Barbara A. Berman

Women and smoking: current trends and issues for the 1990s.

Despite significant change in smoking patterns among women during the 1980s, the toll in tobacco-related morbidity and mortality remains high and will continue to rise for some diseases (e.g., lung cancer). Women with lower educational attainment are at particularly high risk for smoking initiation and continuation. Advances in gender-specific knowledge regarding the processes of initiation, cessation, and relapse provide more specific opportunities for targeted intervention. Strategies for change involve media, clinical approaches, and public health efforts. Emphasis needs to be placed on tailoring the message and on utilizing innovative channels through which women can be effectively reached. Advocacy groups are targeting public policies affecting women. Ongoing gender-specific research is needed in the next decade.

Children's exposure to environmental tobacco smoke in the home: Comparison of urine cotinine and parental reports

Abstract The authors examined the relationship between parent-reported estimates of childrens exposure to environmental tobacco smoke (ETS) in the home and childrens urinary cotinine levels. Data were collected from a largely ethnic minority, low-income, urban sample of households in which a child had asthma and at least 1 household member smoked. Information about level of household smoking restriction, parental smoking status, and number of cigarettes smoked per day accounted for approximately 45% of the variance in cotinine concentration. Detailed information about the duration of household smoking or childrens ETS exposure added no additional significant information. Questionnaires eliciting detailed information about smoking habits and childrens ETS exposure may be no better at predicting childrens urinary cotinine levels than simpler surveys that inquire about smoking restrictions in the home, parental smoking status, and number of cigarettes smoked at home per day.

Why Women Smoke

Although tobacco use by both men and women has been documented throughout history,’1, 2, 3two technological developments in the 19th century radically and irreversibly changed societal patterns of nicotine use. First, the introduction of flue-curing yielded a product with a lower pH and milder smoke that could be readily inhaled through the lungs, producing a rapid rise of nicotine in plasma that appears to contribute to the reinforcing and addictive properties of nicotine by partially overcoming tolerance,4 and delivering nicotine via a process that maximizes exposure to carcinogens. Second, the invention by a Virginian named James Bonsack of a cigaret-rolling machine, which could turn out as many cigarets as could 40 workers rolling manually,5 made that product widely and cheaply available. With these innovations, tobacco use was fairly quickly transformed from a somewhat distasteful and unhealthful habit, alternately lauded and reviled, to what is arguably the most critical public health problem we face today. Certainly.

Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution

Background: Timely diagnostic resolution of abnormal breast findings represents a critical step in efforts to reduce breast cancer morbidity and mortality. Yet, follow-up rates among resource poor populations are not optimal. Efforts to mitigate this disparity are needed. We report results of a randomized trial assessing the effectiveness of a patient support and navigation intervention in increasing timely diagnostic resolution of abnormal breast findings among indigent women. Methods: Women (n = 1,708) diagnosed with a breast abnormality at two public hospitals were randomized to an intervention or control group. The intervention, delivered through telephone, involved one call from a professional health worker and multiple calls from a lay health worker. The outcome, timely diagnostic resolution, defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral, was assessed through medical chart audit. Results: Intent-to-treat analyses revealed no significant effect of the intervention on timely diagnostic resolution. Diagnostic resolution rates were 55% and 56%, respectively, in the intervention and control arms. The significant predictors were method of abnormality identification (odds ratio = 1.50) and location of first scheduled appointment (odds ratio = 0.62). Conclusions: The intervention was not effective in creating change within the County health system. Achieving optimum diagnostic follow-up may require more intensive interventions than the one tested. In addition, system-level rather than patient-level interventions may hold more promise. Impact: There are no randomized trials reported in the literature testing interventions to increase diagnostic follow-up of breast abnormalities. Future research might test patient and system-level interventions that can be sustained beyond the study period. Cancer Epidemiol Biomarkers Prev; 19(8); 1927–36. ©2010 AACR.

Developing a Tobacco Survey for Deaf Youth

Formidable barriers hinder use of standard data collection methods among deaf youth. Culturally and linguistically sensitive data collection strategies are needed to identify the unmet health and programming needs of this population. Unfortunately, researchers often fail to describe the issues involved in developing such targeted methods. The authors describe development of a culturally appropriate data collection instrument for a study of tobacco-related knowledge, attitudes, and practices among deaf youth. The instrument uses interactive multimedia technology to administer a questionnaire translated into the primary languages used by the Deaf. The procedures taken to accommodate this technology to these languages and to Deaf culture are described. This process yielded useful insights with respect to data collection not only among the Deaf, but among other frequently overlooked and underserved populations as well.

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

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.

Development and Testing of an Antitobacco School-Based Curriculum for Deaf and Hard of Hearing Youth

A tobacco use prevention curriculum tailored for deaf/hard of hearing youth was tested using a quasi-experimental design. Two schools for the deaf received the curriculum; two served as noncurriculum controls. Surveys assessed changes in tobacco use, tobacco education exposure, and tobacco-related attitudes and knowledge among students in grades 7–12 over 3 school years (n = 511–616). Current (past month) smoking decreased significantly at one intervention school (23% to 8%, p = .007), and current smokeless tobacco use at the other (7.5% to 2.5%, p = .03). Tobacco education exposure and antitobacco attitudes and knowledge increased significantly at one or both intervention schools. At one control school, reported tobacco education exposure decreased (p < .001) and antitobacco attitudes increased (p = .01). The results indicate that the curriculum increased perceived tobacco education exposure and significantly affected tobacco-related practices, attitudes, and knowledge.

Can a Minimal Intervention Reduce Secondhand Smoke Exposure Among Children with Asthma from Low Income Minority Families? Results of a Randomized Trial

We report on the results of a low-intensity behavioral intervention to reduce second hand smoke (SHS) exposure of children with asthma from low income minority households in Los Angeles, California. In this study, 242 child/adult dyads were randomized to a behavioral intervention (video, workbook, minimal counseling) or control condition (brochure). Main outcome measures included child’s urine cotinine and parental reports of child’s hours of SHS exposure and number of household cigarettes smoked. Implementation of household bans was also considered. No differences in outcomes were detected between intervention and control groups at follow-up. Limitations included high attrition and low rates of collection of objective measures (few children with urine cotinine samples). There continues to be a need for effective culturally and linguistically appropriate strategies that support reduction of household SHS exposure among children with asthma in low income, minority households.

Alcohol and other Substance Use among Deaf and Hard of Hearing Youth

Little research has focused on alcohol and illicit drug use among deaf and hard of hearing youth. Findings are reported from survey data collected among high school students at two phases of a program of research primarily focusing on tobacco use [Phase 1: (1999/2000) n = 226, Phase 2: (2004) n = 618). Evidence of considerable ever (lifetime) drinking (59.1%, 42.6%) and other substance use (21.1%, 18.9%) was found. Gender, age, race/ethnic, grade, school type (mainstream vs. school for the deaf), age when deafened, and aspects of self-perception were examined for their possible association with substance use. Current use rates are reported, and study findings are discussed in relation to national data. Understanding these use patterns is critical to developing interventions for this culturally and linguistically unique population.

Do children with asthma and their parents agree on household ETS exposure? Implications for asthma management

The adverse consequences of passive smoking have spurred efforts to reduce environmental tobacco smoke (ETS) exposure among children, particularly in the home. For children with asthma, teaching them to avoid tobacco smoke at home is an important element of patient self-management. This strategy assumes that children can accurately assess household smoking behaviors and the level of their own exposure in the home. This study compared child and parental assessments of household smoking behaviors in an urban, low-income and largely ethnic minority sample of asthmatic children and their parents. While there was general parent-child agreement on the smoking status of household members, there was less agreement on duration of household smoking and the childs exposure to ETS. Objective validation measures (cotinine, nicotine) suggest that parents were better able than their children to assess hours of indoor smoking. Childrens assessment of the extent of exposure to ETS may be problematic, with important implications for asthma patient self-management efforts.