Tobacco control in a traditional Fijian village: indigenous methods of smoking cessation and relapse prevention.

This case study outlines the unique process by which a village in Fiji (N = 238) developed and implemented an extremely successful community-based smoking cessation program. Both Western smoking cessation methods and native traditional rituals were used. Specific strategies included a group pledge, village rapid inhalation ceremony, social contracting through notices and media, and a tabu formalized through a kava ceremony. Whereas the more conventional, external, health professional oriented approaches were largely unsuccessful, longer term collaborative and village empowerment methods proved most successful. Eventually all persons in the village who smoked were able to give up smoking, with specific exceptions (elders, visitors, etc.) and became nationally known as the village that gave up smoking. Follow up evaluation at 9 and 21 months indicated sustained success. Cases of relapse are described involving supernatural consequences remedied by group and ceremonial methods. The socio-cultural context and larger relationship issues are discussed in order to more fully understand the effectiveness of the program.

A cytologic evaluation of sputum in marijuana smokers.

BACKGROUND: There is growing evidence that smoking marijuana produces pulmonary effects similar to those of smoking tobacco. Cytologic analysis of sputum is readily available to practicing physicians and may be used in evaluating the pulmonary health of marijuana smokers. This study examined the use of sputum cytologic testing in young, athletic, marijuana-only smokers. METHODS: Sputum samples were collected from 25 marijuana-smoking members (surfers) who live in rural areas and do not smoke tobacco (mean age 27.5 years). The samples from the study group were compared with the sputum samples of 25 urban tobacco smokers and 25 nonsmokers of similar ages. Components of sputum were analyzed quantitatively and qualitatively. Subjects were educated and counseled as to the results. RESULTS: Compared with nonsmokers, marijuana smokers showed significantly higher levels of all pathologic components (P < .05), but lower mean levels of neutrophils (5.4 vs 6.4, P = .005) and pigmented macrophages (4.9 vs 6.1, P < .001) than those of tobacco smokers. Two cases of dysplasia were noted among the tobacco smokers and one among the marijuana smokers. Test-result counseling of a limited data set (6 subjects) at 6 months resulted in a 50% self-reported cessation rate. CONCLUSIONS: In this pilot study, results of cytologic evaluations in marijuana smokers closely resembled those observed in tobacco smokers. Further studies are needed to determine longitudinal and dose-related effects of marijuana smoking on cytologic changes. As a noninvasive testing method, sputum cytologic analysis may be a useful tool for evaluating the pulmonary health of marijuana smokers and may present an opportunity to counsel them on the benefits of cessation.

An inner city cancer prevention clinic. Design, methods, and early results.

An American Cancer Society demonstration pilot project is underway that is designed to provide comprehensive cancer prevention-related services to the underserved community of West Oakland, California. An array of cancer prevention services are being made available through an inner-city clinic (West Oakland Health Center), including cancer risk assessments and education about cancer, physical examinations for cancer, teaching of self-examination procedures, smoking cessation, and nutrition counseling, appointments for Pap smears, sigmoidoscopy, mammography, and other more specialized screening procedures, case management for findings suspicious for cancer, and community education programs. Described is the process of implementing these services, their utilization, and their impact (after 6 months).

Low-cost flexible sigmoidoscopy screening: a community demonstration and education project.

The purpose of this project was to demonstrate that a low-cost, community-based screening and education approach (for both patients and physicians), as has been used with mammography, can be successful with flexible sigmoidoscopy. One hundred appointments over four days were made available via a targeted mailing to 12,000 health-interested community members if they were asymptomatic, 50 years old or older, and had never before been screened by flexible sigmoidoscopy. The cost for the procedure was set at $50. Professional education was accomplished by having local physicians interested in gaining greater experience with flexible sigmoidoscopy provide the screenings under supervision. All 100 patient appointments and seven physician-training slots were quickly filled. Ninety-five procedures were performed by seven local physicians, averaging 10 minutes per procedure, with an average insertion depth of 31 cm and a 4.2% premalignant-polyp detection rate. The patients were also given education and counseling about colorectal cancer screening and prevention, and were evaluated by pre- and post-testing, and satisfaction questionnaires. The patients demonstrated markedly significant knowledge gains about colorectal cancer prevention and early detection, with 99% agreeable to having the procedure repeated in the future. This project demonstrated a high level of both public and professional willingness to participate in a flexible sigmoidoscopy screening program. The project method is presented in detail to encourage future such programs.

An inner-city cancer prevention clinic in West Oakland, California.

This article reports on a 3-year (1989-1992) American Cancer Society demonstration project in which a multidisciplinary, continuity-of-care-based comprehensive cancer prevention, education, and early detection clinic was established within an already existing inner-city health center in West Oakland, California. A total of 2058 patients (79% African-American, 78% female, 50% medically uninsured) received 7349 services (3.6 services per patient; averaging 2.5 hours over multiple visits, with 75%-85% appointment-keeping compliance), ranging from risk assessment and education to physical examinations, smoking counseling, mammography, and flexible sigmoidoscopy. In addition to 22 precancers and 15 cancers being diagnosed, statistically significant gains were demonstrated in patient knowledge, attitudes, and behavior. There was high patient satisfaction, particularly with nurse practitioners as service providers. Cancer prevention education was provided to an additional 14,945 community members, targeting students, teen parents, and recovering substance abusers. An in-depth qualitative analysis of recovering substance abusers examined their cancer beliefs and attitudes and showed significant knowledge gains from a subsequent cancer education program. The overall project demonstrated the feasibility of providing comprehensive and effective cancer prevention, education, and early detection services to the poor.