Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals.

OBJECTIVES: The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN: Cross-sectional group comparison. METHODS: Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS: Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS: EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.

Accessing evidence to inform public health policy: a study to enhance advocacy.

OBJECTIVES: Improving population health often involves policy changes that are the result of complex advocacy efforts. Information exchanges among researchers, advocates, and policymakers is paramount to policy interventions to improve health outcomes. This information may include evidence on what works well for whom and cost-effective strategies to improve outcomes of interest. However, this information is not always readily available or easily communicated. The purposes of this paper are to describe ways advocates seek information for health policy advocacy and to compare advocate demographics. STUDY DESIGN: Cross-sectional telephone survey. METHODS: Seventy-seven state-level advocates were asked about the desirable characteristics of policy-relevant information including methods of obtaining information, what makes it useful, and what sources make evidence most reliable/trustworthy. Responses were explored for the full sample and variety of subsamples (i.e. gender, age, and position on social and fiscal issues). Differences between groups were tested using t-tests and one-way analysis of variance. RESULTS: On average, advocates rated frequency of seeking research information as 4.3 out of five. Overall, advocates rated the Internet as the top source, rated unbiased research and research with relevancy to their organization as the most important characteristics, and considered information from their organization as most reliable/believable. When ratings were examined by subgroup, the two characteristics most important for each question in the total sample (listed above) emerged as most important for nearly all subgroups. CONCLUSIONS: Advocates are a resource to policymakers on health topics in the policy process. This study, among the first of its kind, found that advocates seek research information, but have a need for evidence that is unbiased and relevant to their organizations and report that university-based information is reliable. Researchers and advocates should partner so research is useful in advocating for evidence-based policy change.

Multilevel correlates of household anthropometric typologies in Colombian mothers and their infants.

BACKGROUND: The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data. METHODS: Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained. RESULTS: This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology. CONCLUSION: Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.

Saturated fat intake and lung cancer risk among nonsmoking women in Missouri.

BACKGROUND: Although the vast majority of lung cancer cases in women are caused by smoking, 9%-20% of cases occur in nonsmokers. Previous epidemiologic research on the relationship between lung cancer and diet has shown that fruit and vegetable consumption may confer a protective effect against lung cancer, while a diet rich in cholesterol and fat may increase risk. PURPOSE: The purpose of this case-control study was to examine the effects of a broad range of dietary factors on the risk of lung cancer in a population of nonsmoking white women 30-84 years of age. METHODS: A telephone-administered questionnaire was used to determine and/or verify eligibility with regard to age, gender, race, and smoking status. In a second interview at the participant's home, a widely used food frequency questionnaire was filled out, and logistic regression was subsequently used to analyze the responses. We obtained dietary information on 429 case subjects who had a diagnosis of lung cancer reported to the Missouri Cancer Registry between June 1, 1986, and June 1, 1991, and 1021 control subjects. If a case subject had died or was too ill to be interviewed, next-of-kin familiar with the woman's diet were interviewed instead. Of the 429 women with lung cancer, 211 (49%) had lung adenocarcinoma. RESULTS: A strongly increasing trend in lung cancer risk was observed with increased saturated fat consumption among these non-smoking women; the relative risk was more than sixfold greater for the highest quintile of consumption than for the lowest quintile. The effect of saturated fat was more pronounced for adenocarcinoma than for other cell types. Weekly servings of beans and peas were significantly related to decreased lung cancer risk, while citrus fruit and juice showed a twofold increase in risk; this trend was also significant. CONCLUSION: By focusing on non-smoking women with lung cancer, including a large number with adenocarcinoma, we observed a clear association with saturated fat consumption that may have been masked in earlier studies of lung cancer involving a high percentage of smokers.

Residential radon exposure and lung cancer among nonsmoking women.

BACKGROUND: Radon at sufficiently high concentrations is known to cause lung cancer among underground miners and in experimental laboratory animals. PURPOSE: Our aim was to determine whether indoor levels of radon are associated with a detectable increase in lung cancer. Nonsmoking women were selected because they offer the best opportunity to detect radon-related risk while minimizing the potentially confounding influences of cigarette smoking and occupation. METHODS: A population-based, case-control study of incident lung cancer was conducted in Missouri. A total of 538 non-smoking white women diagnosed with lung cancer between 1986 and 1992 and 1183 age-matched control subjects were identified from the Missouri Cancer Registry and from driver's license and Medicare listings, respectively. Information on lung cancer risk factors was obtained by telephone interview. Year-long radon measurements were sought in every dwelling occupied for the previous 5-30 years. RESULTS: Radon measurements covered 78% of the relevant residential period, and women reported being indoors for 84% of this time. The time-weighted average radon concentrations were exactly the same for case subjects and control subjects (1.82 pCi/L of air [pCi L-1]). Radon levels greater than 4 pCi L-1 were experienced by 6.5% of the case subjects and 6.8% of the control subjects. For all data combined, there was little evidence for a trend of lung cancer with increasing radon concentrations (two-tailed trend test, P = .99 continuous data analysis; P = .19 categorical data analysis). A positive dose-response trend was suggested for the adenocarcinoma cell type and among directly interviewed women (two-tailed trend test; P = .31 continuous data analysis; P = .04 categorical data analysis), but not for other histologies or among those who had surrogate interviews. CONCLUSIONS: The possibility of detecting a risk from indoor radon in this study was maximized by (a) including a large number of nonsmoking women with high indoor occupancy, (b) conducting a large number of radon measurements near the time of the diagnosis of cancer, and (c) controlling for known causes of lung cancer. However, an association between lung cancer and the exposure to domestic levels of radon was not convincingly demonstrated. IMPLICATIONS: The magnitude of the lung cancer risk from radon levels commonly found in U.S. dwellings appears low.

Dietary heterocyclic amines and the risk of lung cancer among Missouri women.

Heterocyclic amines (HCAs) such as 2-amino-3,8-dimethylimidazo[4,5f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx,), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) are found in meats cooked at high temperatures. In rodents, MeIQx induces lung tumors. The purpose of this study was to investigate lung cancer risk posed by different HCAs in the diet. A population-based case-control study of 593 cases and 623 frequency-matched controls including both nonsmoking and smoking women was conducted in Missouri. An administered food frequency questionnaire with detailed questions on meat consumption, degrees of internal doneness, surface browning/charring, and cooking technique was linked to a database that provided exposure estimates of three HCAs. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. When comparing the 90th and 10th percentiles, significant excess risks were observed for MeIQx (OR, 1.5; CI, 1.1-2.0), but not for DiMeIQx (OR, 1.2; CI, 0.9-1.6) or PhIP (OR, 0.9; CI, 0.8-1.1). MeIQx consumption was associated with increased risk of lung cancer for nonsmokers (OR, 3.6; CI, 1.3-10.3) and light/moderate smokers (OR, 2.1; CI, 1.3-3.3), but not for heavy smokers (OR, 1.0; CI, 0.7-1.5). There was elevated risk with MeIQx intake for subjects with squamous cell carcinomas (OR, 1.9; CI, 1.2-3.1) and "other histological cell types" (OR, 1.6; CI, 1.1-2.5), but not for subjects with small cell carcinomas and adenocarcinomas. Neither DiMeIQx nor PhIP showed an association with smoking categories or lung cancer histology. In conclusion, MeIQx may be associated with lung cancer risk, but DiMeIQx and PhIP are probably not associated with lung cancer risk.

Worksite nutrition supports and sugar-sweetened beverage consumption.

OBJECTIVE: This study examined the link between worksite environmental supports for nutrition behaviours and sugar-sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity. METHODS: Perceived worksite supports for healthy nutrition and self-reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW-ME) study. RESULTS: Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption. CONCLUSIONS: This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets.

Strength of clean indoor air laws and smoking related outcomes in the USA.

OBJECTIVES: Environmental tobacco smoke (ETS) is often encountered in the workplace. There have been efforts to apply and enforce state laws limiting workplace smoking. There has been little study of the relative effectiveness of state and/or local laws in affecting both rates of workplace ETS exposure and adult smoking rates. This study investigates these hypotheses, as well as the effect of these laws on youth smoking. DESIGN: This is a secondary data analysis using sources including the Current Population Survey (CPS), Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Survey (YRBS), and the National Household Survey of Drug Abuse (NHSDA) between the years of 1996 and 1999. Linear regression models were used to investigate the effect of a state's clean indoor air (CIA) law (using a measure of extensiveness) on the overall amount of people who reported working in a smoke-free environment, youth smoking rates and adult smoking rates. RESULTS: The extensiveness of a state's CIA law was found to be a reliable predictor of the percentage of indoor workers who report a smoke-free work environment and the rates of youth smoking. State CIA laws were not conclusively associated with adult smoking rates. CONCLUSIONS: The extensiveness of a state's CIA law is strongly associated with a higher percentage of indoor workers reporting a smoke-free work environment. This study did not reveal a similar association between local laws and smoke-free work environments. Youth smoking rates, shown to be related to state CIA laws, may be further affected with more stringent CIA policy.

Cigarette smoking and adult leukemia. A meta-analysis.

BACKGROUND: Increasing evidence suggests that certain forms of adult leukemia may be related to cigarette smoking. METHODS: To evaluate the association between cigarette smoking and adult leukemia, we conducted a meta-analysis of available studies. Data were identified through an English-language MEDLINE search for the period 1970 through 1992 and through our knowledge of ongoing and unpublished studies. Among the studies identified, the meta-analysis included seven prospective studies and eight case-control studies. The US Surgeon General's criteria were used to assess the evidence for causality. RESULTS: A positive association between smoking and certain histologic types of leukemia was found in both prospective and case-control studies. The summary smoking-related risk derived from prospective studies (relative risk, 1.3; 95% confidence interval, 1.3 to 1.4) was greater than that based on case-control data (relative risk, 1.1; 95% confidence interval, 1.0 to 1.2). Prospective data suggested an elevated risk of myeloid leukemia associated with cigarette smoking (relative risk, 1.4; 95% confidence interval, 1.2 to 1.6). Pooled case-control data showed increased smoking-associated risk for acute nonlymphocytic leukemia (relative risk, 1.3; 95% confidence interval, 1.1 to 1.5). Risk of leukemia increased according to the number of cigarettes smoked per day. Population-attributable risk calculations suggested that approximately 14% of all US leukemia cases (including 17% of myeloid and 14% of acute nonlymphocytic leukemias) may be due to cigarette smoking. CONCLUSIONS: The consistency, temporality, and biologic plausibility of this relationship augment our findings, which support a causal relationship between cigarette smoking and certain forms of adult leukemia. Further studies are needed to examine risk among women, dose-response effects, and variation in risk by histologic type.

Risk of breast cancer in relation to cigarette smoking.

To provide additional data on the smoking-breast cancer association, a case-control study of 456 cases of breast cancer and 1693 matched controls was conducted among participants in a cancer screening program. The adjusted risk of breast cancer for current smokers was 1.38 (95% confidence interval, 1.01 to 1.90). Analysis of smoking habits restricted to premenopausal women revealed a risk estimate of 2.33 (confidence interval, 1.10 to 4.96) among current smokers and increasing linear trends in risk for number of cigarettes smoked per day and for number of years of smoking. Although smokers had an earlier natural menopause than nonsmokers, there was no evidence of a protective effect of early menopause after adjustment for other factors. These findings suggest that smoking may increase the incidence of breast cancer, especially in premenopausal women.

Estimating the effect of dietary fat on the risk of lung cancer in nonsmoking women.

In 1992, approximately 13 000 lung cancers occurred in nonsmoking U.S. women but the cause of these highly fatal tumors is not well understood. As the rate of smoking declines in many developed countries, the interest in identifying lung cancer risk factors other than tobacco smoking is increasing. A population-based, case-control study of incident lung cancer among nonsmoking women in Missouri was conducted between 1986 and 1992 to assess the effect of a comprehensive list of potential risk factors. Dietary information on 429 case subjects and 1021 control subjects was obtained by personal interview, or next-of-kin interviews (36% and 64%, respectively) and the relationship of diet to lung cancer risk is the focus of this investigation. Odds ratios and population attributable risks (PAR) for dietary fat and dietary saturated fat were computed among lifetime nonsmokers and long-term ex-smokers. The mean age at lung cancer diagnosis was 71 years old, and nearly 50% of the lung cancers were histologically confirmed adenocarcinomas. Dietary intake of saturated fat was the leading identified cause of lung cancer among lifetime nonsmokers and former smokers in Missouri. The etiologic link between dietary saturated fat and lung cancer has not been examined in many other studies and the studies published to date are not completely consistent with the hypothesis so a cautious interpretation of the population attributable risks for these exposures is warranted. Nonetheless, a growing number of studies arising from around the world purport to show a link between fat, saturated fat and/or cholesterol or food groups containing relatively high amounts of these macronutrients (i.e. dairy products, eggs and/or red meat consumption) and lung cancer, and these recent studies add support to this hypothesis. If the results from Missouri are valid and applicable to other Americans, 23% of lung cancer cases among lifetime nonsmokers in the United States could be prevented if the saturated fat consumption of the upper half of saturated fat intake continuum could be reduced to the level consumed by the lower half. Even greater reductions in risk could be achieved if saturated fat consumption were reduced to even lower levels (i.e. 20th percentile of consumption as shown in this paper). However, additional etiologic research and evaluation is needed before specific dietary recommendations concerning fat and saturated fat and lung cancer prevention can be made.

A cancer registry-based study of occupational risk for lymphoma, multiple myeloma and leukaemia.

Mortality and incidence studies have suggested that agricultural workers may be at increased risk for some cancers. Case-control methods were used to investigate the relationship between farming, other occupations, and lymphoma, multiple myeloma, and leukaemia. A total of 475 male cases, aged 20 years or more, and 1425 age-matched controls were identified through the Missouri Cancer Registry for the years 1984-1985. People with smoking-related cancers were excluded as controls to minimize bias associated with farmers' reported smoking patterns. Farmers had slightly elevated risks for non-Hodgkin's lymphoma (odds ratio (OR) = 1.11) and Hodgkin's disease (OR = 1.30). The risk for leukaemia (all types) was not elevated (OR = 0.91); however, for acute lymphatic leukaemia an OR of 2.84 was detected. An OR of 2.78 (95% confidence interval = 1.09-7.07) for reticulosarcoma was observed among farmers 65 years and older. Several other occupational associations were noted which have been reported previously. Carpenters (OR = 3.10) and machinists (OR = 4.85) were at increased risk for Hodgkin's disease. An elevated risk of leukaemia was observed for mechanics (OR = 4.79). Since most previous studies of the associations between lymphatic and haematopoietic cancers and agriculture have been based on mortality data, additional studies of incident cases are suggested.

Reliability of passive smoke exposure histories in a case-control study of lung cancer.

Despite the growing number of studies on the health effects of passive smoke exposure, few data exist on the quality of questionnaire data on passive smoking. To measure the reliability of passive smoking histories, re-interviews were conducted for 110 subjects (37 cases and 73 controls) as part of a larger study of lung cancer among non-smoking women in Missouri. Agreement was high both for parental smoking status (94% concordance; kappa = 0.82) and for spousal smoking status (84% concordance; kappa = 0.67). Concordance also was relatively high for cigarette pack-years of exposure due to the parents or spouse. Reliability tended to be somewhat higher among controls than among cases, and for exposure due to a parent or spouse than for that due to other household members. Questions on the perceived harmfulness of passive smoke exposure showed no differences between cases and controls. These findings indicate a high degree of repeatability in responses regarding passive smoking, but also suggest the potential for misclassification of passive smoke exposure status, the desirability of standardized questions on passive smoking, and the need for additional studies of reliability and validity.

Family history of cancer and risk of lung cancer in lifetime non-smokers and long-term ex-smokers.

BACKGROUND: Genetic factors appear to play a role in the aetiology of lung cancer. METHODS: To examine the association between family history of cancer (all types) and risk of lung cancer among non-smokers, we conducted a case-control study. Cases (n = 618) were identified through the Missouri Cancer Registry for the period 1986 through 1991, and included 432 lifetime non-smokers and 186 ex-smokers who had stopped at least 15 years prior to diagnosis or had smoked for less than one pack-year. Controls (n = 1402) were selected through drivers licence and Medicare files. RESULTS: The risk of lung cancer increased directly in relation to the number of family members affected with cancer. The odds ratio (OR) associated with five or more first-degree relatives with cancer was 2.7 (95% confidence interval [CI] 1.2-6.1), with a significant linear trend in risk according to the number of relatives affected (P = 0.03). Increased lung cancer risk was associated with two or more affected siblings (OR = 1.4; 95% CI: 1.0-1.9) and with two or more affected offspring (OR = 3.2: 95% CI: 1.3-8.1). Risk was slightly elevated for family history of lung cancer (OR = 1.3; 95% CI: 1.0-1.8). CONCLUSIONS: Our study identified a slight increase in risk of lung cancer in relation to five or more relatives with cancer. Preventive implications of this increased risk are unclear because the attributable fraction is low in comparison to a variety of other factors.

Cigarette smoking and alcohol consumption in the aetiology of uterine cervical cancer.

A case-control study of uterine cervical cancer was conducted using 331 cases and 993 age-matched controls identified through the Missouri Cancer Registry during 1984-1986. Patients with smoking- or alcohol-related cancers were excluded from the control series. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (Cls) after adjustment for age, cigarette smoking, alcohol consumption, and stage at diagnosis. A dose-response relation was observed between intensity of cigarette smoking and invasive cervical cancer, with light and heavy smokers having elevated risks (OR = 2.2, 95% Cl = 1.4-3.6 and OR = 3.9, 95% Cl = 2.7-5.6, respectively). Former smokers had less elevated risk (OR = 1.7, 95% Cl = 1.0-2.9), a finding consistent with a greater effect of tobacco smoke on late-stage carcinogenesis. Similar results were obtained in age- and control site-specific analyses. Further, the age-specific data suggested a dose-response relation between duration of smoking and invasive cervical cancer. An association between alcohol consumption and invasive cervical cancer was not observed.

Intraaxonal transport of horseradish peroxidase in the sympathetic nervous system.

Following a single injection of horseradish peroxidase (HRP) into the superior cervical ganglion (SCG) of the rabbit, the uptake and anterograde transport of this label was confirmed in the ganglion cell bodies, postganglionic axons, and preterminal and terminal ending axons in the ciliary processes of the eye. From the same injection site the intraaxonal HRP reaction product was demonstrated in myelinated axons, presumably by retrograde transport. Intracytoplasmic HRP was identified in large, single membrane-bound, dense vesicles predominantly in perinuclear orientation. Intraaxonal HRP appeared throughout, either within single membrane-bound round or oblong vesicles of variable sizes and densities. Frequently, the HRP vesicles in the axons revealed elaborate membranous subunits. A limited number of whole axons or axon fascicles were diffusely stained with HRP reaction product at or near the injection site. This phenomenon may be the result of membrane injury to neurons. The HRP label was found in small amounts in axons and terminals in the ciliary processes of the eye as early as 4 h following injection into the SCG, indicating a rapid anterograde transport of HRP from a single extracellular source. Likewise the HRP label disappeared from the ganglion cell bodies and processes by the 6th day following injection. Presence of numerous HRP-labeled myelinated and non-myelinated axons in the SCG confirms the bidirectional transport of HRP in the sympathetic nervous system.

Measuring the impact of prevention research on public health practice.

CONTEXT: Prevention research involves the translation of established and promising methods of disease prevention and health promotion to communities. Despite its importance, relatively little attention has been paid to systematic approaches to determining the impact of prevention research on public health practice. Evaluation of these effects is challenging, particularly in light of multi-factor causation, long time periods between exposure and disease occurrence, and difficulties in determining costs and benefits. OBJECTIVE: To develop a framework that allows the prospective or retrospective evaluation of the effects and effectiveness of prevention research. RESULTS: The proposed framework allows assessment of prevention research in five areas of public health practice: surveillance and disease investigation, program delivery, policies and regulations, recommendations to the public, and public health education and training. A brief case study of environmental tobacco smoke illustrates the public health impact of prevention research. CONCLUSIONS: Greater translation of prevention research findings is needed to accomplish public health goals--efforts are enhanced by academic-practice partnerships. The relevance and utility of the current framework needs additional testing with a variety of public health issues.

Selected chronic disease risk factors in Missouri: 10-year trends and predictions for the year 2000.

INTRODUCTION: A study was undertaken to determine the prevalence rates of three chronic disease risk factors among adult Missourians from 1986 to 1995, to predict rates, and to compare them with national and Missouri's goals for the year 2000. METHODS: Using data from Missouri Behavioral Risk Factor Surveillance System Surveys (BRFSS) 1986-1995, prevalence rates of smoking, physical inactivity, and obesity were calculated across age, gender, race, and educational levels. Linear regression was used to predict rates for year 2000, for the adults of Missouri as a whole and for particular subgroups. RESULTS: There was a 0.9% annual decrease in smoking prevalence and a 4.6% annual increase in obesity over the 10 years, controlling for age and gender. The trend in rates of physical inactivity was nonsignificant. Continuation of these rates will give smoking rates of 23.6%, obesity rates of 35.5%, and sedentary rates of 36.3% by the year 2000. Those with less than a high school education had higher rates for each of the risk factors. CONCLUSIONS: This rate of decrease in rates of cigarette smoking is not sufficient to enable the year 2000 goal to be reached until year 2040, and the rates of obesity and sedentary lifestyle are increasing. The BRFSS, which has now been implemented in all 50 states and the District of Columbia, is a useful tool for monitoring progress towards health behavior targets.

State youth-access tobacco control policies and youth smoking behavior in the United States.

CONTEXT: State policies aimed at controlling youth access to tobacco are an important component of public health efforts to reduce smoking prevalence among youth and prevent subsequent disease. OBJECTIVES: This study sought to assess the extensiveness of state youth access tobacco control legislation in the United States, describe how state policies changed over a 4-year period, explore how various political and economic characteristics are related to state policies, and determine the relationship of youth smoking behavior to state youth tobacco control policies. DESIGN: This descriptive and correlational study utilized data from multiple national surveillance, economic, and sociodemographic data sets. PARTICIPANTS: All 50 states and the District of Columbia provided economic and political data. A standard tobacco-control policy score was developed by an expert panel for each state. Aggregated state-level measures of youth smoking behavior were provided by 79,491 youth in 33 states and the District of Columbia. MAIN OUTCOME MEASURES: Included were extent of state tobacco control policies and changes over time, relationship between state political and economic characteristics and tobacco control policies, and relationship between state policies and youth smoking behavior. RESULTS: State policy scores increased in variability and in mean value over the 4-year period, from a mean score of 7.2 in 1993 to 9.0 in 1996. State policy scores were significantly correlated with several state political and economic variables. States with more extensive tobacco control policies had significantly lower youth smoking rates. There was some evidence that a strong state tobacco economy may limit the effectiveness of tobacco control policies on youth smoking rates. CONCLUSIONS: It is possible to reliably measure the extent to which states are achieving important public health goals in limiting youth access to tobacco products. Comprehensive state tobacco control policies are important for increasing prevention and cessation of smoking among youth.

Physician advice to reduce chronic disease risk factors.

The U.S. Preventive Services Task Force recommends that physicians advise their patients regarding smoking cessation, weight loss, and physical inactivity. Few studies, however, have assessed the extent to which persons with these risk factors receive advice from their physicians. Using data from the 1990-1991 Missouri Behavioral Risk Factor Surveillance System (BRFSS), a random digit-dialed telephone survey of adults, we identified Missouri residents with one or more of these modifiable risk factors. We examined whether these persons reported being advised by their physicians to modify their behavior(s) within the past year. Of the 2,791 respondents, 764 (26%) smoked, 1,720 (59%) were sedentary, and 686 (23%) were overweight. Five hundred and thirty-five smokers reported having a routine checkup within the past year, but only 224 (42%) reported being advised by their physicians to stop smoking. Of the 1,246 sedentary persons who had a routine checkup within the past year, 192 (15%) reported being told by their physicians to exercise more. Of the 521 overweight respondents who had a routine checkup within the past year, 225 (43%) reported being advised to lose weight. Physician advice for these risk factors was less frequently reported among men, blacks, younger persons, and persons from rural areas. Although most Missouri residents with these modifiable risk factors reported seeing their physicians within the past year, less than half reported that they received advice from their physicians to alter their risk behavior(s). Further efforts are necessary to increase the effectiveness of physician advice for at-risk patients about quitting smoking, losing weight, and increasing physical activity.