Preventive Medicine 42 (2006) 399 – 400
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This Month in Preventive Medicine
Smoke on the run? The American Legacy Foundation is a U.S. tobacco-control group that is funded by the March 1999, $246 billion Master Settlement Agreement between a coalition of attorneys general in 46 states and 5 U.S. territories in association with the tobacco industry (www.americanlegacy. org). The foundation's two goals are to help young people reject tobacco and to eliminate disparities in access to tobacco prevention and cessation services. On March 10, 2006, it announced that data from the Tobacco Tax Bureau of the US Department of the Treasury indicate that cigarette sales in 2005 declined by 4.2% from 2004 levels. Fewer cigarettes were sold last year in the U.S. than at any time since 1951, and their per capita consumption is returning to levels of the early 1930s. The foundation has provided a graph (http://www.americanlegacy.org/ mediacenter/pdf/AL_PR_graph.pdf) showing that cigarette sales have declined by 21% since 1998. The drop is attributed to the 1998 Master Settlement Agreement, which sharply increased the cost of cigarettes (from an average of $1.74 a pack in 1997 to $3.16 in 2004); restricted advertising, promoting, and marketing of cigarettes; recommended better education, prevention and counseling, public information and counter-marketing efforts; and stimulated tax increases and clean indoor air initiatives. This is of course good news, but it should not obscure the fact that the numbers related to cigarette smoking in the US are still of astronomical magnitude. About 45 million Americans 18 years of age and older still smoke, tobacco smoke causes more than 400,000 deaths a year, and within the last year alone about 378 billion cigarettes were sold in the U.S. Worldwide, the situation is even worse. Indeed, as reported in several papers in this issue, the tobacco news is not uniformly good. Maziak et al. (2006) found that 98% of adult nonsmokers in a Syrian survey had detectable saliva cotinine levels. Even though the prevalence of smoking is rapidly declining in South Korea, especially among women, Khang and Cho (2006) report that more than half of the male population aged 20 to 64 currently smoke, which is more than twice the prevalence in the US. Kelishadi et al. (2006) observed an overall prevalence of self-reported smoking in Iranian adolescents of 14%. According to Ino et al. (2006), 57% of 261 Japanese children, both of whose parents smoked, tested positive for urinary cotinine, a marker of exposure to environmental tobacco smoke. And Leistikow et al. (2006) estimates that smoke overload explains disparities in cancer mortality among Asian– and Pacific Islander–Americans, with about a 70% smoking attributable fraction of cancer death among Korean–Californians and Hawaiian males. Four other papers in this issue deal with various aspects of breast, ovarian, colon, and skin cancer screening, while a fifth paper reports on the development of a reliable questionnaire to measure the walking distance covered within and outside of the neighborhood. In a review of the conflicting recent evidence, Hay et al. (2006) found that although high levels of breast cancer worry are probably uncommon, there is still a small positive association between more worry and subsequently, higher incidence of breast self-examination and mammography screening. Gaugler et al. (2006) found that asymptomatic women who received a “normal” ovarian screening test were psychologically disposed to have confidence in and to seek future cancer screening. Robertson et al. (2006) report that in the US Medicare and Tricare populations, screening colonoscopies increased while barium enemas and flexible sigmoidoscopies decreased during 1999–2001, and that gastroenterologists appeared to be the preferred providers of 0091-7435/$ - see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2006.04.020
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This Month in Preventive Medicine
colonoscopies. In a cluster-randomized trial of melanoma prevention, Glazebrook et al. (2006) found that the interactive multimedia intervention “Skinsafe” group had increased knowledge, additional protective behaviors, and performed more mole checking than the control group. And Giles-Corti et al. (2006) reports that the test–retest reliability of the Neighborhood Physical Activity Questionnaire (NPAQ), developed from the International PAQ and the Active Australia Survey for the longitudinal RESIDE (RESIDential Environment) study was worthy of endorsement in other studies investigating environmental correlates of walking. Turning again to cigarette smoking, two further studies report on randomized trials of the effectiveness of smoking cessation interventions in special populations. Park et al. (2006) presents process evaluation data to show that brief, peer-delivered, telephone counseling intervention is an effective way to intervene with adult survivors of childhood cancer who smoke. And perhaps not surprisingly, Rapp et al. (2006) found that a 3-day intervention for student nurses that focused on their professional roles in advising people who wish to quit smoking, but not on their own individual smoking behavior, led to increases in the student nurses' medical knowledge and competence in giving advice to others, but was not an effective strategy for reducing their own cigarette smoking. On balance, is tobacco smoke on the run? Not yet. References Gaugler, J.E., Pavlik, E., Salsman, J.M., Andrykowski, M.A., 2006. Psychological and behavioral impact of receipt of a normal ovarian screening test. Prev. Med. 42, 463–470. Giles-Corti, B., Timperio, A., Cutt, H., Pikora, T.J., Bull, F.C.L., Knuiman, M., Bulsara, M., Van Niel, K., Shilton, T., 2006. Development of a reliable measure of walking within and outside the local neighborhood: RESIDE'S Neighborhood Physical Activity Questionnaire. Prev. Med. 42, 455–459. Glazebrook, C., Garrud, P., Avery, A., Coupland, C., Williams, H., 2006. Impact of a multimedia intervention Skinsafe on patients' knowledge and protective behaviors. Prev. Med. 42, 449–454. Hay, J.L., McFaul, K.D., Magnum, R.E., 2006. Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev. Med. 42, 401–408. Ino, T., Shibuya, T., Saito, K., Ohshima, J., Okada, R., 2006. A passive smoking screening program for children. Prev. Med. 42, 427–429. Kelishadi, R., Ardalan, G., Gheiratmand, R., Majdzadeh, R., Delavari, A., Heshmat, R., Mokhtari, M.R., Razaghi, E.M., Motaghian, M., Ahangar-Nazari, I., et al., 2006. Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study. Prev. Med. 42, 423–426. Khang, Y.-H., Cho, H.-J., 2006. Socioeconomic inequality in cigarette smoking: trends by gender, age, and socioeconomic position in South Korea, 1989–2003. Prev. Med. 42, 415–422. Leistikow, B.N., Chen, M., Tsodikov, A., 2006. Tobacco smoke overload and ethnic, state, gender, and temporal cancer mortality disparities in Asian–Americans and Pacific Islander–Americans. Prev. Med. 42, 430–434. Maziak, W., Ward, K.D., Eissenberg, T., 2006. Measuring exposure to environmental tobacco smoke (ETS): a developing country's perspective. Prev. Med. 42, 409–414. Park, E.R., Puleo, E., Butterfield, R.M., Zorn, M., Mertens, A.C., Gritz, E.R., Li, F.P., Emmons, K.M., 2006. A process evaluation of a telephone-based peer-delivered smoking cessation intervention for adult survivors of childhood cancer: the partnership for health study. Prev. Med. 42, 435–442. Rapp, K., Büchele, G., Jähnke, A.G., Weiland, S.K., 2006. A cluster-randomized trial on smoking cessation in German student nurses. Prev. Med. 42, 443–448. Robertson, R.H., Burkhardt, J.H., Powell, M.P., Eloubeidi, M.A., Pisu, M., Weissman, N.W., 2006. Trends in colon cancer screening procedures in the US Medicare and Tricare populations: 1999–2001. Prev. Med. 42, 460–462.
Alfredo Morabia, M.D., Ph.D. Center for the Biology of Natural Systems, Queens College–CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA E-mail address:
[email protected]. Corresponding author. Michael C. Costanza, Ph.D. Geneva University Hospitals, Division of Clinical Epidemiology, 25, Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland E-mail address:
[email protected].