Reporting of tobacco use and tobacco-related analyses in cancer cooperative group clinical trials: a systematic scoping review.

BACKGROUND: Continued smoking after a diagnosis of cancer negatively impacts cancer outcomes, but the impact of tobacco on newer treatments options is not well established. Collecting and evaluating tobacco use in clinical trials may advance understanding of the consequences of tobacco use on treatment modalities, but little is known about the frequency of reporting and analysis of tobacco use in cancer cooperative clinical trial groups. PATIENTS AND METHODS: A comprehensive literature search was conducted to identify cancer cooperative group clinical trials published from January 2017-October 2019. Eligible studies evaluated either systemic and/or radiation therapies, included ≥100 adult patients, and reported on at least one of: overall survival, disease/progression-free survival, response rates, toxicities/adverse events, or quality-of-life. RESULTS: A total of 91 studies representing 90 trials met inclusion criteria with trial start dates ranging from 1995 to 2015 with 14% involving lung and 5% head and neck cancer patients. A total of 19 studies reported baseline tobacco use; 2 reported collecting follow-up tobacco use. Seven studies reported analysis of the impact of baseline tobacco use on clinical outcomes. There was significant heterogeneity in the reporting of baseline tobacco use: 7 reported never/ever status, 10 reported never/ex-smoker/current smoker status, and 4 reported measuring smoking intensity. None reported verifying smoking status or second-hand smoke exposure. Trials of lung and head and neck cancers were more likely to report baseline tobacco use than other disease sites (83% versus 6%, P < 0.001). CONCLUSIONS: Few cancer cooperative group clinical trials report and analyze trial participants' tobacco use. Significant heterogeneity exists in reporting tobacco use. Routine standardized collection and reporting of tobacco use at baseline and follow-up in clinical trials should be implemented to enable investigators to evaluate the impact of tobacco use on new cancer therapies.

A structural equation model relating adiposity, psychosocial indicators of body image and depressive symptoms among adolescents.

OBJECTIVE: Psychosocial factors, including pressure to be thin and body dissatisfaction, have been hypothesized to mediate the relationship between obesity and depression, especially during adolescence when vulnerability to social pressures around body shape and image is heightened. The objective was to test a model of the relationships among adiposity, psychosocial factors and depression in adolescents. METHOD: In a population-based sample of 1127 boys and 1167 girls aged 13 and 16 years, a model of the relationships between adiposity, pressure to be thin, body dissatisfaction and depressive symptoms was tested using structural equation modeling. RESULTS: Among girls, adiposity accounted for 62% of the total effect of depressive symptoms through its association with pressure to be thin and body dissatisfaction. Pressure to be thin was also uniquely related to depressive symptoms. Among boys, only body dissatisfaction was associated with depressive symptoms. CONCLUSION: Results support a relationship between adiposity, body satisfaction, pressure to be thin and depressive symptoms. Depressive symptoms should be assessed in obese adolescents, and interventions to prevent and treat obesity should incorporate elements targeting body dissatisfaction.

Tobacco on campus: industry marketing and tobacco control policy among post-secondary institutions in Canada.

OBJECTIVE: Post-secondary institutions provide a unique opportunity to implement and evaluate leading edge tobacco policies, while influencing a key group of young adults. To date, however, we know little about the tobacco control environment at post-secondary institutions outside the USA. DESIGN: Telephone surveys were conducted with campus informants from 35 post-secondary institutions in Canada to evaluate tobacco control policies and the presence of tobacco marketing on campus. MAIN OUTCOME MEASURES: Tobacco marketing on campus, tobacco control policies, and attitudes towards tobacco control. RESULTS: The findings indicate that tobacco marketing is prevalent among post-secondary institutions in Canada. Every university and half of all colleges surveyed had participated in some form of tobacco marketing in the past year. Among universities, 80% had run a tobacco advertisement in their paper and 18% had hosted a tobacco sponsored nightclub event. Tobacco control policies varied considerably between institutions. Although several campuses had introduced leading edge policies, such as campus wide outdoor smoking restrictions and tobacco sales bans, there is a general lack of awareness of tobacco issues among campus decision makers and fundamental public health measures, such as indoor smoke-free policies, have yet to be introduced in many cases. CONCLUSIONS: Post-secondary institutions in Canada remain tobacco friendly environments. Without increased direction and support from the public health community, post-secondary institutions will continue to lag behind, rather than lead current policy standards.