A randomised clinical trial of nicotine patches for treatment of spit tobacco addiction among adolescents.

BACKGROUND: This study tested the efficacy of nicotine patches in combination with behavioural therapy for the treatment of adolescent spit tobacco addiction. Prior interventions had resulted in mean cessation rates below 15% at one year. METHODS: This study, the PATCH Project, used a three group, placebo controlled, randomised clinical trial design. The control group received a standard 3-5 minute counselling followed by a two week follow up phone call. The two intervention groups received a six week behavioural intervention; in addition, one group received active nicotine patches while the other group received placebo patches. Both groups received quarterly stage based telephone counselling. RESULTS: At one year, the usual care group's spit tobacco cessation rate was 11.4% (exact 95% confidence interval (CI) 6.1% to 19.1%), placebo patch 25.0% (95% CI 16.9% to 34.7%), and the active patch 17.3% (95% CI 10.4% to 26.3%). When both patch groups were combined, the cessation rate was 21.2% (95% CI 15.7% to 27.6%). The cessation rates for active and placebo patch were not significantly different (exact two sided p = 0.22), while the combined patch groups had a significantly greater cessation rate than usual care (exact two sided p = 0.04). CONCLUSIONS: The behavioural intervention proved to be about twice as successful as previous interventions, but the nicotine patch offered no improvement in cessation rates. The behavioural intervention is based on publicly available materials and can be easily adapted for widespread use, particularly in high schools.

Increasing mammography practice by African American women.

PURPOSE: This study examines the effectiveness of the Witness Project, a culturally competent cancer education program that trains cancer survivors to promote early detection and increased breast self-examination and mammography in a population of rural, underserved, African American women. DESCRIPTION OF STUDY: The primary setting for the Witness Project-an intensive, community-based, culturally sensitive educational program that incorporates spirituality and faith-was the African American church. Baseline and 6-month follow-up surveys were obtained from 206 African American women in two intervention counties and from 204 African American women in two control counties in the rural Mississippi River Delta region of Arkansas. RESULTS: Witness Project participants significantly increased (P <.0001) their practice of breast self-examination and mammography (P <.005) compared with the women in the control counties. CLINICAL IMPLICATIONS: These results demonstrate that intensive, community-based, culturally sensitive educational programming incorporating the spiritual environment of the faith community, such as the Witness Project, can positively influence breast cancer screening behaviors among rural, underserved African American women. Through the use of community churches and cancer survivors, breast cancer screening activities can be improved in this population.

Increasing mammography and breast self-examination in African American women using the Witness Project model.

BACKGROUND: The five-year survival rate for African American women with breast cancer is notably lower than the rate for white women; thus, appropriate cancer education and screening efforts are needed to increase mammography and breast self-examination practices by African American women. METHODS: The Witness Project is a theory-based intervention designed to provide culturally sensitive messages, from African American breast cancer survivors, in churches and community organizations. These messages emphasize the importance of early detection to improve survival. RESULTS: Intervention research in eastern Arkansas with 204 African American women demonstrated a significant increase in the practice of breast self-examination (p < 0.001) and mammography (p < 0.001) after participation in the Witness Project. There was no significant difference between the pre- and postintervention scores for scaled items for the health-belief model and locus of control. CONCLUSIONS: Results demonstrate that culturally appropriate cancer education programs are able to change behavior by meeting the beliefs of participants rather than attempting to change their beliefs.

Rapid metabolic phenotypes for acetyltransferase and cytochrome P4501A2 and putative exposure to food-borne heterocyclic amines increase the risk for colorectal cancer or polyps.

The metabolic activation of food-borne heterocyclic amines to colon carcinogens in humans is hypothesized to occur via N-oxidation followed by O-acetylation to form the N-acetoxy arylamine that binds to DNA to give carcinogen-DNA adducts. These steps are catalyzed by hepatic cytochrome P4501A2 (CYP1A2) and acetyltransferase-2 (NAT-2), respectively, which are known to be polymorphic in humans. On the basis of this proposed metabolic activation pathway, patients at greatest risk to develop colorectal cancer or nonfamilial polyps should be those who possess both the rapid NAT-2 and rapid CYP1A2 phenotypes and are exposed to high dietary levels of carcinogenic heterocyclic amines. Using a method that involves caffeine administration and high pressure liquid chromatographic analysis of urinary metabolites, we have determined the CYP1A2 and NAT-2 phenotypes of 205 controls and 75 cancer/polyp cases. Exposure information was obtained using a dietary and health habits questionnaire. Both the rapid CYP1A2 and rapid NAT2 phenotypes were each slightly more prevalent in cases versus controls (57% and 52% versus 41% and 45%, respectively). However, the combined rapid CYP1A2-rapid NAT-2 phenotype was found in 35% of cases and only 16% of the controls, giving an odds ratio of 2.79 (P = 0.002). Univariate analysis of the questionnaire indicated that age, rapid-rapid phenotype, and consumption of well done red meat were associated with increased risk of colorectal neoplasia. Furthermore, a logistic regression model that included age (as a continuous variable), consumption of well done red meat, and rapid-rapid phenotype as independent covariates gave odds ratios of 1.08, 2.08, and 2.91, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A model for making project funding decisions at the National Cancer Institute.

This paper describes the development of a model for making project funding decisions at The National Cancer Institute (NCI). The American Stop Smoking Intervention Study (ASSIST) is a multiple-year, multiple-site demonstration project, aimed at reducing smoking prevalence. The initial request for ASSIST proposals was answered by about twice as many states as could be funded. Scientific peer review of the proposals was the primary criterion used for funding decisions. However, a modified Delphi process made explicit several criteria of secondary importance. A structured questionnaire identified the relative importance of these secondary criteria, some of which we incorporated into a composite preference function. We modeled the proposal funding decision as a zero-one program, and adjusted the preference function and available budget parametrically to generate many suitable outcomes. The actual funding decision, identified by our model, offers significant advantages over manually generated solutions found by experts at NCI.

Application of the Salmon model: a tale of two cities.

This report demonstrates the application of a recently developed conceptual model of public health nursing practice to a specific community problem. The nurse was able to assist one community group and lead another in identifying their needs, developing a plan to meet those needs, implementing the plan, and evaluating the results. The model provided a structure for the nurse to use in determining scope of practice, the importance of values, practice priorities and interventions, and the relevant determinants of health. This project also served to demonstrate faculty practice. Graduate students in community health nursing attended the nonsmokers' group meetings and city council hearings. They participated at various levels, but primarily they observed their instructor putting into practice the role of the public health nurse specialist as described in the classroom. Discussions regarding group dynamics and community action strategies often occurred in the classroom as a direct result of faculty and student involvement. The Salmon model for public health nursing practice has significant potential for application in numerous areas. It can serve as a unifying force in considering the many variables that influence community action. Being specifically designed for public health nursing, it holds great promise for optimizing the practice of the nurse in community settings.

Smoking cessation among blacks.

The burden of cancer on the U.S. black population has been compounded by a high prevalence of smoking among blacks. Lung cancer among blacks is a serious public health problem, with a mortality rate of 119 per 100,000 among black males compared to 81 per 100,000 for white males. Blacks, both male and female, have lower quit rates for smoking than does the general U.S. population. Why more blacks than whites continue to smoke is not clear, but the National Cancer Institute has recently funded several research projects to facilitate smoking cessation among blacks. It appears from preliminary findings that smoking cessation efforts among blacks are most successful if they use broadcast media that reach black audiences, if they tailor their print materials to address the needs of black smokers, and if black community networks are utilized.