were in the predicted direction in every category; changes by the wives were, however, related to changes by fire fighters. Involvement of the fire fighters in the preparation of meals and sharing of information from the intervention program by the participant with the wife, were related to change in health habits of the wives.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk-factor changes in wives with husbands at high risk of coronary heart disease (CHD): the spin-off effect.

This study of 220 wives of participants from four of the 22 clinics in the Multiple Risk Factor Intervention Trial (MRFIT) addresses the question of whether spouses of men exposed to a continuous coronary heart disease (CHD) risk-factor intervention program (SI group) make changes in their own risk status compared to wives of men who did not receive the intervention program (UC group). Total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly lower for the SI wives. These differences were found for both hypertensive and normotensive wives, although the magnitudes were much greater for the hypertensive wives. There were also significant differences between the two groups of wives in the food-record rating and in dietary-knowledge scores, indicating that the probable mechanism for the beneficial effect of the intervention with respect to cholesterol levels was the change in the family diet. Although not statistically significant, differences indicating a lower risk for SI wives were found for diastolic blood pressure. There was also a greater mean reduction in cigarettes per day for SI wives who smoked.

The MRFIT behavior pattern study. II. Type A behavior and incidence of coronary heart disease.

Behavior pattern was assessed by interview for 3,110 men at eight centers in the Multiple Risk Factor Intervention Trial (1973-1976). The Type A pattern was not significantly associated with risk of first major coronary events (coronary death and definite nonfatal myocardial infarction) after a mean follow-up of 7.1 years. Crude relative risks for Types A1-A2 versus X-B were 1.08 in usual care, 0.82 in special intervention, and 0.92 overall. Adjustment for age, blood pressure, cigarette smoking, serum cholesterol, consumption of alcohol, and educational attainment yielded relative risks of 0.99 in usual care, 0.81 in special intervention, and 0.87 overall (95% confidence interval = 0.59-1.28). The Jenkins Activity Survey Type A score, obtained for 12,772 men at all 22 centers, was also not significantly associated with risk of first major coronary events. Overall, crude risks in the lowest (Type B) through highest (Type A) quintiles of the score's distribution were 5.0%, 4.4%, 4.0%, 4.3%, and 4.1%, respectively. The proportional hazards regression coefficient, adjusted for the variables listed above, was -0.006 (95% confidence interval = -0.015-0.003). These results raise questions regarding the robustness of the Type A hypothesis in its present form. Further studies are needed to investigate these questions and to evaluate the validity of procedures used to assess behavior patterns.

Interpersonal distance: a factor in infectious disease morbidity and mortality?

We hypothesized a greater incidence of diseases transmitted by airborne vectors in countries where people interact at shorter distances from each other compared to countries where people interact at greater distances. Therefore, we examined the relationship between the interpersonal distance of pairs of people from different countries and the incidence of infectious disease in those countries. Morbidity and mortality data for 1981 were obtained from WHO reports, while interpersonal distance estimates were taken from Watson's study of proxemic behavior. Respiratory tuberculosis morbidity was negatively correlated with interpersonal distance (r = -.51, p = .037), while respiratory tuberculosis mortality was not (r = -.42, p = .051). Mortality from non-respiratory tuberculosis was negatively related to interpersonal distance (r = -.60, p = .007). To verify these correlations, we repeated the analyses using incidence data from 1977. Neither of the correlations remained significant, although for respiratory tuberculosis morbidity r = -.44 (p = .059). Our inability to replicate the original findings suggests the significant results for 1981 may have been spurious.

Children's type A interview: interrater, test-retest reliability, and interviewer effect.

The Miami Structured Interview--1 was developed to assess Type A behavior in preadolescents and adolescents in the United States and Greece. This report describes the interrater and test-retest reliability of the Miami Structured Interview--1, and the effect of different interviewers on the assessment process. Interrater agreements on the A vs not A scale were 73% for Greek American (k = 0.49, p less than 0.01, n = 88), 80% for Mixed American (k = 0.61, p less than 0.01, n = 69), and 88% for Native Greek interviews (k = 0.76, p less than 0.01, n = 65). Exact agreements on a five-point scale were 48% (weighted k = 0.73, p less than 0.01), 42% (weighted k = 0.70, p less than 0.01), and 48% (weighted k = 0.80, p less than 0.01), respectively. Although levels of agreement were all greater than chance, rater bias was observed. Test-retest administrations within 10 min showed 91% agreement (k = 0.82, p less than 0.01) on the A vs not A scale. Analyses suggest interviewers can affect the assessment of Type A behavior. These findings indicate the Miami Structured Interview--1 can (1) reach acceptable levels of interrater reliability, (2) is susceptible to rater bias, (3) has sufficient test-retest reliability for use in longitudinal studies, and (4) must be presented in a standardized way before ratings from interviews conducted by different interviewers can be combined or compared. The strengths and limitations of the Miami Structured Interview-1 are discussed.

Cross-cultural validity of the Miami Structured Interview--1 for type A in children: the American-Hellenic Heart Study.

The Miami Structured Interview--1 was developed (1) to assess Type A behaviour in a broader age range of children than tested with previous interviews, and (2) for cross-cultural studies. This study examined the validity of the Miami Structured Interview--1 for assessing Type A behavior in 507 American and Greek preadolescent (ages 7-11) and adolescent (ages 12-16) boys. The interview was scored on voice stylistics such as speed of speech, word emphasis, and latency of response. Validity was tested using the Matthews Youth Test for Health (MYTH), a teacher rating scale of Type A behaviors. Interview determined Type A's received significantly higher MYTH scores than non Type A's for American adolescents (p less than 0.05), Greek preadolescents (p less than 0.01), and Greek adolescents (p less than 0.05). The interview also identified extreme groups of Type A's and Type B's for American adolescents (p less than 0.01) and Greek preadolescents (p less than 0.05). The findings support the cross-cultural validity of the Miami Structured Interview--1 and the Type A construct for children. Limitations of the Miami Structured Interview--1 are discussed.