Philip Huang

Telephone counseling increases cessation rates among young adult smokers.

During June 2000-May 2001, the American Cancer Society conducted a randomized trial of telephone counseling among more than 3,500 current smokers who called to seek assistance in quitting. All eligible callers were randomized to receive either self-help booklets through the mail or booklets and up to 5 sessions of telephone counseling. Approximately 12% (420/3,522) of study participants were 18-25 years of age. Using intent to treat analyses, 3- and 6-month quit rates among both younger and older smokers were significantly higher among those who received telephone counseling than among those who received self-help booklets only. Three-month rates were 20% versus 9% for 18-25 year olds and 15% versus 10% for older adults. Results indicate that younger smokers can benefit from telephone counseling.

Media and Community Campaign Effects on Adult Tobacco Use in Texas

The present study reports on the effects on adult tobacco cessation of a comprehensive tobacco-use prevention and cessation program in the state of Texas. Differences in cessation rates across treatment conditions were measured by following a panel of 622 daily smokers, recruited from the original cross-sectional sample, from baseline to follow-up. The adult media campaign combined television, radio, newspaper and billboard advertisements featuring messages and outreach programs to help adults avoid or quit using tobacco products. The ads also promoted quitting assistance programs from the American Cancer Society Smokers’ Quitline, a telephone counseling service. The cessation component of the intervention focused on increasing availability of and access to cessation counseling services and pharmacological therapy to reduce nicotine dependence. Both clinical and community-based cessation programs were offered. Treatment areas which combined cessation activities with high level media campaigns had a rate of smoking reduction that almost tripled rates in areas which received no services, and almost doubled rates in areas with media campaigns alone. Analyses of the dose of exposure to media messages about smoking cessation show greater exposure to television and radio messages in the areas where high level media was combined with community cessation activities than in the other areas. Results also show that exposure to media messages was related to processes of change in smoking cessation and that those processes were related to the quitting that was observed in the group receiving the most intensive campaigns.

From Model to Action: Using a System Dynamics Model of Chronic Disease Risks to Align Community Action

Health planners in Austin, Texas, are using a System Dynamics Model of Cardiovascular Disease Risks (SD model) to align prevention efforts and maximize the effect of limited resources. The SD model was developed using available evidence of disease prevalence, risk factors, local contextual factors, resulting health conditions, and their impact on population health. Given an interest in understanding opportunities for upstream health protection, the SD model focused on the portion of the population that has never had a cardiovascular event. Leaders in Austin used this interactive simulation model as a catalyst for convening diverse stakeholders in thinking about their strategic directions and policy priorities. Health officials shared insights from the model with a range of organizations in an effort to align actions and leverage assets in the community to promote healthier conditions for all. This article summarizes the results from several simulated intervention scenarios focusing specifically on conditions in East Travis County, an area marked by higher prevalence of adverse living conditions and related chronic diseases. The article also describes the formation of a new Chronic Disease Prevention Coalition in Austin, along with shifts in its members’ perceived priorities for intervention both before and after interactions with the SD model.

The Impact of Put Prevention Into Practice on Selected Clinical Preventive Services in Five Texas Sites

OBJECTIVE To determine whether the implementation of the Put Prevention Into Practice (PPIP) office-based system would increase the delivery rates of specific clinical preventive services among demonstration clinics. METHODS Chart review was conducted before (n=372) and 33 to 39 months after (n=376) the implementation of the PPIP office-based system in two community health centers and three family practice residency programs in Texas. The population included all adult patients aged > or = 19 years who had presented to the clinic during the study periods. RESULTS Documentation of timely cholesterol screening increased from 70% to 84%; smoking assessment, from 56% to 80%; for women, up-to-date Papanicolaou smear, from 70% to 81%; annual mammograms (women aged > or =51), from 30% to 48%; and up-to-date tetanus-diphtheria immunizations, from 19% to 59%. For adults aged > or =66 years, documentation of pneumococcal immunization increased from 22% to 48%, while influenza immunizations improved, although not significantly (45% to 49%). Blood pressure screening was almost universal (99%) at baseline and at 33- to 39-month follow-up. CONCLUSION PPIP system changes were associated with an observed increase in delivery of selected clinical preventive services.

Collaborating to Conquer Cancer: A Comprehensive Approach to Cancer Control

Despite substantial contributions on the part of public, non-profit, and private sector organizations, the burden of cancer in the United States remains high. As public health organizations, particularly county, state, tribal, and territorial health departments, try to reduce the significant burden of cancer, they face additional issues that make it difficult to address cancer in a comprehensive way. These challenges along with the need to accelerate progress in reducing the U.S. cancer burden, prompted the Centers for Disease Control and Prevention (CDC) and its national partners to begin to work together to further define and describe comprehensive cancer control (CCC) as an approach to reducing the burden of cancer. CCC is defined as “an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation.” This article describes the national effort to support comprehensive cancer control, outlines national and state level success in comprehensive cancer control, and provides a call to action to public, private, and non-profit organizations, governments of all levels, and individuals to renew their commitments to reducing the burden of cancer.

Nutrition and physical activity counseling practices of family practice residents.

BACKGROUND Nutritional behaviors and physical activity can influence risk for the development and prognosis of cancer. This study reports findings of a literature review and a survey of nutrition and physical activity counseling practices of family practice (FP) residents. METHODS 110 FP residents (response rate = 93.2%) from four clinics that received funding from the Texas Department of Health completed the survey. Hierarchical linear regression models were used to identify determinants of nutrition and physical activity counseling practices. RESULTS About a fifth of the residents reported that they usually or always asked their patients about nutrition and physical activity. In general, residents were most likely to address these issues with asymptomatic obese adult patients. Perceived effectiveness was a significant predictor of both assessment and counseling, except for nutrition counseling for asymptomatic patients. Attitude toward behavioral counseling predicted assessment, but not counseling. Use of resources predicted counseling on both topics with all patients. CONCLUSION FP residents assess and counsel about nutrition and physical activity at suboptimal rates. There is a need to convince residents of the value of such assessment and counseling and to increase their belief that patients will follow through on their recommendations.

Minors’ tobacco possession law violations and intentions to smoke: implications for tobacco control

Objectives: To test: (1) whether citation under the Minors in Possession (MIP) law, vicarious citation (knowing someone who was cited), and threat of driving licence suspension are associated with decreased intentions to smoke next year; and (2) whether the policy is differentially enforced. Subjects: 28 249 white, Hispanic, and African American students in grades 6–12 (11–18 years old) participated in the study. Method: The 86 item anonymous Texas Youth Tobacco Survey was completed by students attending 37 schools in 14 east and central Texas communities. Results: Hierarchical linear modelling showed that MIP citation was unrelated to the future smoking intentions of most youth. However, there was a negative association between citation and smoking intentions for ever daily smoking youth at four schools. Threat of licence suspension was associated with a lower likelihood of future smoking intentions among ever daily smoking youth and vicarious citation did not deter youth from future smoking. African American and Hispanic youth had a higher probability of being cited than their peers. Conclusions: Threat of driving licence suspension has the intended effect upon youth who are/were committed smokers and MIP citation has the intended effect upon committed smokers at only four schools. However, differential enforcement of the law based on ethnicity may be occurring. Before drawing firm conclusions, current findings must be replicated with longitudinal data to determine the consequences of citation on subsequent tobacco use.

Smoke-Free Ordinances in Texas Worksites, Restaurants, and Bars, 2000-2007

BACKGROUND Policies to protect citizens from secondhand smoke (SHS) exposure are widely noted to bring numerous economic and health benefits and contribute to changes in public norms. In 2000, the Texas Department of State Health Services established a database to track changes in the number and content of municipal secondhand smoke ordinances. This study utilizes that data to describe existing municipal ordinances; identify changes in population coverage across worksites, restaurants, and bars; and examine disparities in coverage associated with race/ethnicity. METHODS Ordinance features are examined in five settings: municipal worksites, private-sector worksites, restaurants, bars in restaurants, and bars not in restaurants. This descriptive, time-series study analyzes changes in smoke-free ordinance content and population coverage from 2000 to 2007. RESULTS In 2000, no Texas municipal populations were covered by smoke-free ordinances in more than one study setting. By 2007, over 25% of the states municipal population resided in cities with smoke-free ordinances in all five settings, and 40% were smoke-free in three or more settings. By 2007, over 50% of the municipal population had smoke-free worksite ordinance protections; 40% had smoke-free protections in private worksites, restaurants, and bars in restaurants; and over 25% were protected in bars not in restaurants. Populations in predominantly minority cities had more ordinance protection from SHS. CONCLUSIONS Changes in smoke-free ordinance provisions have been rapid in Texas cities of all sizes and locations. Evaluating whther these local gains can translate into continued support for further municipal and state SHS legislation will be important.

Settlement-Funded Tobacco Control in Texas: 2000-2004 Pilot Project Effects on Cigarette Smoking

Because settlement proceeds allocated for tobacco control in Texas are insufficient for statewide activity at federally recommended funding levels, the Texas Department of State Health Services has used the available funds in quasi-experimental pilot studies in which varying amounts of support are provided for selected parts of the state. Trends in tobacco use were measured in telephone surveys of 7,998 (2000), 5,150 (2002), and 5,721 (2004) adults. Prevalence of cigarette smoking declined by almost one-third in the pilot area where comprehensive and sustained pilot activities to reduce tobacco use were organized at close to the federally recommended funding level. Significantly smaller reductions were observed in other parts of the state. In the group with the highest use, white non-Hispanic men, cigarette consumption declined by half in the pilot area. It is reasonable to expect similar reductions in tobacco use if funds are provided for statewide expansion of the pilot activities.

Effects of a Tobacco-Free Work Site Policy on Employee Tobacco Attitudes and Behaviors, Travis County, Texas, 2010–2012

Background The adoption of tobacco-free policies in behavioral health settings is an important step in reducing staff tobacco use as well as the high rates of tobacco use among people with mental illness and behavioral disorders. Studies have demonstrated the importance of staff support when implementing tobacco-free workplace policies, but there is limited research examining tobacco use prevalence among staff and staff attitude before and after policy adoption. Community Context Integral Care, a local authority for behavioral health and developmental disabilities in Austin, Texas, and Austin Public Health embarked on a comprehensive planning process before implementing a 100% tobacco-free campus policy. The objectives were 1) assess staff tobacco use and attitudes toward a tobacco-free policy, 2) communicate policy to staff, 3) provide staff education and training, and 4) provide cessation resources. Methods Integral Care and Austin Public Health conducted a web-based employee survey 6 months before and 6 and 12 months after implementation of the policy to measure tobacco use prevalence and attitudes among employees. Outcome Employees had significant improvements in tobacco use prevalence and attitudes toward the tobacco-free policy from pre-implementation to post-implementation. Tobacco use prevalence among staff decreased from 27.6% to 13.8%, and support for the policy increased from 60.6% to 80.3% at 12 months post-implementation. Interpretation Adoption of 100% tobacco-free campus policies in behavioral health settings can result in significant reductions in staff tobacco use. Leadership should provide staff with education, training, and cessation support before adoption of tobacco-free work site policies to ensure success.