Phillip S. Gardiner

The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension ∗

PURPOSE We sought to determine whether propranolol has adverse effects on cognitive function, depressive symptoms, and sexual function in patients treated for diastolic hypertension. SUBJECTS AND METHODS We performed a placebo-controlled trial among 312 men and women, 22 to 59 years of age, who had untreated diastolic hypertension (90 to 104 mm Hg). Patients were randomly assigned to treatment with propranolol (80 to 400 mg/day) or matching placebo tablets. Thirteen tests of cognitive function were assessed at baseline, 3 months, and 12 months. Five tests measured reaction time to, or accuracy in, interpreting visual stimuli; one test measured the ability to acquire, reproduce, and change a set of arbitrary stimulus-response sets; and seven tests measured memory or learning verbal information. Depressive symptoms and sexual function were assessed by questionnaires at baseline and 12 months. RESULTS There were no significant differences by treatment assignment for 11 of the 13 tests of cognitive function at either 3 or 12 months of follow-up. Compared with placebo, participants treated with propranolol had slightly fewer correct responses at 3 months (33 +/- 3 [mean +/- SD] versus 34 +/- 2, P = 0.02) and slightly more errors of commission at 3 months (4 +/-5 versus 3 +/- 3, P = 0.04) and at 12 months (4 +/- 4 versus 3 +/- 3, P = 0.05). At 12 months, depressive symptoms and sexual function and desire did not differ by treatment assignment. CONCLUSIONS Treatment of hypertension with propranolol had limited adverse effects on tests of cognitive function that were of questionable clinical relevance, and there were no documented adverse effects on depressive symptoms or sexual function. Selection of beta-blockers for treatment of hypertension should be based on other factors.

Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

Menthol Cigarettes: Setting the Research Agenda

The First Conference on Menthol Cigarettes wasconvened in Atlanta, Georgia, on March 21–22, 2002.The purpose of the conference was to evaluate thepresent state of the science concerning the potentialincreased harm caused by adding menthol to cigar-ettes, and to set the priorities for further studies ofmenthol cigarettes. More than 80 researchers andtobacco control experts participated in the conference.This supplement to Nicotine & Tobacco Researchprovides a summary of the state of our knowledge ofthe history, sociology, epidemiology, and toxicologyof menthol cigarettes as well as the proposed futureresearch agenda.IntroductionMenthol is unique in that it is the only cigaretteadditive actively marketed to consumers. It is the onlyaspect of cigarette design that is marketed explicitlybased on its physiological effects, as an anti-irritantand a cooling agent. It is the only cigarette additiveabout which consumers make conscious buyingchoices.Although the tobacco industry has activelyinvestigated menthol as an additive (Best, 1993;Borgerding, 1993; Borschke, 1993; Hopp, 1993;Reid, 1993; Wilson, 1993), relatively few studieshave been published in the public health literatureabout the following topics:

Menthol Cigarettes: Moving Toward a Broader Definition of Harm

RATIONALE The current practice of the tobacco industry of primarily focusing on the extent that menthol cigarettes contribute or do not contribute to excess morbidity and mortality in various diseases does not, in and of itself, fully illuminate the harm caused by these products. In fact, this practice actually masks and obscures the public health harm associated with menthol cigarettes. Given this, this commentary develops and presents a broader definition of harm in which to view menthol cigarettes and as the necessary and underlying rationale of why this candy-flavored ingredient should be removed from all tobacco products. METHODS This paper relies on the scientific presentations of the 2nd Conference on Menthol Cigarettes, and the peer-reviewed literature on menthol cigarettes. OUTCOMES A broader definition of harm from menthol cigarettes must be analyzed from a broad public health perspective and take into account youth uptake and initiation, menthols ability to augment addiction through unique sensory properties, spurious health messages associated with these products, menthols role in cessation inhibition and relapse promotion, and the blatant predatory marketing of these products to the most vulnerable sectors of society. CONCLUSIONS The Food and Drug Administration (FDA) should apply the same logic that outlawed other candy flavorings and apply it to menthol cigarettes; in the end, all candy flavorings, including menthol, only serve to make the poisons inherent in tobacco smoke go down easier. Additionally, the mobilization of communities most affected by the menthol cigarettes, the FDA, and candy flavorings and the tobacco industrys machinations will be discussed.

Substance Use Among Chinese, Filipino, and Vietnamese Adult Men Living in San Jose, Daly City, and San Francisco, and Its Implications on ATOD Prevention Services

This intervention study collected data on Chinese, Filipino, and Vietnamese high-risk adults to ascertain similarities and differences in drug use patterns. Study participants (N = 126) participated in a 5-week intervention study to mitigate substance abuse and the prevalence of hepatitis C and HIV among high-risk adults in San Francisco, San Mateo, and Santa Clara Counties of California. Data reported were collected at baseline. The National Outcome Measures questionnaire was used to document individual substance use in the past 30 days. Filipinos reported higher use rates for alcohol, cigarettes, marijuana, and crack cocaine in the past 30 days compared with their Chinese and Vietnamese counterparts; these differences proved to be statistically significant (p ≤ .03). Data analysis also showed that the alcohol use of Filipino and Vietnamese homosexual men was significantly greater than their Chinese counterparts (p = .04). A statistically significant inverse association was found for alcohol use for those in the criminal justice system during the past 30 days (odds ratio [OR] = 0.37, p = .03). In addition, a positive association for other tobacco use (OR = 11.98, p = .00) was reported for those in the criminal justice system. Age group analyses indicated a positive association for those between 18-25 years old for alcohol use (OR = 5.40, p = .00). These data confirm the importance of disaggregation of data. If collapsed into a general Asian or Asian and Pacific Islander ethnic group category, as is often the case, the unique behaviors of the individual groups would be lost.

Understanding Tobacco Use Behaviors Among African Americans: Progress, Critical Gaps, and Opportunities

INTRODUCTION Although multiple factors likely influence the differences between African Americans (AAs) and whites in cardiovascular disease and lung cancer mortality rates, historical patterns of tobacco use, particularly cigarette smoking, are the major contributors. This issue of Nicotine & Tobacco Research presents original research, a review, and commentaries that will serve to advance our understanding of several relevant behavioral similarities and differences between AAs and whites. BEHAVIORAL ANALYSIS Here, we illustrate how the diverging trends in cigarette smoking between AA and white high school seniors observed since the mid-1970s were influenced by patterns of ever use and current use among ever users. During 1977 to 2014, the percentage of current users among ever users was higher, but less variable, among whites than AAs. Among adults, trends in self-reported cigarette smoking among non-Hispanic AAs and non-Hispanic whites are available since 1978. The trends observed were likely due in part to the maturation of the high school senior cohorts from the 1970s and 1980s when AA smoking rates declined sharply relative to whites. Later age of initiation among AAs and less quitting among older AAs, relative to whites, also contribute. CONCLUSIONS Further research on multiple topics, including the continuation of use among ever users, use of multiple combusted and noncombusted products, provision of cessation support services, influence of discrimination, and validity of self-report would expand the science base. Strategies to reduce the marketing and availability of menthol and other characterizing flavorings and to enrich environments would promote the publics health.

CORRELATES OF HIV AND HCV RISK AND TESTING AMONG CHINESE, FILIPINO, AND VIETNAMESE MEN WHO HAVE SEX WITH MEN AND OTHER AT-RISK MEN

Asian Americans are one of the more under-researched groups in the United States. This holds true with regard to research on risk assessment, screening, and testing for human immunodeficiency virus (HIV) and hepatitis C (HCV). Here, we address that lack by exploring correlates of risk and testing for the two diseases among Chinese, Filipino, and Vietnamese men who have sex with men (MSM) and other at-risk men in the San Francisco Bay Area. We do so by analyzing findings from the study of a community-based prevention program, Project 3-3-3 (P333), designed to address the often comorbid conditions of substance abuse, HIV infection, and HCV infection among underserved and high-risk Chinese, Filipino, and Vietnamese adults, most of whom are MSM. A risk-behavior survey completed at preintervention identified risk factors related to HIV, HCV, and substance use among this population (n = 273). The study of survey data identifies and distinguishes between correlates of HIV and HCV testing. Among our findings, significant differences were found between Asian ethnic subpopulation groups with respect to number of sexual partners (p = .007), and HIV testing rates comparing MSM and heterosexual men differed significantly (p < .002). Those who spoke English at home were more likely to be tested for HIV (p < .008). With HCV testing, the number of partners was positively correlated to getting tested (p < .047), and Filipino men were significantly more likely to get tested for HCV than Chinese men (p < .022).

The African American Youth Smoking Experience: An Overview.

INTRODUCTION Beginning in the late 1970s, a very sharp decline in cigarette smoking prevalence was observed among African American (AA) high school seniors compared with a more modest decline among whites. This historic decline resulted in a lower prevalence of cigarette smoking among AA youth that has persisted for several decades. METHODS We synthesized information contained in the research literature and tobacco industry documents to provide an account of past influences on cigarette smoking behavior among AA youth to help understand the reasons for these historically lower rates of cigarette smoking. RESULTS While a number of protective factors including cigarette price increases, religiosity, parental opposition, sports participation, body image, and negative attitudes towards cigarette smoking may have all played a role in maintaining lower rates of cigarette smoking among AA youth as compared to white youth, the efforts of the tobacco industry seem to have prevented the effectiveness of these factors from carrying over into adulthood. CONCLUSION Continuing public health efforts that prevent cigarette smoking initiation and maintain lower cigarette smoking rates among AA youth throughout adulthood have the potential to help reduce the negative health consequences of smoking in this population. IMPLICATIONS While AA youth continue to have a lower prevalence of cigarette smoking than white youth, they are still at risk of increasing their smoking behavior due to aggressive targeted marketing by the tobacco industry. Because AAs suffer disproportionately from tobacco-related disease, and have higher incidence and mortality rates from lung cancer, efforts to prevent smoking initiation and maintain lower cigarette smoking rates among AA youth have the potential to significantly lower lung cancer death rates among AA adults.

Menthol Should Not Be Given a Free Pass Based on Studies of Biomarkers of Toxicity

Exposure and toxicity studies comparing menthol and nonmenthol cigarettes have resulted in mixed results. On the basis of those results, cigarette manufacturers have concluded that there is no increased harm from the addition of menthol to cigarettes. We propose that such a narrow definition of harm is not appropriate in dealing with the issue of menthol, and its broader negative public health impact. Cancer Epidemiol Biomarkers Prev; 20(7); 1269–71. ©2011 AACR.