M. Lyndon Haviland

Are menthol cigarettes a starter product for youth

This study assessed the relationship between menthol use and nicotine dependence. Data from the National Youth Tobacco Survey indicated that menthol cigarette use was significantly more common among newer, younger smokers. Additionally, youth who smoked menthol cigarettes had significantly higher scores on a scale of nicotine dependence compared with nonmenthol smokers, controlling for demographic background and the length, frequency, and level of smoking. The study suggests that menthol cigarettes are a starter product that may be associated with smoking uptake by youth.

Progression to established smoking among US youths.

OBJECTIVES Our study presents national estimates of the proportion of youths in each of 7 stages of smoking and investigates the associations between risk/protective factors and progression to established smoking. METHODS We analyzed data from the 1999 and 2000 National Youth Tobacco Surveys. RESULTS In 1999 and 2000, 48.6% of US adolescents had at least experimented with tobacco, and 7.8% were established smokers. Important correlates of progression to established smoking included parental advice not to smoke, antismoking lessons in school, susceptibility to tobacco industry advertising and promotion, peer smoking, and exposure to smoking at home. CONCLUSIONS Interventions to stop adolescent progression to established smoking should target susceptible never smokers and early experimenters as well as those in later stages of smoking.

Measurement properties of a nicotine dependence scale for adolescents

This paper reports on the measurement properties of a scale intended to measure nicotine dependence in adolescents using data from the American Legacy Longitudinal Tobacco Use Reduction Study. The Nicotine Dependence Scale for Adolescents (NDSA) is a simple linear sum of items associated with behaviors to avoid withdrawal and items associated with experiences of craving. An exploratory factor analysis indicated that the items formed a single scale. The reliability of the scale was assessed by estimating Cronbachs alpha for the scale items. The estimated alpha reliability was.81. The scales validity was assessed by estimating the correlation between the scale and measures of smoking and quitting behaviors. As hypothesized, the scale was positively correlated with lifetime number of cigarettes smoked (r=.44, p<.001), days smoked in the past 30 days (r=.66, p<.001), cigarettes smoked per day on days smoked (r=.61, p<.001), and number of quit attempts (r=.10, p<.001) and negatively correlated with the length of the quit attempt (r=-.22, p<.001). We also examined the measurement properties of the NDSA separately for middle and high school students and by gender and race or ethnicity. We found no meaningful differences in the measurement properties of the NDSA across these groups. The six-item self-report NDSA had good measurement properties in our sample.

Women's Knowledge of the Leading Causes of Cancer Death

This paper describes adult womens knowledge of the leading causes of cancer mortality among women. Exposure to antismoking advertisements or media messages also is examined as a potentially effective mechanism for changing inaccurate beliefs. We used data from the 2002 and 2003 American Smoking and Health Survey (ASHES), a national telephone survey of adults, to measure womens knowledge about cancer mortality. Logistic regression models were used to estimate the likelihoods of women indicating either breast or lung cancer as the leading cause of cancer mortality among women. The independent influence of individual characteristics such as race, smoking status, education, and awareness of antismoking messages or advertising on womens knowledge of cancer mortality was assessed. Overall, 66.7% of women inaccurately indicated breast cancer as the leading cause of cancer death among women, whereas 29.7% of women correctly indicated lung cancer. Black women were 43% less likely than White women to indicate lung cancer as the leading cause of cancer mortality among women. Current smokers were 35% less likely than noncurrent smokers to state that lung cancer is the leading cause of cancer mortality among women. Awareness of antismoking messages or advertisements was associated with a higher probability of correctly indicating lung cancer as the leading cause of cancer mortality among women. Our evidence suggests that antismoking media messages may help to correct inaccurate beliefs about the leading causes of cancer death among women.

Will the Master Settlement Agreement Achieve a Lasting Legacy

This article outlines the mission and activities of the American Legacy Foundation (Legacy)—the public charity created by the Master Settlement Agreement (MSA) between 46 states attorneys general and the tobacco industry. Payments to Legacy are made by the 46 settling states. Legacy has achieved much in its short 5-year tenure and has faced and continues to face challenges. These include the “sunset” clause of the MSA that may terminate payments to Legacy’s public education fund—the source of funds for most of Legacy’s public education campaigns and grant making, a unique set of MSA provisions intended to rein in the activities of Legacy and rising public expectations in the context of sharply reduced resources. The inextricable link between Legacy, state tobacco control, and the politics of tobacco are discussed.

Essential Tensions in the Journal

The last few years have been a time of enormous activity for the American Public Health Association (APHA) and the Journal. APHA has endured political and fiscal adversity, adopted a global public health mission, worked through staff departures and subsequent hires, and embraced a change in leadership with the appointment of Georges C. Benjamin, MD, FACP, as its newest executive director. The Journal has revamped its design to include more compelling use of imagery, implemented a Web-based manuscript tracking and publication system, embarked on eclectic fundraising initiatives and press events, and reinstated the publication of supplements after a hiatus of more than a decade. To respond effectively to these challenges and opportunities, members of the Journal’s editorial team, editorial board, and staff have communicated regularly—in person, by phone, and by e-mail—to revitalize the Journal’s strategic plan, alleviate problems brought about by constant deadlines and resource trade-offs, and offer each other support and counsel on evolving concerns. A consequence of this closer working relationship has been the opportunity to develop a shared vision for the future of the Journal, which is evident in its current physical layout, as detailed below. Beginning with the first term of the current editor-in-chief, and intensifying with the Journal’s redesign and the ongoing development of innovative formats to meet the needs of diverse disciplines and sundry sectors within the public health community, there has been a deliberate attempt to restructure the table of contents and bring out “in front” certain features and departments that were previously buried “in the back.” One outcome of our often passionate deliberations was our affirmation that the Research and Practice section—consisting of briefs and research articles—remains the hallmark of every peer-reviewed scientific journal, including this one. The title of this section was expanded from “Research” to “Research and Practice” to signify our belief that research informs practice and practice informs research. We resist calling this section the back of the Journal, as it is vital to the advancement of scientific knowledge and public health practice and is in no way secondary to or less important than the front.

Creating training opportunities for public health practitioners.

In response to several reports issued by the federal government and private foundations on the under-training of public health practitioners, Joseph L. Mailman School of Public Health of Columbia University (SPH) and the New York City Department of Health (NYC DOH) initiated the Public Health Scholars program (SPH-PHS) to make degree-level public health training available to NYC DOH employees. Public Health Scholars receive a 50% tuition scholarship and enroll part-time while working full-time at NYC DOH. Sixteen scholars have enrolled during the past three years. The SPH-PHS program is considered a success by both SPH and NYC DOH. This article details the history of the collaboration between the two agencies and the structure of the program and provides a critical analysis of the SPH-PHS program based on interviews with 16 scholars. It also examines the cost and benefit to other schools of public health of implementing such a program.

Editorial independence at the journal.

The title of this editorial honors Richard Smith, the outgoing editor of BMJ, who recently published a spirited and honorable editorial of his own, “Editorial Independence at the BMJ.”1 That short piece helped crystallize for us a common underlying principle as we wrangled over issues of guest editorship, outside funding for Journal publications, and peer review of various categories of papers. We began writing this editorial in March 2004 at the annual spring meeting of the Journal’s editorial board and editors. Allocating 12 months for preparation and publication of this editorial allowed us to gain additional input from the American Public Health Association’s executive board in addition to the Journal editorial board and editorial team members during the 132nd Annual Meeting and Exposition of the Association in November 2004. Genuine collaboration takes time and many drafts to get it right. The motivation for writing this piece at this particular time came not from outright threats to continued editorial independence at the Journal, but rather from our collective desire to reaffirm the core value of editorial freedom. Together, we represent the editor-in-chief (M.E.N.), the outgoing editorial board chair (K.R.M.), the incoming editorial board chair (M.L.H.), the executive editor (N.J.J.), and the publisher (G.C.B.) of the Journal. This is not our first attempt at coauthorship,2 nor will it be our last. We honor the process and enjoy the struggle of working together to uphold the scientific integrity and ethical principles that form the common mission of the Journal and the Association, that is, to continue to strive to improve public health for everyone.3 Nonetheless, we wish to underscore the very real need for a clear separation between the Journal and the Association on editorial matters, as elaborated below. As representatives of both the Journal and the Association, we agree with Smith when he asserts, “Journals should be on the side of the powerless not the powerful, the governed not the governors. If readers once hear that important, relevant, and well argued articles are being suppressed or that articles are being published simply to fulfill hidden political agendas, then the credibility of the publication collapses—and everybody loses.”1(p0) Furthermore, we want to avoid even the appearance of threats to editorial independence vis-a-vis new Journal and Association initiatives and to reassure our readers and members that editorial freedom is alive and well. This is no small affirmation. We live in a time when there are increasing attempts to censor or restrict information provided to the public under the auspices of national security.4 Limitations on societal resources for health care have reduced funding from medical schools and hospitals for the infrastructure of continuing medical education (CME); commercial support now constitutes more than 50% of the total income of accredited CME providers.5 The cumulative influence of this support is increasingly biasing CME development, presentation, and participation toward topics that benefit commercial interests.5 Smith, unconventional editor and original thinker that he is, believes that “[u]ltimately . . . editorial independence is a space in editors’ heads, a complex function of their personality, courage, power, and the pressures they feel from owners, business people, and others.”1(p0) We appreciate this belief. But given how fundamentally important editorial independence is to safeguarding the public’s health and upholding the scientific integrity of the Journal, we have elected to go public with our plan to defend editorial independence now and in the future by making this statement of our collective position.