Why Can't I Stop Smoking: Predictors of Tobacco Use and Quit Rates in the Freedom From Tobacco Program.

Introduction  As the leading cause of preventable chronic diseases in adults 18 years and older, tobacco usage in the U.S. results in over 20 million premature deaths annually. Current smokers might need extra support on the path to successfully quitting.  Aim To evaluate the influence of predictors of smoking-on-smoking cessation in the Freedom From Tobacco Program (FFT) offered by Southern California Permanente Medical Group (SCPMG). Methods This was a quasi-experimental study to evaluate rates of smoking cessation among participants in the FFT program. There were 471 participants in the study. Factors of the Social Ecological Model (SEM) and demographics were examined to determine if they could predict tobacco cessation. The SEM suggests that an individual's behavior is integrated into a network of intrapersonal characteristics, interpersonal processes, institutional factors, community features, and public policy. In particular, the study mainly addressed the institutional factor. It was promoted within a Health Management Organization and the interpersonal process because it was a group intervention.  Findings  After multiple regression analyses with all predictors from the SEM and demographics, the only significant predictor was the number of previous attempts to quit. Smokers who tried to stop four or more times in the past were 2.6 times (p<0.03) more likely to quit than those who tried fewer times. As we are aware, this was the first time this result was found for programs implemented by Health Management Organizations. The general quit rate at 12 months for the FFT program was 43.1%. Conclusion As the only predictor of quitting in this study was the number of previous attempts to quit smoking, the recommendation is to develop longer-term smoking cessation programs or a longer follow-up to facilitate smokers who relapse to go back and try to quit again. Another recommendation is to identify the main reasons for relapse and try to address these factors in further interventions.

Lower Utilization of Colorectal Cancer Screening Among Vegetarians, Adventist Health Study-2.

This study aims to examine lifestyle predictors of the utilization of colorectal cancer screening. Using modified Poisson regression, we studied self-reported colorectal cancer screening utilization (colonoscopy or fecal occult blood test) with various dietary and lifestyle characteristics among 33,922 subjects aged 51 + years in the Adventist Health Study-2, a large population-based prospective cohort study. According to the multivariable-adjusted models, vegetarians were less likely to report screening: vegans, prevalence ratio (PR) = 0.80 (95% confidence interval 0.77-0.83); lacto-ovo-vegetarians (0.95 [0.93-0.97]); and semi-vegetarians (0.97 [0.94-0.99]) compared to non-vegetarians. Blacks were more likely than non-Blacks to be screened (1.04 [1.02-1.06]) and males were less likely (0.93 [0.92-0.95]) to utilize the screening tests. Older subjects were more likely to be screened, and unmarried and divorced/widowed subjects were less likely to screen. Education, personal income, and BMI were positively associated with screening, with p-value for trend < 0.001 for all three variables. A family history of colorectal cancer was associated with higher screening prevalence (1.15 [1.12-1.17]). Our stratified analyses on race and gender with dietary patterns showed non-Hispanic White vegans (PR = 0.77 [0.74-0.81]) and male vegans (PR = 0.76 [0.72-0.81]) were least likely compliant with colorectal cancer screening (p = 0.009 and p = 0.04, respectively). Vegans may believe that their personal risk for colorectal cancer is low due to their healthy lifestyle, resulting in lack of compliance to colorectal cancer screening. It remains to be seen whether vegans in AHS-2 also experience higher incidence of colorectal cancer or are diagnosed at a later stage.

The Association between Affect and Biomarkers of Stress and Inflammation in Healthy Seventh-Day Adventists.

OBJECTIVE: To evaluate the association between positive and negative affective states with stress biomarkers, biomarkers of inflammation and blood pressure in a population of healthy Seventh-day Adventists. DESIGN: In a cross-sectional study, biomarkers were regressed on positive and negative affect and control variables among reportedly healthy 133 females and 100 males (35% Black and 65% White) who provided blood and urine samples following completion of a questionnaire and measurement of anthropometrics and vital signs. SETTING/LOCATION: Data were extracted from the Biological Manifestations of Religion Study, an NIA-funded study conducted in members of the entity who lived within driving distance of two clinic sites. OUTCOME MEASURES: The stress biomarkers, epinephrine, and norepinephrine, were measured in 12-hour overnight urine samples analyzed by high-performance liquid chromatography. Urinary cortisol was evaluated by enzyme-linked immunosorbent assay (ELISA) and normalized for urinary output (reported in µg/g creatinine). Serum DHEA-S (reported in µg/ml) was measured by ELISA. Inflammatory markers included CRP (ng/ml), IL-6, IL-10, and TNF-α, all analyzed in serum by ELISA, and the data expressed in pg/ml. RESULTS: Multiple linear regression analyses showed after controlling for age, gender, ethnicity, body mass index (BMI), education, socioeconomic status, exercise, and use of blood pressure medication, that negative affect was associated with higher levels of epinephrine (ß = .143; P = .030). Positive affect was not associated with the biomarkers. CONCLUSIONS: While negative affect was associated with a biomarker of sympathetic stimulation, positive affect was not protective against such stimulation.