An RNA pseudoknot stimulates HTLV-1 pro-pol programmed -1 ribosomal frameshifting.

Programmed -1 ribosomal frameshifts (-1 PRFs) are commonly used by viruses to regulate their enzymatic and structural protein levels. Human T-cell leukemia virus type 1 (HTLV-1) is a carcinogenic retrovirus that uses two independent -1 PRFs to express viral enzymes critical to establishing new HTLV-1 infections. How the cis-acting RNA elements in this viral transcript function to induce frameshifting is unknown. The objective of this work was to conclusively define the 3' boundary of and the RNA elements within the HTLV-1 pro-pol frameshift site. We hypothesized that the frameshift site structure was a pseudoknot and that its 3' boundary would be defined by the pseudoknot's 3' end. To test these hypotheses, the in vitro frameshift efficiencies of three HTLV-1 pro-pol frameshift sites with different 3' boundaries were quantified. The results indicated that nucleotides included in the longest construct were essential to highly efficient frameshift stimulation. Interestingly, only this construct could form the putative frameshift site pseudoknot. Next, the secondary structure of this frameshift site was determined. The dominant structure was an H-type pseudoknot which, together with the slippery sequence, stimulated frameshifting to 19.4(±0.3)%. The pseudoknot's critical role in frameshift stimulation was directly revealed by examining the impact of structural changes on HTLV-1 pro-pol -1 PRF. As predicted, mutations that occluded pseudoknot formation drastically reduced the frameshift efficiency. These results are significant because they demonstrate that a pseudoknot is important to HTLV-1 pro-pol -1 PRF and define the frameshift site's 3' boundary.

Bioaccumulation of trace metals in shellfish and fish of Bonny River and creeks around Okrika in Rivers State, Nigeria.

Lead, nickel, vanadium and cadmium were determined in fish and shellfish muscles, to assess contamination levels and identify bio-indicators. Vanadium was not detectable. Lead and cadmium were slightly above legal limits used in South East Asia, but lower than those of Australia and New Zealand. Higher contents of nickel, cadmium and lead in Pachymelania aurita and Crassostrea rhizophorae, lead in Mugil cephalus and cadmium in Periophthalmus koelreuteri, mark these species out as possible bio-indicators for the three metals in aquatic systems. Patterns of bioaccumulation seem to suggest that biophysiological and ecological characteristics influence bioaccumulation of trace metals in fish and shell fish.

Prevalence of cigarette smoking in the United States: estimates from the 1985 current population survey.

In September 1985, the Census Bureau collected health information on 114,342 individuals as part of its Current Population Survey (CPS). A special supplement that included questions on smoking practices was sponsored by the Office on Smoking and Health. The CPS, with its large sample size, provides a unique opportunity to examine region, division, and state estimates of smoking prevalence. The overall prevalence rate for males in the 1985 CPS was estimated at 31.3%, compared with 25.0% for females. For males, smoking rates were highest in the South (34.5%) and lowest in the West (28.0%). For females, smoking rates were highest in the North Central region (26.3%) and lowest in the West (22.7%). Among males, blacks reported higher smoking rates (37.2%) than whites (30.7%) or Hispanics (30.9%). In contrast, white females (25.8%) and black females (26.0%) reported virtually identical smoking rates, while Hispanic females reported a considerably lower rate (16.5%). White-collar workers (both males and females) also reported substantially lower smoking rates than service or blue-collar workers. For both males and females, peak smoking prevalence occurred in the 40-49-year age group (males = 38.1%, females = 30.6%).

Recruiting minority cancer patients into cancer clinical trials: a pilot project involving the Eastern Cooperative Oncology Group and the National Medical Association.

PURPOSE: Minority accrual onto clinical trials is of significant interest to cooperative oncology study groups. The Eastern Cooperative Oncology Group (ECOG) conducted a study to identify barriers and solutions to African American accrual onto clinical trials. METHODS: We hypothesize that the National Medical Association (NMA) might provide insight into ways to increase minority participation and that ECOG might facilitate that participation. Four sites were selected in which NMA chapters existed and ECOG main institutions with less than half of the corresponding percentage of minorities in their communities entered trials for 1992. Fifteen workshops were conducted using discussions and open-ended, self-administered questionnaires. RESULTS: Seventy percent of NMA physicians cited mistrust of the research centers, fear of losing patients, and a lack of respect from ECOG institutions as the most important barriers to minority cancer patient referrals, compared with 30% for ECOG physicians. Sixty-nine percent of NMA and 43% of ECOG physicians cited a lack of information about specific trials. Nearly half of NMA physicians (47%) cited a lack of minority investigators as a barrier, compared with 4% of ECOG physicians. Solutions by both groups were improved communication (73%) and culturally relevant educational materials (40%). ECOG physicians cited more minority outreach staff as a potential solution (22% v 6%). NMA physicians cited increased involvement of referring physicians (44% v4%). CONCLUSION: NMA physicians who serve a significant sector of the African American population demonstrated a willingness to participate and work with a cooperative group effort to increase participation of minority patients and investigators.

New directions for risk communication research: a discussion with additional suggestions.

The papers by Huerta and Macario and Kreuter share the theme of suggesting new directions for risk communication research in cancer prevention and control. Huerta and Macario remind us once again that sociocultural factors must be considered when conducting risk communication research on underserved populations. Of special note is their recommendation to target the family, which could introduce a compelling new chapter in risk communication research in cancer prevention and control. In contrast, Kreuter challenges us to consider multiple cancer risks and risk-reducing behaviors in our research and provides a provocative framework for achieving this goal. Given this common theme and the need to position specific recommendations within the larger context of other competing research questions, this paper also highlights several additional recommendations for future research. These recommendations include the following: more research on risk presentation; establishing guidelines for measuring risk; additional research testing strategies to de-bias optimistic and pessimistic perceptions of risk and evaluating risk communication as a strategy for behavior change; more research investigating the sociology of risk communication, with a special emphasis on the family as the unit of investigation; and, finally, more research that specifically targets underserved populations in diverse community settings.

The Cancer Information Service as a laboratory for research: the first 15 years.

Over the past 15 years, the Cancer Information Service (CIS) of the National Cancer Institute has generated a substantial body of research. In the present report, this research is reviewed as it pertains to five key questions: 1) Who uses the CIS? 2) What are the topics of inquiry? 3) How do callers learn of the CIS? 4) Do CIS campaigns and unplanned events affect CIS call volume? 5) Can the CIS influence behavior? Major conclusions from this review can be summarized as follows: 1) The vast majority of callers to the CIS are female, White/Anglo, and of middle-class background. 2) Most calls relate directly or indirectly to cancer-treatment issues. 3) A variety of media and sources are reported by CIS callers, with television ranking high across most studies. 4) CIS call volume can be substantially influenced by promotion campaigns and unplanned events. 5) The available evidence suggests that the CIS can influence behavior, especially information-seeking behavior. Recommendations for future research are discussed in light of the results of this review.

Proactive screening mammography counseling within the Cancer Information Service: results from a randomized trial.

In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a randomized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service (CIS). This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography; this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief (6-minute) proactive telephone-counseling protocol. The screening-mammography counseling intervention was tested in two regional CIS offices using a randomized two-group design. Callers were randomly assigned to the intervention or control group based on the week of their call to the CIS (n = 1831 eligible female callers). Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months' follow-up (87% response rate). Among all CIS callers enrolled in this study, self-reported adherence to screening-mammography guidelines at 12 months' follow-up was 63.5%. The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy (52%), cost (36%), lack of physician referral (34%), no symptoms (34%), and fear of radiation (29%). A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $30,000 or more (odds ratio = 1.38, P = .04). The vast majority (90%) of CIS callers (both intervention and control subjects) endorsed the concept of proactive counseling by the CIS. The implications of these findings for the CIS and future research are discussed.

The first 15 years: what has been learned about the Cancer Information Service and the implications for the future.

The Cancer Information Service (CIS) has been in existence for over 15 years. During that period, lessons have been learned that have been used to increase the effectiveness of the network. This paper lists 12 of those lessons, covering issues such as giving sophisticated medical information; reaching diverse target audiences; using the mass media; developing systems needed for quality assurance, research, and information technology; and nurturing a local-national partnership. The paper also discusses major accomplishments of the program and lists recommendations for meeting the challenges to be faced by the CIS in the future.

Initial and repeat mammography screening in a low income multi-ethnic population in Los Angeles.

Low income, older, minority women are at high risk for underutilization of screening mammography. One strategy for increasing utilization is to conduct interventions targeting local and state health departments where a majority of these women seek health care. A prerequisite for conducting effective screening programs is to obtain current and accurate information on baseline screening rates to understand the nature and scope of the problem and to plan appropriate intervention strategies. The sample consisted of 3240 women who were 50+ years of age from 2 hospitals and 2 comprehensive health centers operated by the Los Angeles County Department of Health Services. Reviews of medical records indicated that only 21% of the sample had received a mammogram in the 12 months prior to the clinic visit on which they were sampled and 23% of the sample received a mammogram in the following 9 months. Approximately 5% of the total sample received a repeat mammogram in the 21-month period over which they were tracked. Prospective independent predictors of screening were age, number of visits to primary care clinics, number of visits to specialty care clinics, and history of breast abnormalities. The results underscore the importance of implementing programs to increase mammography implementing programs to increase mammography screening within public facilities serving low income multiethnic women. An important finding is that a large number of older women are seen in specialty clinics, which represents an untapped resource for increasing screening in this population. Innovative interventions targeting such specialty clinics could substantially contribute to increasing screening rates. A comprehensive approach targeting system, physician, and patient barriers is recommended.

Physician perspectives on increasing minorities in cancer clinical trials: an Eastern Cooperative Oncology Group (ECOG) Initiative.

PURPOSE: This paper describes the ECOG-NMA Minority Accrual Initiative to assure minority participation in cancer clinical trials. METHODS: Focus groups were held to identify physician-reported barriers to the enrollment of minority patients in Cleveland, OH, Indianapolis, IN, Santa Clara County, CA, and Philadelphia, PA. Community physicians affiliated with the National Medical Association (NMA), and Eastern Cooperative Oncology Group (ECOG) investigators participated in the focus groups. A four-step process consisting of focus group workshops were conducted to (i) identify barriers, (ii) develop potential solutions to the barriers, (iii) define solutions to barriers involving specific clinical trials, and (iv) implement the solutions. RESULTS: Focus group participants identified physician lack of information, patient fears and suspicion, the fear of losing patients, and distrust of the health care system as the major barriers to enrollment of African Americans. We found significant differences between community physicians and cancer program physicians in several areas. Community physicians emphasized personal contacts to address the lack of information and to overcome patient fears and suspicions, while the cancer program physicians emphasized printed materials. There was no difference by region in the barriers identified in the focus group workshops; however, the proposed solutions to overcoming the barriers were specific to each site. CONCLUSION: The four-step process developed by the ECOG and the NMA used the focus group methodology to identify and overcome barriers to participation of African Americans in cancer clinical trials. Outreach efforts to educate patients, their families, and community physicians about cancer clinical trials should be directed at overcoming patient suspicions and providing practical information to physicians about specific trials and how to enroll patients.

Screening for cervical cancer in emergency centers and sexually transmitted disease clinics.

Low-income women are at increased risk of developing cervical cancer compared with middle- and upper-income women. How can poor women be reached for screening and early diagnosis of cervical cancer and its precursor stages? One answer to this question is based on the observation that a high percentage of the unscreened population has received some form of medical care within the previous 5 years. Emergency centers and sexually transmitted disease (STD) clinics often provide such care to patients who lack a regular source of health care. Thus, they represent potential resources for cervical cancer screening. However, in a survey of 19 hospitals whose patient populations include a high proportion of low-income patients, only five reported a protocol for cervical cancer screening in their emergency centers. Similarly, all 11 STD clinics included in this survey reported that fewer than 5% of their female patients had a Papanicolaou smear taken even though virtually all of them received a pelvic examination. Based on these findings, it appears that health care administrators and policymakers could intensify their cancer prevention programs by mobilizing these resources for cancer control.

Sex differences in reports of illness and disability: a further test of the fixed role hypothesis.

Data from a longitudinal study of adult health behavior (N = 1088) were used to test the 'fixed role' hypothesis as an explanation for sex differences in reports of illness and disability. According to this hypothesis, the traditional female excess in reported morbidity is due to females having more flexible role obligations than men--thus making it easier for women to adopt the sick role. In this analysis, regression techniques were used to examine sex differentials in reports of both 'symptom episodes' and bed days, while controlling statistically for fixed roles such as employment status, head of household and % contribution to the total family income. Our findings showed that the three fixed role measures did not explain sex differences in reports of symptom episodes or total bed days (N = 1088). However, among people reporting at least one bed day (N = 503), such obligations did explain the female excess in reported bed days. These findings suggest that fixed role obligations may play a larger role in determining when to relinquish the sick role as opposed to its adoption. These analyses also suggest that role obligations associated with employment status have the major influence on such sick role behavior.

Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors.

This paper describes the prevalence of anal sex among heterosexual adults in California and investigates the relationship of anal sex to other risk behaviors associated with AIDS and STDs. The study consisted of telephone interviews with a household probability sample of 3,545 California adults undersampling those age 44 and older. Seven percent of the sexually active respondents, 8% of males, and 6% of females reported having anal sex at least once a month during the year prior to the survey. Of these, most engage in this activity one to five times per month, and about 60% report never using condoms. Younger respondents and those who were not married were more likely to report anal intercourse. Respondents who had anal sex were more likely to report standard AIDS risks and lifestyle risks associated with STDs, and to engage in recreational use of drugs and alcohol. Both anal sex and condom use during anal intercourse were poorly predicted by these demographic and risk variables. It is concluded that a non-trivial proportion of California heterosexual adults engages in anal sex regularly, most without condoms, and those who have anal sex are more likely to have other risk behaviors associated with AIDS and STDs. These results suggest that anal sex must be addressed specifically in clinical and educational programs designed to reduce the spread of AIDS.

Weight change among registered nurses in a self-help smoking cessation program.

Abstract Weight-related beliefs, attitudes, and patterns of weight change were analyzed for 144 registered nurses followed for one year in a self-help smoking cessation study. Smoking history and outcome status, physical descriptors, weight orientation, and use of self-help smoking cessation materials were examined in relation to weight change. A multiple regression analysis which included all subjects yielded three predictors of weight gain: continuous abstainer smoking status, lower body mass index, and greater fear of weight gain. A logistic regression confirmed the influence of smoking status at outcome on weight change. Abstinence was associated with weight gain; continuous abstainers were more likely to gain weight (88.2%) than noncontinuous abstainers (50%) and never quitters (35.9%). Weight variables were found to be interrelated, forming an "eating orientation" linked to smoking behavior.

Evaluation of a worksite self-help smoking cessation program for registered nurses.

Cigarette smoking among nurses remains a public health concern despite a recent decline in current smoking prevalence. We recruited 149 registered nurses into a no-cost, targeted, self-help smoking cessation program supplemented by a supportive worksite environmental module. The study was designed to expand understanding of nurses' smoking and to measure program effectiveness. Follow-ups were conducted at one, six and 12 months post-intervention to assess self-reported smoking status (92% objectively validated) and predictors of cessation. Point prevalence abstinence at these time points (22.5%, 21.5% and 19.5%), continuous abstinence (12.7%), and an ever-quit rate of 57% (i.e., quit for at least 48 hours), compare favorably to population quit rates and to rates reported for other self-help programs. Logistic regression analyses were utilized to identify predictors of short-term cessation [time before needing a cigarette, concern regarding the health hazards of smoking, working in a critical care setting, use of targeted weight manual] and long-term cessation [dosage (inverse relationship), use of standard American Lung Association maintenance manual, working with dying patients, and M.D.s' opposition to upgrading nursing service (inverse relationship)].

Breast cancer detection behavior among urban women.

Data from the ongoing Los Angeles Health Study were analyzed to determine women's behavior and behavioral intentions regarding three modes of breast cancer detection behavior: breast self-examination (BSE), physician examination of the breasts, and mammography. Two questions were addressed: Are women who engage in one type of breast surveillance behavior likely to engage in all three? What are the social characteristics of women who engage in these breast cancer detection behaviors?The data indicated that women who had had a recent professional (physician) breast examination did not necessarily practice monthly BSE. Only 82 of a sample of 540 women had had mammography; thus, it was not possible to relate this type of surveillance to the other two types. However, 93 percent of the women interviewed indicated they would obtain a mammography examination if their physicians recommended it. There were few differences among the sociodemographic subgroups with respect to BSE and professional examination, with the exception that black women were more likely to report practicing monthly BSE than were white or Hispanic women.

Cancer prevention counseling on telephone helplines.

Since 1983, the National Cancer Institute (NCI) has collected data by means of its Cancer Information Service (CIS), a toll-free telephone helpline for health care professionals and members of the public who have questions about cancer treatment, diagnosis, and prevention. These data reveal information about the characteristics of callers and their questions and about how inquiries reflect mass media promotions and secular trends. A request for a publication is the most common type of inquiry, followed by information about specific cancer sites, smoking prevention and cessation, other types of prevention, cancer treatment, cancer symptoms, referrals to physicians, NCI clinical trials, hospital and clinic-based screening programs, and general counseling or coping. Breast cancer is the most common cancer of interest, followed by respiratory system cancers, colon and prostate cancers, leukemia, melanoma, nonHodgkin's lymphoma, cervical cancer, general or unspecified skin cancer, and ovarian cancer. Responding to these other caller inquiries, CIS counselors may proactively guide callers to a desirable goal, such as screening mammography. Protocols have been developed to assist counselors' proactive efforts, and preliminary results are beginning to support this approach. The findings gathered in this study underscore the health education potential of telephone helplines and point to the need for controlled evaluation research on the effectiveness of proactive counselor advice.

Ethnic variations in the prevalence of smoking among registered nurses.

A survey of smoking behavior was conducted on 1,569 registered nurses in six unrelated acute care hospitals in Los Angeles in 1984-1985. Smoking prevalence, higher than for other health professionals but lower than for women in the United States or in other recently surveyed samples of nurses, was closely linked to the ethnicity and the age distribution of the nurses surveyed. Patterns for black and white nurses, who account for the majority of nurses nationally, were similar to those found in other recent studies of registered nurses. Among Asian nurses, however, prevalence was lower, age of initiation was higher, and the mean number of cigarettes smoked daily was lower than for other nurses. Smoking prevalence for younger nurses was lower than for other nurses, and these nurses were more likely to report themselves as never having smoked. Smoking patterns among nurses remain a significant public health concern.