Brian Colwell

Cancer knowledge, self‐efficacy, and cancer screening behaviors among Mexican‐American women

Latina women are at significantly greater risk of death from cancer than Anglo women in the United States. Reasons for this include a lack of knowledge regarding cancer, lack of access to cancer screening services, and feelings of fatalism. This study was designed to determine the relationship between cancer knowledge and cancer screening self-efficacy in this population. One hundred twelve Mexican-American women living in southern Texas were surveyed regarding their self-efficacy toward engaging in age-appropriate cancer screening activities. Each subject answered questions related to knowledge and self-efficacy in four topical areas; general cancer knowledge, cervical cancer and Pap smears, breast cancer and breast self-examination (BSE), and colorectal cancer and sigmoidoscopy. A majority of the responders had significant misconceptions related to cancer causation, symptoms, and treatment and expressed feelings of little control over prevention of the disease. Only a minority felt that they could undergo the appropriate screenings, even if they were available. There were strong relationships between all of the knowledge variables examined, and between knowledge and self-efficacy related to BSE and colorectal cancer screening. Strong relationships were not found for the areas of Pap smears and general cancer knowledge. The results suggest that increased knowledge is associated with increased self-efficacy for cancer screening.

Preliminary Outcomes of a Pre-Adjudication Diversion Initiative for Juvenile Justice Involved Youth with Mental Health Needs In Texas

Estimates of mental health disorders among youth involved with the juvenile justice system range from 50% to 75%, while general population prevalence is 9% to 20%. The system is ill-equipped to supervise these juveniles, and many are funneled deeper into the system due to noncompliance and often preventable problems. The authors used a retrospective design and evaluated a pre-adjudication diversion initiative utilizing specialized juvenile probation officers in Texas. Use of specialized supervision was effective at diverting youth with mental health needs from adjudication and increased participation and access to services by juveniles with such needs. Youth who received specialized supervision were significantly less likely to be adjudicated for the initial offense than those in a comparison group who received traditional supervision.

Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol

Objectives A heat-not-burn (HNB) tobacco product, IQOS, was first launched in Japan and Italy as test markets and is currently in commerce in 30 countries. Using two data sources, we examined interest in HNB tobacco (IQOS, Ploom and glo), its prevalence, predictors of its use and symptoms from exposure to secondhand HNB tobacco aerosol in Japan, where HNB tobacco has been sold since 2014. Methods Population interest in HNB tobacco was explored using Google search query data. Prevalence of HNB tobacco current use (ie, use in the previous 30 days) was calculated using a longitudinal internet survey of 8240 individuals (15–69 years old in 2015) followed up to 2017. Rates of perceived symptoms from exposure to exhaled aerosol of others’ HNB tobacco were also calculated. Results The largest internet search volume for IQOS occurred in April 2016 in the week after a popular national entertainment TV show introduced IQOS. For Ploom and glo, search volumes have remained limited since their launch. Prevalence of IQOS users increased from 0.3% in January–February 2015 to 0.6% in January–February 2016 and up to 3.6% in January–February 2017, while estimated rates of use of other HNB tobacco products remained low in 2017. Respondents who had seen the TV programme in 2016 were more likely to have used IQOS than those who had not seen it (10.3% vs 2.7%). Among never-smokers who had been exposed to secondhand HNB tobacco aerosol, nearly half reported at least one acute symptom, although these symptoms were not serious. Conclusions A popular TV programme triggered IQOS diffusion in Japan. Extrapolating from survey results to the general population, around 3.1 million people currently use IQOS in Japan. Tobacco control organisations and governments should closely monitor HNB tobacco and consider how to regulate it.

Seasonal variations in the initiation of smoking among adolescents.

Numerous studies have identified a variety of reasons that youths give for starting smoking. Few efforts have been made, however, to identify seasonal variations in initiation. This study was an attempt to fill that void. We examined data from 342 youths participating in a mandated smoking education and cessation program in Texas. Data were collected based on responses to questions in participant workbooks, including an item asking participants about the month in which they started smoking. A total of 47% of the participants indicated that they started smoking in May through August (chi2 = 91.42, df = 3). Post-hoc analyses indicated that significantly more youths than expected began smoking in May and June, whereas significantly fewer youths than expected began smoking in September and November. Unsupervised time out of school during the first months of summer vacation is a period of increased danger for smoking initiation. The significantly lower rates during September seem to be related to the beginning of school.

Theory-Based Development and Testing of an Adolescent Tobacco-Use Awareness Program.

OBJECTIVE To develop and disseminate an effective tobacco awareness and cessation program. METHODS Self-report data from youth (n=1,601) and implementation data from site facilitators (n=16) provided the basis for the trial program evaluation. RESULTS Approximately 146 total classes and 1,601 youth were served. Significantly (p<.01) more participants were in the action stage of change at the end of the program. At follow-up, 40% of the participants indicated they were tobacco free. CONCLUSION The multiple iterative steps in program development were described. A theoretically based program, like the ATCP, is well worth exploring as a public health intervention.

Factors Associated With Tobacco Smoking Practices Among Middle-Aged and Older Women in Texas

This study examines middle-aged and older womens smoking practices and identifies factors associated with tobacco use and cessation in this population. Data of 593 women were analyzed from a seven-county random household sample in Texas. Sequential multinomial logistic regression compared associations with having never smoked, having quit smoking, and currently smoking. Compared to smokers, never smokers and past smokers were significantly more likely to be older, more educated, of better general health, and report past-year physician visits and fewer depressive symptoms. Mental health and smoking are interrelated, indicating the need for addressing depression in smoking-cessation efforts for aging women.

Disparity and Trends in Secondhand Smoke Exposure among Japanese Employees, Particularly Smokers vs. Non-Smokers.

Background Monitoring disparities in secondhand smoke (SHS) exposure is important for tailoring smoke-free policies to the needs of different groups. We examined disparity and trends in SHS exposure among both nonsmokers and smokers at Japanese workplaces between 2002 and 2012. Methods A total of 32,940 employees in nationally representative, population-based, repeated cross-sectional surveys in 2002, 2007 and 2012 in Japan was analyzed. Adjusted rate ratios for workplace SHS exposure from other people (“everyday” and “everyday or sometimes”) were calculated according to covariates, using log-binomial regression models with survey weights. In this survey, employees who do not smoke at workplace are defined as workplace-nonsmokers; and those smoke at workplace are used as workplace-smokers. SHS exposure for smokers does not involve their own SHS. Results While everyday SHS exposure prevalence in workplace-nonsmokers decreased markedly (33.2% to 11.4%), that in workplace-smokers decreased only slightly (63.3% to 55.6%). Workplace-smokers were significantly more likely to report everyday SHS exposure than workplace-nonsmokers, and the degree of association increased over time: compared with the nonsmokers (reference), covariates-adjusted rate ratio (95% confidence interval) for the smokers increased from 1.70 (1.62–1.77) in 2002 to 4.16 (3.79–4.56) in 2012. Similar results were observed for everyday or sometimes SHS exposure. Compared with complete workplace smoking bans, partial and no bans were consistently and significantly associated with high SHS exposure among both nonsmokers and smokers. We also observed disparities in SHS exposure by employee characteristics, such as age group and worksite scale. Conclusions Although overall SHS exposure decreased among Japanese employees between 2002 and 2012, the SHS exposure disparity between nonsmokers and smokers widened. Because smokers reported more frequent SHS exposure than nonsmokers, subsequent mortality due to SHS exposure may be higher in smokers than in nonsmokers. This information may be useful for advocating workplace smoke-free policies.

A Smoke-Free Paso del Norte: Impact Over 10 Years on Smoking Prevalence Using the Behavioral Risk Factor Surveillance System

OBJECTIVES We assessed the impact of a tobacco control initiative over 10 years on cessation and prevention. METHODS We examined 2000-2009 Behavioral Risk Factor Surveillance System cases of a metropolitan statistical area (MSA) with systematic tobacco control efforts throughout the decade (El Paso, TX) and 2 comparison MSAs similar in size and population with less coordinated tobacco control efforts (Austin-Round Rock, TX and San Antonio, TX). RESULTS Yearly, El Paso exhibited a 6% increase in the prevalence of former smokers, a 6% decrease in prevalence of daily smokers, and a 7% decrease in the prevalence of established smoking (≥ 100 cigarettes per lifetime and currently smoking); we did not observe similar trends in the comparison MSAs. There was no change in the prevalence of nondaily smokers in any of the MSAs. CONCLUSIONS The coordinated tobacco control activities in El Paso are related to cessation among daily smokers and prevention of established smoking at the population level but have not stimulated cessation among nondaily smokers. Comprehensive tobacco control should focus more on not only daily smokers but also nondaily smokers.

Cancer Risk Behaviors of Adolescents: Youth Risk Behavior Survey Data.

The school years represent a time span of tremendous growth and development for children. These early years are an important formative stage for health behaviors. Children are constantly ex-posed to new situations, ideas, and concepts, and the habits they develop during this period have a lifelong influence on their health. Given that youngsters are malleable and face extreme contemporary pressures, it is not surprising that the leading causes of death for school children are linked to high-risk behaviors. Kann et al noted that 72% of all deaths among school-age individuals are the result of four causes: motor-vehicle accidents, homicides, suicides, and other unintentional injuries. Some of the major risk factors for youth morbidity (eg, alcohol use and early sexual experience) also reflect behavioral patterns that increase risks for future chronic diseases, including cancer. Furthermore, despite significant progress in recent years in education on cancer prevention and control issues, the American Cancer Society predicts that in the United States, men have a 1 in 2 lifetime risk of developing cancer, and the risk for women is 1 in 3.2

Importance of Tobacco Cessation Services at Higher Education Public Institutions in Texas.

While rates of tobacco use on university campuses rose over the past decade, little is known about what institutions are doing to address this rising concern. Health center directors at public institutions of higher education across the state of Texas were surveyed (n = 42) regarding the perceived importance of smoking cessation, prevalence of interventions on their campuses, and perceived success of intervening efforts. While most health center directors regarded smoking cessation as important, over half of the directors indicated that their sites did not offer tobacco cessation services of any kind. Furthermore, of those offering smoking cessation, most believed that their smoking cessation programs were only somewhat or not at all effective. Findings revealed that there is a noticeable gap between perceived importance and actual implementation of smoking cessation programs within universitybased health centers. Recommendations include implementing innovative cessation methods, such as those that are Web-based and highly accessible to students.