Paula M. Lantz

Investing in youth tobacco control: a review of smoking prevention and control strategies

OBJECTIVE To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating “youth centred” tobacco prevention and control activities.

Continuity and Change in the Social Stratification of Aging and Health Over the Life Course: Evidence From a Nationally Representative Longitudinal Study From 1986 to 2001/2002 (Americans' Changing Lives Study)

Objectives. This article overviews previously published and ongoing research from the Americans’ Changing Lives (ACL) Study, a longitudinal study of a nationally representative sample of 3,617 adults aged 25 years and older when first interviewed in 1986, focusing on socioeconomic disparities in the way health changes with age during middle and later life, especially in terms of compression of morbidity/functional limitations. Methods. A variety of descriptive and multivariate regression and growth curve analyses are done on the ACL sample, now surveyed over four waves spanning 15.5 years between 1986 and 2001/2002 with continuing mortality ascertainment via the National Death Index, death certificate searches, and informant reports. Results. Both cross-sectional and longitudinal analyses indicate that socioeconomic disparities in health are small in early adulthood, increase through middle and early old age, and then lessen again in later old age. In other terms, compression of morbidity/functional limitations into the later stages of the life course is realized to a much greater degree among the better educated compared with the less educated. Cross-sectional evidence suggests that this reflects differential exposure to or experience of a wide range of psychosocial, environmental, and biomedical risk factors for health (and perhaps their differential impact at different ages and life stages), as well as variations in biological robustness and frailty and also perhaps in the strength of social welfare supports for health at different life stages. Longitudinal analyses reveal several new insights: (a) The flow of causality is much greater from socioeconomic position to health than vice versa; (b) education plays a greater role relative to income in the onset of functional limitations, whereas income has much stronger effects on their progression or course; and (c) educational disparities in the onset and hence of compression of functional limitations over the life course have increased strikingly in later middle and early old age (ages 55‐84 years) since 1986. Discussion. The results indicate that understanding and alleviating social disparities in health are both theoretically and methodologically quintessential problems of life course analysis and research.

Patient Involvement in Surgery Treatment Decisions for Breast Cancer

PURPOSE High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer. METHODS All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844). RESULTS Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041). CONCLUSION Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.

Can Communities and Academia Work Together on Public Health Research? Evaluation Results From a Community-Based Participatory Research Partnershipin Detroit

This article reports the results of a formative evaluation of the first 4 years of the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research partnership that was founded in 1995 with core funding from the Centers for Disease Control and Prevention (CDC). Several organizations are members of this partnership, including a university, six community-based organizations, a city health department, a health care system, and CDC. The Detroit URC is a strong partnership that has accomplished many of its goals, including the receipt of over

Smoking on the rise among young adults: implications for research and policy

11 million in funding for 12 community-based participatory research projects during its initial 4 years. Detroit URC Board members identified a number of facilitating factors for their growth and achievements, such as (1) developing a sound infrastructure and set of processes for making decisions and working together, (2) building trust among partners, (3) garnering committed and active leadership from community partners, and (4) receiving support from CDC. Board members also identified a number of ongoing challenges, including organizational constraints, time pressures, and balancing community interests in interventions and academic research needs. Overall, the Detroit URC represents a partnership approach to identifying community health concerns and implementing potential solutions.

The Influence of Race, Ethnicity, and Individual Socioeconomic Factors on Breast Cancer Stage at Diagnosis

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.

Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer.

OBJECTIVES Previous research has generally found that racial/ethnic differences in breast cancer stage at diagnosis attenuate when measures of socioeconomic status are included in the analysis, although most previous research measured socioeconomic status at the contextual level. This study investigated the relation between race/ethnicity, individual socioeconomic status, and breast cancer stage at diagnosis. METHODS Women with stage 0 to III breast cancer were identified from population-based data from the Surveillance, Epidemiology, and End Results tumor registries in the Detroit and Los Angeles metropolitan areas. These data were combined with data from a mailed survey in a sample of White, Black, and Hispanic women (n=1700). Logistic regression identified factors associated with early-stage diagnosis. RESULTS Black and Hispanic women were less likely to be diagnosed with early-stage breast cancer than were White women (P< .001). After control for study site, age, and individual socioeconomic factors, the odds of early detection were still significantly less for Hispanic women (odds ratio [OR]=0.45) and Black women (OR = 0.72) than for White women. After control for the method of disease detection, the White/Black disparity attenuated to insignificance; the decreased likelihood of early detection among Hispanic women remained significant (OR=0.59). CONCLUSION The way in which racial/ethnic minority status and socioeconomic characteristics produce disparities in womens experiences with breast cancer deserves further research and policy attention.

Instrument for evaluating dimensions of group dynamics within community-based participatory research partnerships

Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy on quality of life (QOL) after breast cancer and determine if sociodemographic characteristics modify the observed relationships. Methods: A population-based sample of women with Stages 0–II breast cancer in the United States (N=1357) completed surveys including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ BR-23). Regression models calculated mean QOL scores across primary surgical treatment and chemotherapy. Clinically significant differences in QOL were defined as 10 point difference (out of 100) between groups. Results: Meaningful differences in QOL by surgical treatment were limited to body image with women receiving mastectomy with reconstruction reporting lower scores than women receiving breast conserving surgery (p < 0.001). Chemotherapy lowered QOL scores overall across four QOL dimensions (p values < 0.001), with a disproportionately greater impact on those with lower levels of education. Younger women reported lower QOL scores for seven of nine QOL dimensions (p values < 0.001). Conclusions: Women should be reassured that few QOL differences exist based on surgical treatment, however, clinicians should recognize that the impact of treatment on QOL does vary by a woman’s age and educational level.

Breast and cervical cancer screening in a low-income managed care sample: the efficacy of physician letters and phone calls.

We describe the development, adaptation, and use of evaluation approaches assessing key dimensions of group partnerships. A review of relevant literature describes the rationale for the evaluation of partnership dynamics, and the selection of relevant dimensions for evaluation and assessment. Three case studies are presented to illustrate the use of this evaluation instrument in community-based participatory research partnerships to assess key dimensions of partnership process. The use of evaluation results in self-assessment and partnership development are described and lessons learned in the application of these results are discussed. Finally, we discuss the potential, challenges, and areas for further development of evaluation tools to assess group dynamics in partnership efforts. q 2003 Elsevier Science Ltd. All rights reserved.

The detroit community-academic urban research center: Development, implementation, and evaluation

A randomized trial was conducted to evaluate the combined impact of a physician reminder letter and a telephone contact on the use of Pap tests and mammograms in a low-income managed care program. Women 40 to 79 years of age who were past due for cancer screening were randomly assigned to an intervention or control group. Medical claims were reviewed after 6 months to determine intervention effectiveness. The odds of receiving all needed cancer screening tests during follow-up were four times higher in the intervention group. Women who reported having to take time off from work to see a doctor had lower odds of getting screened.