Women Smokers Perceptions of Smoking-Related Health Risks

Size: px
Start display at page:

Download "Women Smokers Perceptions of Smoking-Related Health Risks"

Transcription

1 JOURNAL OF WOMEN S HEALTH Volume 12, Number 4, 2003 Mary Ann Liebert, Inc. Women Smokers Perceptions of Smoking-Related Health Risks SUSAN MORAN, M.D., M.S.C.E., 1 GINA GLAZIER, M.B., B.Ch., 2 and KATRINA ARMSTRONG, M.D., M.S.C.E. 3 ABSTRACT Objective: Unrealistic perceptions of personal susceptibility to the health hazards of smoking may be an important determinant of cigarette smoking and a barrier to smoking cessation. This study was undertaken to assess perceptions of smoking-related health risks among women smokers. Methods: A secondary analysis was conducted using cross-sectional data collected from 1184 (response rate 61%) perimenopausal women patients from one university-affiliated health system. Results: The majority of respondents were white and college-educated and had an annual household income of over $60,000. Twelve percent of respondents were current smokers, 37% were former smokers, and 51% were never smokers. Sixty percent of current smokers rated their lifetime risk for developing heart disease or lung cancer as average or below average, and 75% of current smokers rated their lifetime risk for developing osteoporosis as average or below average. Multivariable logistic regression analysis revealed that any smoking history (past or current) was associated with perception of above average risk for developing lung cancer, but only heavier smoking ($10 cigarettes per day) was associated with perception of above average risk for developing heart disease. No level of smoking was associated with perception of above average risk for developing osteoporosis. Conclusions: The majority of women smokers surveyed perceived their lifetime risk for developing heart disease, lung cancer, and osteoporosis as average or below average. It appears that women smokers are more aware of their increased risk for developing lung cancer than their increased risk for developing heart disease or osteoporosis. INTRODUCTION CIGARETTE SMOKING IS RECOGNIZED as the most preventable cause of death and disease among women in the United States, with nearly one half of all deaths among current women smokers and one fourth of all deaths among former women smokers attributable to smoking. 1 Women smokers are at increased risk for lung cancer, cardiovascular disease (CVD), and pulmonary disease, as well as gender-specific health consequences, such as osteoporosis, cervical cancer, infertility, and early menopause. 1 Lung cancer mortality rates among women in- 1 General Internal Medicine Unit, Tobacco Research and Treatment Center, Medical Services, Massachusetts General Hospital and the Department of Medicine, Harvard Medical School, Boston, Massachusetts. 2 Midlothian Family Practice, Midlothian, Virginia. 3 Department of Medicine, Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. This work was funded by Public Health Service National Research Service Award T32HP to S.M. 363

2 364 creased 600 percent since 1950, and in 1987, lung cancer surpassed breast cancer as the leading cause of cancer death in women. 1 Approximately 90% of lung cancer deaths among women are attributable to smoking. Although the risk for developing lung cancer increases with quantity, duration, and intensity of smoking, a Canadian study estimated that 1 in 8 women smokers will develop lung cancer in her lifetime (compared to 1 in 71 women nonsmokers). 2 Former smokers have a lower risk of lung cancer than current smokers, and risk declines with the number of years since quitting. 1 Coronary heart disease (CHD) is the leading cause of mortality among middle-aged and older women, and 41% of deaths from CHD in women under the age of 65 are attributable to cigarette smoking. 1 Even women who smoke only a few cigarettes per day have double the risk for CHD compared with nonsmoking women. 3 Smoking cessation substantially reduces the increased risk for CHD after only 1 2 years of abstinence, and after years of abstinence, the risk approaches that of a nonsmoker. 1,3 Bone density is also affected by cigarette smoking. Women who smoke have lower bone density than women who do not smoke. 1 Osteoporosis and resultant bone fracture are an important problem for postmenopausal women. Sixteen percent of white women and 5.5% of black women over age 50 will sustain a hip fracture in their lifetime, and mortality from hip fracture is high. 4,5 The age-adjusted relative risk (RR) for hip fracture among women current smokers is between 1.5 and 2.0 compared with the RR of women who do not smoke. 1 This increased risk appears to decrease to that of a nonsmoker after quitting smoking. 1 Despite the overwhelming evidence of the harm of smoking, 22% of women in the United States smoke cigarettes. 1 Although there are many factors that contribute to smoking behavior, unrealistic perceptions of personal susceptibility to the health hazards of smoking may be an important determinant of cigarette smoking and a barrier to smoking cessation. Perception of risk is important in several well-established models of preventive behavior, including the Health Belief Model, the Theory of Reasoned Action, and the Precaution Adoption Process Model. 6 8 The available evidence largely supports that smokers in general acknowledge the health risks associated with smoking but underestimate the magnitude MORAN ET AL. and personal relevance There are some studies, however, concluding that smokers are informed of the risks associated with smoking and, if anything, err on the side of overestimating the risks of smoking It has been proposed that this discordance is a result of differences in the health outcomes rated and the methods used to measure risk perception Little is known specifically about women smokers perceptions of the health-related risks associated with cigarette smoking. The Surgeon General recently declared a full-blown epidemic of tobacco-related diseases among women. 1 Decreasing tobacco use requires a multifactorial approach, including interventions at the individual and public policy levels. Nevertheless, if women smokers do not accurately perceive the health risks of smoking, improving communication of risk could be a crucial step in the process of quitting smoking. This study reports perceptions of the health-related risks of smoking among women smokers who responded to a survey designed to assess attitudes toward health in the years surrounding menopause. This population of women smokers is at increased risk for the adverse health consequences of tobacco use, particularly heart disease, lung cancer, and osteoporosis, because of age, menopausal status and the likelihood that they have been smoking for a number of years. MATERIALS AND METHODS A random sample was obtained of 2200 perimenopausal women who had seen a primary care physician at least once in the University of Pennsylvania Health System (UPHS) in the 2 years prior to January At the time of this study, the UPHS included 225 primary care physician practices in Pennsylvania and New Jersey. The age group was chosen to assess women s attitudes toward health in the years surrounding menopause. The target age range for inclusion was between the ages of 53 and 55, as determined by demographic information entered into the patient database. The actual age range (46 58) varies as a result of discrepancies between information in the database and patient report. Primary care physicians were defined as general internists, family physicians, and gynecologists. Following identification of the random sample, the patients physicians were contacted to ensure

3 WOMEN SMOKERS PERCEPTIONS OF SMOKING RISK 365 that there were no medical reasons for exclusion. If the physicians thought that the patients would be unable to complete the survey for some reason, these names were removed from the pool of potential subjects. This resulted in the removal of 47 subjects. A further 152 subjects had incomplete postal addresses. Subjects received a letter informing them of the primary study objective and asking them to complete an anonymous questionnaire. Of the 2001 women invited to participate, 3 were deceased and 152 were undeliverable. Two mailings were sent, and responses were confidential. Of the 1928 deliverable questionnaires, 1191 were returned (62%). Seven subjects provided insufficient data and were not included in the analysis. Thus, this study reports on data from 1184 subjects (61%). The primary study objective was to assess women s attitudes toward the use of hormone replacement therapy (HRT), but the questionnaire also included questions about smoking and risk perception. The questionnaire was developed based on a literature review and semistructured interviews of 24 women. The questionnaire was further refined through pilot testing of 115 perimenopausal women visiting primary care physicians at the University of Pennsylvania. The questionnaire took approximately 10 minutes to complete and had an eighth grade reading level. Smoking status was defined as follows: never smokers (answered no to the question, Have you ever smoked cigarettes? ), former smokers (have ever smoked but answered no to the question, Do you still smoke? ), and current smokers (have ever smoked and answered yes to the question, Do you still smoke? ). Current smokers were also asked about number of cigarettes smoked per day (,10, 10 20, 21 39, and $40) and whether or not they had received previous smoking cessation advice from their physician (yes/no). Subjects were asked to rate their lifetime risk for developing heart disease/heart attack, lung cancer, and osteoporosis ( Rate what you think is your lifetime risk of getting... ) on a 3-point scale (1, below average; 2, average; 3, above average). A fourth option allowed subjects to indicate that they already had the disease in question. These women were not included in the risk perception analysis for that disease. Demographic information was obtained for age, race, education (, high school, high school, 2 years of college, 4 years of college, graduate/professional school), and income. Subjects were also asked about menopausal status, whether or not they were currently taking HRT, and questions concerning personal medical history and family medical history. Characteristics of current smokers, former smokers, and never smokers were compared using the Kruskal-Wallis test for continuous variables and the Pearson chi-square test for categorical variables. Ratings of perceived risk were compared according to smoking status (never, former, and current smokers) using the Pearson chi-square test. Multivariable logistic regression models were developed to determine independent predictors of perception of increased risk (rating of risk as above average vs. else) for heart disease, lung cancer, and osteoporosis among all respondents. The models were adjusted for race (white, non- Hispanic vs. else), education (high school or less vs. 2 or more years of college), smoking status (never smoker, former smoker, and current smoker; subdivided into categories of,10 cigarettes per day and $10 or more cigarettes per day), and family history of the disease in question. The cutoff point for smoking intensity among current smokers was chosen to differentiate between lighter and heavier smokers but was not further divided because of small cell sizes. The models for perception of risk for heart disease and osteoporosis were also adjusted for current use of HRT. The model for perception of risk for heart disease was also adjusted for personal history of hypertension and hypercholesterolemia. The Institutional Review Board of the University of Pennsylvania approved this study. RESULTS Characteristics of the study population Demographic characteristics are shown in Table 1. The mean age of the subjects was 54.6 years (range 46 58). Most subjects were white and college educated and had an annual household income of over $60,000. Of the 1184 respondents, 12% (138) were current smokers, and 37% (441) were former smokers. A higher proportion of current smokers were nonwhite (p ) and reported lower levels of education and income than never smokers or former smokers (p, 0.001). The majority of current smokers (59%) reported

4 366 MORAN ET AL. TABLE 1. CHARACTERISTICS OF STUDY SUBJECTS BY SMOKING STATUS Never smokers Former smokers Current smokers p Characteristic (n 5 605) (n 5 441) (n 5 138) value Age, mean, years Education, %,High school High school years college years college ,0.001 Graduate school $2 years college Other Race, % White, non-hispanic Black, non-hispanic Other Income, %,$30,000/year $30,000 $59,900/year $60,000 $100,000/year ,0.001.$100,000/year Postmenopausal, % Currently taking HRT, % Family history, % Lung cancer Heart disease Osteoporosis Personal medical history, % Lung cancer Heart disease Osteoporosis Hypercholesterolemia Hypertension Smoking intensity, %,10 cigarettes per day n/a n/a cigarettes per day n/a n/a cigarettes per day n/a n/a 17.7 smoking cigarettes a day for a mean of 30 years (range 3 45 years). Former smokers reported smoking for a mean of 15.4 years (range 1 40 years). Current smokers were more likely to be postmenopausal than never smokers and former smokers (p ) and less likely to take HRT than never smokers (p ). Ninety-percent of current smokers reported receiving smoking cessation advice from their physicians. Perception of lifetime risk of disease Figure 1 presents the percentage of subjects reporting below average, average, or above average perception of lifetime risk for developing heart disease, lung cancer, and osteoporosis by smoking status. Current smokers rating of lifetime risk for developing heart disease was higher than the rating of never smokers or former smokers (p ). The rating of perceived lifetime risk for developing lung cancer differed significantly among never smokers, former smokers, and current smokers (p, 0.001). There was no difference in perception of lifetime risk for developing osteoporosis (p ) among the three groups. Although current smokers were more likely than never and former smokers to rate their lifetime risk for developing heart disease and lung cancer as above average, 60% of current smokers rated their lifetime risk for developing heart disease or lung cancer as average or below average. Three quarters of current smokers rated their lifetime risk for developing osteoporosis as average or below average. Perceptions of risk for heart disease and lung

5 WOMEN SMOKERS PERCEPTIONS OF SMOKING RISK 367 cancer were positively correlated among current smokers (Spearman s rho 0.52, p, 0.001) and less so for never smokers (Spearman s rho 0.10, p ) and former smokers (Spearman s rho 0.09, p ). Likewise, there was a weak positive correlation between perception of risk for heart disease and osteoporosis among never smokers (Spearman s rho 0.15, p, 0.001) and former smokers (Spearman s rho 0.10, p ) but not among current smokers (Spearman s rho 0.10, p ). Perceptions of risk for lung cancer and osteoporosis were not correlated (Spearman s rho 0.05, p ). Predictors of increased risk perception Table 2 presents the results of multivariable logistic regression analysis to determine predictors of increased risk perception (rating of risk as above average vs. else) among all subjects. Each level of smoking was associated with perception of above average risk for developing lung cancer, and increased smoking was associated with increased odds of perception of above average risk. However, only heavier smoking ($10 cigarettes daily) was associated with perception of above average risk for developing heart disease. No level of smoking was significantly associated with perception of elevated risk for developing osteoporosis. Nonwhite race was inversely associated with perception of increased risk for developing heart disease, lung cancer, and osteoporosis. Higher educational attainment was associated with perception of increased risk for developing heart disease and osteoporosis but not for lung cancer. Family history of the disease in question was strongly associated with perception of above average risk for developing the same disease. Women with a personal history of hypertension and hypercholesterolemia perceived increased risk for developing heart disease. Additionally, current use of HRT was associated with perception of above average risk for developing heart disease. Use of HRT was not associated with perception of risk for developing osteoporosis. FIG. 1. Perception of lifetime risk for developing heart disease, lung cancer, and osteoporosis by smoking status. Shown are the percentages of women in each smoking status category who rated their lifetime risk for developing each disease as below average, average, or above average. DISCUSSION The majority of perimenopausal women smokers in this population of educated women (.85% of the women smokers completed at least high

6 368 MORAN ET AL. TABLE 2. PREDICTORS OF PERCEPTION OF ABOVE AVERAGE RISK OF HEART DISEASE, LUNG CANCER, AND OSTEOPOROSIS AMONG STUDY SUBJECTS Heart disease Lung cancer Osteoporosis Adjusted OR (95% CI) a Adjusted OR (95% CI) Adjusted OR (95% CI) Race White Nonwhite 0.35 ( )* 0.45 ( )* 0.35 ( )* Education High school or less $2 years college 1.47 ( )* 1.20 ( ) 1.62 ( )* Smoking status Never smoker Former smoker 1.12 ( ) 2.65 ( )* 1.01 ( ) Current smoker,10 cigarettes/day 1.39 ( ) ( )* 2.30 ( ) $10 cigarettes/day 2.85 ( )* ( )* 1.22 ( ) Family history Heart disease 3.73 ( )* Lung cancer 2.35 ( )* Osteoporosis 6.42 ( )* Personal history Hypercholesterolemia 1.88 ( )* Hypertension 2.09 ( )* Current HRT use 1.47 ( )* 1.05 ( ) a OR, odds ratio adjusted for all variables in the table; CI, confidence interval. *p, school, and 44% completed $2 years of college) did not perceive above average personal risk for developing heart disease, lung cancer, or osteoporosis. These findings are consistent with other studies that have shown that although smokers perceive increased risk compared with never smokers and former smokers, they underestimate their personal risk of suffering the health-related consequences of smoking. 9 11,15 21 These findings are contrary to studies finding that smokers overestimate the risk of smoking-related disease Those studies differ from the current study in that respondents were not asked about their personal risk for developing disease, and accuracy of risk perception was judged by how well respondents estimates of risk agreed with epidemiological statistics. Our finding that smokers underestimate risk may be because people tend to minimize their personal risk, a phenomenon known as optimism bias. 9,17,22 In addition, it has been demonstrated that a person s numerical estimate of risk probability does not necessarily correlate with subjective perception of personal susceptibility to harm. 10,23,24 Although all levels of smoking were associated with perception of above average risk for developing lung cancer, only heavier smoking (defined as smoking $10 cigarettes per day) was associated with perception of above average risk for developing heart disease. Ayanian and Cleary 18 found that heavier smokers (.20 cigarettes per day) were more likely than lighter smokers (1 19 cigarettes per day) to perceive increased risk of myocardial infarction (MI) and cancer but did not compare the perception of lighter smokers with that of nonsmokers. Although it is true that the risks of smoking increase with smoking intensity, low and moderate intensity smokers are still at increased risk for suffering adverse health consequences. 1,3 These findings suggest that there is greater awareness of the link between smoking and lung cancer than that between smoking and CVD. Additionally, no level of smoking was associated with increased perception of osteoporosis risk, suggesting that there is little awareness of the correlation between smoking and osteoporosis risk. An unexpected finding was the inverse association between nonwhite race and perception of increased risk of developing heart disease and lung cancer. The majority of nonwhites in this population were non-hispanic African Americans. A previous survey of black female smokers living in public housing found that they had a

7 WOMEN SMOKERS PERCEPTIONS OF SMOKING RISK 369 weaker belief in the risk of lung cancer from smoking than white women. 20 This finding is particularly of concern given the greater burden of smoking-related disease in the African American population. Lung cancer incidence and mortality are higher for African American women than for white women under the age of Likewise, the death rate from CVD is 69% higher for African American women than for white women. 26 With.50% of myocardial infarctions (MIs) in middle-aged women attributed to cigarette smoking 27 and the knowledge that cardiovascular risk approaches that of a nonsmoker after 3 5 years of quitting, 28 it is imperative that efforts be made to communicate the health risks of smoking to African American women. Family history was highly predictive of increased risk perception for all three disease entities. Although this might be because these women recognize that they are at increased risk, it might also be the case that personal experience with a disease increases perception of personal risk. This is consistent with models of preventive behavior that suggest that personal experience and salience are important determinants of perceiving personal susceptibility. 8 This lends support to the idea that future attempts to communicate smoking risk should focus on increasing the salience of risks. Finally, the association between current use of HRT and perception of disease risk is interesting. Current use was not associated with perception of osteoporosis risk, as might be expected (i.e., women might have been taking HRT to treat or prevent osteoporosis). However, HRT use was associated with perception of above average risk for CVD. Whether subjects were aware of recent data about the effect of HRT on CVD 29,30 or were more likely to be prescribed HRT if at increased risk for heart disease is unknown. The findings of this study have implications for future research aimed at designing smoking cessation interventions. The results suggest that overcoming optimism bias is the greatest challenge to communicating risk to smokers in an effort to motivate smoking cessation, and there is evidence that individual differences influence how risk information is processed. 31 Stage-based models of preventive behavior, such as the Transtheoretical Model 32 and the Precaution Adoption Process Model, 8,33 suggest that individuals pass through stages in the process of quitting a risky behavior, and risk information may be beneficial if presented at the appropriate stage. There is little research focusing on efforts to increase risk perception specifically as a means to decrease smoking behavior. One trial conducted in a college student population found that health risk factor feedback significantly increased smoking cessation rates from 6% to 26%. 34 A trial incorporating biomarker and genetic susceptibility feedback into smoking cessation counseling found no overall effect of the intervention on quitting behavior, but there was evidence that subjects in the preparation stage of change (planning to quit in the next month) who were exposed to risk information smoked fewer cigarettes at follow-up. 35 More research is needed to better understand the effect of risk communication on smoking behavior. Nonetheless, the U.S. Public Health Service guideline for treating tobacco use outlines a strategy for motivating smokers to quit that includes discussion of personal relevance, the acute and long-term risks of smoking, the benefits of cessation, and the barriers to cessation. 36 There are several limitations to this study. First, the proportion of smokers among survey respondents was lower than national statistics would suggest. Twenty-one percent of women aged in the United States were smokers in This limitation could be due to nonresponse by smokers, or the source population could be less likely to smoke. Second, the respondents were a homogeneous group of predominantly white, educated women recruited from one health system, and results may not be generalizable to the underlying population of perimenopausal women. However, prior studies suggest that higher educational status is correlated with increased perception of risk, suggesting that these results underestimate the number of women smokers who minimize their personal susceptibility to smoking-related health risks. Third, as this was a secondary analysis, we lacked data on a number of potentially interesting covariates, such as cigarette brand and tar content, duration of abstinence for former smokers, and specifics of physician smoking cessation advice. 16,18,38 Future studies with sampling of a larger, more diverse population are needed to better understand women smokers perception of risk. CONCLUSIONS The findings of this study suggest an opportunity for improvement in smoking risk communi-

8 370 cation. Despite large public health campaigns to inform the public of the health risks of smoking, the majority of women smokers in this population did not perceive that they were at increased risk for suffering the ill effects of cigarette smoking. This optimistic bias among smokers has been shown previously, and interventions to address this bias are urgently needed. 16,22 Although communication of risk is one facet in the campaign to decrease smoking, the extent of the role for risk communication in smoking prevention and cessation cannot be known until we are able to demonstrate accurate perception of smoking risk. REFERENCES 1. U.S. Department of Health and Human Services. Women and smoking: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Villeneuve P, Mao Y. Lifetime probability of developing lung cancer, by smoking status, Canada. Can J Public Health 1994;85: Willett W, Green A, Stampfer M, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med 1987; 317: Cummings S, Black D, Rubin S. Lifetime risks of hip, Colles, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med 1989;149: Magaziner J, Simonsick E, Kashner T, Hebel J, Kenzora J. Survival experience of aged hip fracture patients. Am J Public Health 1989;79: Becker M. The health belief model and personal health behavior. Health Educ Monogr 1974;2: Fishbein M, Azjen I. Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley, Weinstein N. The Precaution Adoption Process. Health Psychol 1988;7: Weinstein N. Accuracy of smokers risk perceptions. Ann Behav Med 1998;20: Slovic P. Rejoinder: The perils of Viscusi s analyses of smoking risk perceptions. J Behav Decision Making 2000;13: Slovic P. Smoking: risk, perception & policy. Thousand Oaks, CA: Sage Publications, Inc, Viscusi W. Do smokers underestimate risks? J Political Econ 1990;98: Viscusi W. Making the risky decision. New York: Oxford University Press, Visusi W. Comment: The perils of qualitative smoking risk measures. J Behav Decision Making 2000;13: 267. MORAN ET AL. 15. Lee C. Perceptions of immunity to disease in adult smokers. J Behav Med 1989;12: Strecher V, Kreuter M, Kobrin S. Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks? J Behav Med 1995;18: Hansen W, Malotte C. Perceived personal immunity: The development of beliefs about susceptibility to the consequences of smoking. Prev Med 1986;15: Ayanian J, Cleary P. Perceived risks of heart disease and cancer among cigarette smokers. JAMA 1999;281: Price J, Everett S. Perceptions of lung cancer and smoking in an economically disadvantaged population. J Community Health 1994;19: Manfredi C, Lacey L, Warnecke R, Buis M. Smokingrelated behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago. Am J Public Health 1992;82: Schoenbaum M. Do smokers understand the mortality effects of smoking? Am J Public Health 1997;87: Weinstein N. Why it won t happen to me: Perceptions of risk factors and susceptibility. Health Psychol 1984; 3: Borland R. What do people s estimates of smoking related risk mean? Psychol Health 1997;12: Weinstein N. What does it mean to understand a risk? Evaluating risk comprehension. J Natl Cancer Inst Monogr 1999;25: Ries L, Eisner M, Kosary C, et al. The SEER cancer statistics review, Bethesda, MD: National Cancer Institute, Mosca L, Manson J, Sutherland S, Langer R, Manolio T, Barrett-Connor E. Cardiovascular disease in women. Circulation 1997;96: Willett W, Green A, Stampfer M, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med 1987;317: Rich-Edwards J, Manson J, Hennekens C, Buring J. The primary prevention of coronary heart disease in women. N Engl J Med 1995;332: Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. JAMA 1998;280: Mosca L, Collins P, Herrington D, et al. Hormone replacement therapy and cardiovascular disease: A statement for healthcare professionals from the American Heart Association. Circulation 2001;104: Gerrard M, Gibbons F, Reis-Bergan M. The effect of risk communication on risk perceptions: The significance of individual differences. J Natl Cancer Inst Monogr 1999;25: Prochaska J, DiClemente C. Stage and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol 1983;51: Weinstein N, Lyon J, Sandman P, Cuite C. Experimental evidence for stages of health behavior change:

9 WOMEN SMOKERS PERCEPTIONS OF SMOKING RISK 371 The Precaution Adoption Process Model applied to home radon testing. Health Psychol 1998;17: Chan C, Witherspoon J. Health risk appraisal modifies cigarette smoking behavior among college students. J Gen Intern Med 1988;3: Lerman C, Gold K, Audrain J, et al. Incorporating biomarkers of exposure and genetic susceptibility into smoking cessation treatment: Effects on smoking-related cognitions, emotions, and behavior change. Health Psychol 1997;16: Fiore M, Bailey W, Cohen S, et al. Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, CDC. Cigarette smoking among adults United States, MMWR 2001;50: CDC. Smokers beliefs about the health benefits of smoking cessation 20 U.S. Communities, MMWR 1990;39:653. Address correspondence to: Susan Moran, M.D., M.S.C.E. MGH Tobacco Research and Treatment Center 50 Staniford Street, 9th Floor Boston, MA smoran1@partners.org

BRIEF REPORT OPTIMISTIC BIAS IN ADOLESCENT AND ADULT SMOKERS AND NONSMOKERS

BRIEF REPORT OPTIMISTIC BIAS IN ADOLESCENT AND ADULT SMOKERS AND NONSMOKERS Pergamon Addictive Behaviors, Vol. 25, No. 4, pp. 625 632, 2000 Copyright 2000 Elsevier Science Ltd. Printed in the USA. All rights reserved 0306-4603/00/$ see front matter PII S0306-4603(99)00072-6 BRIEF

More information

Menopausal hormone therapy currently has no evidence-based role for

Menopausal hormone therapy currently has no evidence-based role for IN PERSPECTIVE HT and CVD Prevention: From Myth to Reality Nanette K. Wenger, M.D. What the studies show, in a nutshell The impact on coronary prevention Alternative solutions Professor of Medicine (Cardiology),

More information

CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO

CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO OHIO MEDICAID ASSESSMENT SURVEY 2012 Taking the pulse of health in Ohio CHRONIC DISEASE PREVALENCE AMONG ADULTS IN OHIO Amy Ferketich, PhD Ling Wang, MPH The Ohio State University College of Public Health

More information

T he familiar idea that people begin to smoke cigarettes or

T he familiar idea that people begin to smoke cigarettes or 55 RESEARCH PAPER Smokers unrealistic optimism about their risk N D Weinstein, S E Marcus, R P Moser... See end of article for authors affiliations... Correspondence to: Neil D Weinstein, PhD, Department

More information

A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE

A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE RESULTS FROM THE ADMINISTRATION OF THE DELAWARE YOUTH TOBACCO SURVEY IN SPRING 00 Delaware Health and Social Services Division

More information

Introduction, Summary, and Conclusions

Introduction, Summary, and Conclusions Chapter 1 Introduction, Summary, and Conclusions David M. Burns, Lawrence Garfinkel, and Jonathan M. Samet Cigarette smoking is the largest preventable cause of death and disability in developed countries

More information

Hormone therapy. Dr. med. Frank Luzuy

Hormone therapy. Dr. med. Frank Luzuy Hormone therapy Dr. med. Frank Luzuy Reasons for Initiating/Continuing HT* Menopause-Related Symptoms Osteoporosis, Bone Loss, Fracture Prevention Doctor Prescribed It, Told Me to Take It Cardiovascular

More information

Impact of UNC Health Care s Tobacco-Free Hospital Campus Policy on Hospital Employees

Impact of UNC Health Care s Tobacco-Free Hospital Campus Policy on Hospital Employees Impact of UNC Health Care s Tobacco-Free Hospital Campus Policy on Hospital Employees February 5, 2008 Prepared for: UNC Health Care Prepared by: UNC School of Medicine Nicotine Dependence Program For

More information

Cessation and Cessation Measures

Cessation and Cessation Measures Cessation and Cessation Measures among Adult Daily Smokers: National and State-Specific Data David M. Burns, Christy M. Anderson, Michael Johnson, Jacqueline M. Major, Lois Biener, Jerry Vaughn, Thomas

More information

TOBACCO USE AMONG AFRICAN AMERICANS

TOBACCO USE AMONG AFRICAN AMERICANS TOBACCO USE AMONG AFRICAN AMERICANS Each year, approximately 45,000 African Americans die from smoking-related disease. 1 Smoking-related illnesses are the number one cause of death in the African-American

More information

Kathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School

Kathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School Update: Hormones and Cardiovascular Disease in Women Kathryn M. Rexrode, MD, MPH Assistant Professor Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School Overview Review

More information

2010 Community Health Needs Assessment Final Report

2010 Community Health Needs Assessment Final Report 2010 Community Health Needs Assessment Final Report April 2011 TABLE OF CONTENTS A. BACKGROUND 3 B. DEMOGRAPHICS 4 C. GENERAL HEALTH STATUS 10 D. ACCESS TO CARE 11 E. DIABETES 12 F. HYPERTENSION AWARENESS

More information

The New England Journal of Medicine

The New England Journal of Medicine The New England Journal of Medicine Copyright, 1997, by the Massachusetts Medical Society VOLUME 336 J UNE 19, 1997 NUMBER 25 POSTMENOPAUSAL HORMONE THERAPY AND MORTALITY FRANCINE GRODSTEIN, SC.D., MEIR

More information

Smoking Status and Body Mass Index in the United States:

Smoking Status and Body Mass Index in the United States: Smoking Status and Body Mass Index in the United States: 1996-2000 Jun Yang, MD, PhD and Gary Giovino, PhD Roswell Park Cancer Institute Elm and Carlton Streets Buffalo, NY 14263, USA Society for Research

More information

Performance Measure Name: Tobacco Use: Assessing Status after Discharge

Performance Measure Name: Tobacco Use: Assessing Status after Discharge Measure Information Form Collected For: The Joint Commission Only CMS Informational Only Measure Set: Tobacco Treatment (TO) Set Measure ID #: Last Updated: New Measure Version 4.0 Performance Measure

More information

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Biases in clinical research Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Learning objectives Describe the threats to causal inferences in clinical studies Understand the role of

More information

Marketing a healthier choice: Exploring young people s perception of e-cigarettes

Marketing a healthier choice: Exploring young people s perception of e-cigarettes Marketing a healthier choice: Exploring young people s perception of e-cigarettes Abstract Background: As a consequence of insufficient evidence on the safety and efficacy of e- cigarettes, there has been

More information

Modelling Reduction of Coronary Heart Disease Risk among people with Diabetes

Modelling Reduction of Coronary Heart Disease Risk among people with Diabetes Modelling Reduction of Coronary Heart Disease Risk among people with Diabetes Katherine Baldock Catherine Chittleborough Patrick Phillips Anne Taylor August 2007 Acknowledgements This project was made

More information

Parental Attitudes toward Human Papilloma Virus Vaccine Participation of Adolescent Daughters in a Rural Population

Parental Attitudes toward Human Papilloma Virus Vaccine Participation of Adolescent Daughters in a Rural Population Diversity and Equality in Health and Care (2018) 15(4): 164-168 2018 Insight Medical Publishing Group Research Article Parental Attitudes toward Human Papilloma Virus Vaccine Participation of Adolescent

More information

Attitudes and Beliefs of Adolescent Experimental Smokers: A Smoking Prevention Perspective

Attitudes and Beliefs of Adolescent Experimental Smokers: A Smoking Prevention Perspective Attitudes and Beliefs of Adolescent Experimental Smokers: A Smoking Prevention Perspective By: Min Qi Wang, Eugene C. Fitzhugh, James M. Eddy, R. Carl Westerfield Wang, M.Q., Fitzhugh, E.C.*, Eddy, J.M.,

More information

Menthol Cigarettes, Smoking Cessation, Atherosclerosis and Pulmonary Function

Menthol Cigarettes, Smoking Cessation, Atherosclerosis and Pulmonary Function Center for Regulatory Effectiveness (CRE) assessment of the following research report: Menthol Cigarettes, Smoking Cessation, Atherosclerosis and Pulmonary Function By: Mark J. Pletcher, MD, MPH; Benjamin

More information

Screening and Resistance to Cessation Efforts

Screening and Resistance to Cessation Efforts Screening and Resistance to Cessation Efforts Elyse R. Park, Ph.D., MPH Associate Professor in Psychiatry, Massachusetts General Hospital/Harvard Medical School Funding Acknowledgements and Disclosures

More information

A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE :

A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE : A REPORT ON THE INCIDENCE AND PREVALENCE OF YOUTH TOBACCO USE IN DELAWARE : RESULTS FROM ADMINISTRATION OF THE DELAWARE YOUTH TOBACCO SURVEY IN SPRING 2000 Delaware Health and Social Services Division

More information

Despite substantial declines over the past decade,

Despite substantial declines over the past decade, 19 The journey to quitting smoking Margot Shields Abstract Objectives This article outlines smoking trends over the past 10 years among the population aged 18 or older. Factors associated with smoking

More information

ARTICLE. Access of Over-the-counter Nicotine Replacement Therapy Products to Minors

ARTICLE. Access of Over-the-counter Nicotine Replacement Therapy Products to Minors ARTICLE Access of Over-the-counter Nicotine Replacement Therapy Products to Minors Karen C. Johnson, MD, MPH; Lisa M. Klesges, PhD; Grant W. Somes, PhD; Mace C. Coday, PhD; Margaret DeBon, PhD Background:

More information

Myths, Heart Disease and the Latino Population. Maria T. Vivaldi MD MGH Women s Heart Health Program. Hispanics constitute 16.3 % of US population!

Myths, Heart Disease and the Latino Population. Maria T. Vivaldi MD MGH Women s Heart Health Program. Hispanics constitute 16.3 % of US population! Myths, Heart Disease and the Latino Population Maria T. Vivaldi MD MGH Women s Heart Health Program Hispanics constitute 16.3 % of US population! 1 LEADING CAUSES OF DEATH IN LATINOS Heart disease is the

More information

Perceptions of cancer risk and self-care practices: comparison of groups at different risk for cancers

Perceptions of cancer risk and self-care practices: comparison of groups at different risk for cancers Title Perceptions of risk and self-care practices: comparison of groups at different risk for s Author(s) Fielding, R; Lam, WWT; Liao, Q; Lai, CL; Tsang, WHJ; Ip, DKM; Yuen, RMF Citation Hong Kong Medical

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Li S, Chiuve SE, Flint A, et al. Better diet quality and decreased mortality among myocardial infarction survivors. JAMA Intern Med. Published online September 2, 2013. doi:10.1001/jamainternmed.2013.9768.

More information

Predictors of smoking cessation among Chinese parents of young children followed up for 6 months

Predictors of smoking cessation among Chinese parents of young children followed up for 6 months Title Predictors of smoking cessation among Chinese parents of young children followed up for 6 months Author(s) Abdullah, ASM; Lam, TH; Loke, AY; Mak, YW Citation Hong Kong Medical Journal, 2006, v. 12

More information

CHANGING HEALTH BEHAVIOUR

CHANGING HEALTH BEHAVIOUR CHANGING HEALTH BEHAVIOUR Dr Sam Caton ScHARR s.caton@sheffield.ac.uk Learning objectives 1. Identify different types of heath behaviour 2. Identify the importance of understanding health behaviours 3.

More information

Heidi Mochari-Greenberger, Ph.D., M.P.H., 1 Thomas Mills, M.S., 2 Susan L. Simpson, Ph.D., 2 and Lori Mosca, M.D., M.P.H., Ph.D. 1

Heidi Mochari-Greenberger, Ph.D., M.P.H., 1 Thomas Mills, M.S., 2 Susan L. Simpson, Ph.D., 2 and Lori Mosca, M.D., M.P.H., Ph.D. 1 JOURNAL OF WOMEN S HEALTH Volume 19, Number 7, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089=jwh.2009.1749 Original Article Knowledge, Preventive Action, and Barriers to Cardiovascular Disease Prevention

More information

Dr. Wonkyong Beth Lee, The University of Western Ontario, Canada February 13, 2013

Dr. Wonkyong Beth Lee, The University of Western Ontario, Canada February 13, 2013 Dr. Wonkyong Beth Lee, The University of Western Ontario, Canada February 13, 2013 1 Smoking is the cause of one in five cancer deaths Globally, 1.1 billion are current smokers 10 million deaths each year

More information

Risk Factors and Primary and Secondary Prevention of Coronary Heart Disease

Risk Factors and Primary and Secondary Prevention of Coronary Heart Disease Special Issue Risk Factors and Primary and Secondary Prevention of Coronary Heart Disease Shung Chull Chae, M.D. Department of Internal Medicine / Division of Cardiology Kyungpook National University College

More information

Postmenopausal hormones and coronary artery disease: potential benefits and risks

Postmenopausal hormones and coronary artery disease: potential benefits and risks CLIMACTERIC 2007;10(Suppl 2):21 26 Postmenopausal hormones and coronary artery disease: potential benefits and risks R. A. Department of Obstetrics and Gynecology, Columbia University, New York, New York,

More information

Misperceptions still exist that cardiovascular disease is not a real problem for women.

Misperceptions still exist that cardiovascular disease is not a real problem for women. Management of Cardiovascular Risk Factors in the Cynthia A., MD University of California, San Diego ARHP 9/19/08 Disclosures Research support Wyeth, Lilly, Organon, Novo Nordisk, Pfizer Consultant fees

More information

Declaration of Conflict of Interest. No potential conflict of interest to disclose with regard to the topics of this presentations.

Declaration of Conflict of Interest. No potential conflict of interest to disclose with regard to the topics of this presentations. Declaration of Conflict of Interest No potential conflict of interest to disclose with regard to the topics of this presentations. Clinical implications of smoking relapse after acute ischemic stroke Furio

More information

IUPUI Campus Smoking Survey Methods and Preliminary Findings January, 2004

IUPUI Campus Smoking Survey Methods and Preliminary Findings January, 2004 IUPUI Campus Smoking Survey Methods and Preliminary Findings January, 2004 Background: Indiana University-Purdue University Indianapolis (IUPUI) is a major urban university located within Marion County,

More information

Predictors of Cigarette Smoking Behavior Among Military University Students in Taiwan. Wang, Kwua-Yun; Yang, Chia-Chen

Predictors of Cigarette Smoking Behavior Among Military University Students in Taiwan. Wang, Kwua-Yun; Yang, Chia-Chen The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

WHI, HERS y otros estudios: Su significado en la clinica diária. Manuel Neves-e-Castro

WHI, HERS y otros estudios: Su significado en la clinica diária. Manuel Neves-e-Castro WHI, HERS y otros estudios: Su significado en la clinica diária III Congreso Ecuatoriano de Climaterio Menopausia y Osteoporosis por Manuel Neves-e-Castro (Lisboa-Portugal) Julho, 2003 Machala The published

More information

Page down (pdf converstion error)

Page down (pdf converstion error) 1 of 6 2/10/2005 7:57 PM Weekly August6, 1999 / 48(30);649-656 2 of 6 2/10/2005 7:57 PM Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999

More information

Wellness Coaching for People with Prediabetes

Wellness Coaching for People with Prediabetes Wellness Coaching for People with Prediabetes PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY Volume 12, E207 NOVEMBER 2015 ORIGINAL RESEARCH Wellness Coaching for People With Prediabetes: A Randomized Encouragement

More information

Performance Measure Name: TOB-3 Tobacco Use Treatment Provided or Offered at Discharge TOB-3a Tobacco Use Treatment at Discharge

Performance Measure Name: TOB-3 Tobacco Use Treatment Provided or Offered at Discharge TOB-3a Tobacco Use Treatment at Discharge Measure Information Form Collected For: The Joint Commission Only CMS Informational Only Measure Set: Tobacco Treatment (TOB) Set Measure ID #: Last Updated: New Measure Version 4.0 Performance Measure

More information

Changes in Number of Cigarettes Smoked per Day: Cross-Sectional and Birth Cohort Analyses Using NHIS

Changes in Number of Cigarettes Smoked per Day: Cross-Sectional and Birth Cohort Analyses Using NHIS Changes in Number of Cigarettes Smoked per Day: Cross-Sectional and Birth Cohort Analyses Using NHIS David M. Burns, Jacqueline M. Major, Thomas G. Shanks INTRODUCTION Smoking norms and behaviors have

More information

HORMONE REPLACEMENT THERAPY

HORMONE REPLACEMENT THERAPY TRIALS OF HR RUTH (Barrett- Connor et al 29 ) JULY 2006 (Country) mean ± sd, range International trial 67.5 an Placebo component in 67.5 ± 6.7 women with Raloxifene or multiple 67.5 ± 6.6 risk factors

More information

Current Use of Unopposed Estrogen and Estrogen Plus Progestin and the Risk of Acute Myocardial Infarction Among Women With Diabetes

Current Use of Unopposed Estrogen and Estrogen Plus Progestin and the Risk of Acute Myocardial Infarction Among Women With Diabetes Current Use of Unopposed Estrogen and Estrogen Plus Progestin and the Risk of Acute Myocardial Infarction Among Women With Diabetes The Northern California Kaiser Permanente Diabetes Registry, 1995 1998

More information

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes FRANK B. HU, MD 1,2,3 MEIR J. STAMPFER,

More information

Perceived Recurrence Risk and Health Behavior Change Among Breast Cancer Survivors

Perceived Recurrence Risk and Health Behavior Change Among Breast Cancer Survivors University of Massachusetts Amherst ScholarWorks@UMass Amherst Masters Theses 1911 - February 2014 2013 Perceived Recurrence Risk and Health Behavior Change Among Breast Cancer Survivors E Konieczny University

More information

Bias. A systematic error (caused by the investigator or the subjects) that causes an incorrect (overor under-) estimate of an association.

Bias. A systematic error (caused by the investigator or the subjects) that causes an incorrect (overor under-) estimate of an association. Bias A systematic error (caused by the investigator or the subjects) that causes an incorrect (overor under-) estimate of an association. Here, random error is small, but systematic errors have led to

More information

Brief interventions delivered in GP surgeries to improve quit rates

Brief interventions delivered in GP surgeries to improve quit rates Brief interventions delivered in GP surgeries to improve quit rates Matrix Insight, in collaboration with Imperial College London, Kings College London and Bazian Ltd, were commissioned by Health England

More information

Asthma and Tobacco: Double Trouble for Wisconsin Adolescents

Asthma and Tobacco: Double Trouble for Wisconsin Adolescents Asthma and Tobacco: Double Trouble for Wisconsin Adolescents Livia Navon, MS, RD; Beth Fiore, MS; Henry Anderson, MD ABSTRACT Background: Environmental tobacco smoke (ETS) exposure has been identified

More information

CLINICIAN INTERVIEW CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN

CLINICIAN INTERVIEW CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN Nanette K. Wenger, MD, is a recognized authority on women and coronary heart disease. She chaired the US National Heart, Lung, and Blood Institute conference

More information

Patterns of adolescent smoking initiation rates by ethnicity and sex

Patterns of adolescent smoking initiation rates by ethnicity and sex ii Tobacco Control Policies Project, UCSD School of Medicine, San Diego, California, USA C Anderson D M Burns Correspondence to: Dr DM Burns, Tobacco Control Policies Project, UCSD School of Medicine,

More information

EliScholar A Digital Platform for Scholarly Publishing at Yale

EliScholar A Digital Platform for Scholarly Publishing at Yale Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Public Health Theses School of Public Health January 2015 Evaluating The Effectiveness Of Smoking Cessation Intervention Program

More information

The 5A's are practice guidelines on tobacco use prevention and cessation treatment (4):

The 5A's are practice guidelines on tobacco use prevention and cessation treatment (4): Smoking Cessation Module Tobacco use is the single greatest preventable cause of chronic diseases and premature deaths worldwide. The Canadian Cancer Society reports that tobacco product use is responsible

More information

Getting to Quit: Smoking Cessation Initiatives. Women in Government National Legislative Conference June 22, 2018

Getting to Quit: Smoking Cessation Initiatives. Women in Government National Legislative Conference June 22, 2018 Getting to Quit: Smoking Cessation Initiatives Women in Government National Legislative Conference June 22, 2018 KATRINA F. TRIVERS, PHD, MSPH LEAD EPIDEMIOLOGIST OFFICE ON SMOKING AND HEALTH 1 Acknowledgements

More information

Perceived Effectiveness of Pictorial versus Textual Health Warning Labels on Waterpipe Tobacco Packages (Tumbac packages)

Perceived Effectiveness of Pictorial versus Textual Health Warning Labels on Waterpipe Tobacco Packages (Tumbac packages) Perceived Effectiveness of Pictorial versus Textual Health Warning Labels on Waterpipe Tobacco Packages (Tumbac packages) NELLY LAYOUN, PhD, MPH Epidemiologist Misperceived as less harmful than cigarette

More information

H istorically, smoking prevalence surveillance data were

H istorically, smoking prevalence surveillance data were 178 RESEARCH PAPER Improving the self reporting of tobacco use: results of a factorial experiment D W Cowling, T P Johnson, B C Holbrook, R B Warnecke, H Tang... See end of article for authors affiliations...

More information

Parental Opinions of Anti-Tobacco Messages within a Pediatric Dental Office

Parental Opinions of Anti-Tobacco Messages within a Pediatric Dental Office Parental Opinions of Anti-Tobacco Messages within a Pediatric Dental Office Kari Sims, DDS June 10, 2014 MCH 2014 Research Festival THESIS COMMITTEE Penelope J. Leggott, BDS, MS Melissa A. Schiff, MD,

More information

The impact of workplace smoking bans: results from a national survey

The impact of workplace smoking bans: results from a national survey 272 Center for Economics Research, Research Triangle Institute, 3040 Cornwallis Rd, Research Triangle Park, North Carolina, USA M C Farrelly A E S Sfekas Department of Economics, University of Maryland,

More information

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Biases in clinical research Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Learning objectives Understand goal of measurement and definition of accuracy Describe the threats to causal

More information

The Healthy User Effect: Ubiquitous and Uncontrollable S. R. Majumdar, MD MPH FRCPC FACP

The Healthy User Effect: Ubiquitous and Uncontrollable S. R. Majumdar, MD MPH FRCPC FACP The Healthy User Effect: Ubiquitous and Uncontrollable S. R. Majumdar, MD MPH FRCPC FACP Professor of Medicine, Endowed Chair in Patient Health Management, Health Scholar of the Alberta Heritage Foundation,

More information

SMOKING RELAPSE ONE YEAR AFTER DELIVERY AMONG WOMEN WHO QUIT SMOKING DURING PREGNANCY

SMOKING RELAPSE ONE YEAR AFTER DELIVERY AMONG WOMEN WHO QUIT SMOKING DURING PREGNANCY International Journal of Occupational Medicine and Environmental Health, 2005;8(2):59 65 SMOKING RELAPSE ONE YEAR AFTER DELIVERY AMONG WOMEN WHO QUIT SMOKING DURING PREGNANCY KINGA POLAŃSKA, WOJCIECH HANKE,

More information

diagnosis and initial treatment at one of the 27 collaborating CCSS institutions;

diagnosis and initial treatment at one of the 27 collaborating CCSS institutions; Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the Partnership for Health Study Emmons K M, Puleo E, Park E, Gritz E R, Butterfield R M, Weeks J C, Mertens

More information

Perceived Risk of Tobacco Products among Adult Tobacco Users in Bangladesh and India. Natalie Sansone. A thesis

Perceived Risk of Tobacco Products among Adult Tobacco Users in Bangladesh and India. Natalie Sansone. A thesis Perceived Risk of Tobacco Products among Adult Tobacco Users in Bangladesh and India by Natalie Sansone A thesis presented to the University of Waterloo in fulfillment of the thesis requirement for the

More information

Current Cigarette Smoking Among Workers in Accommodation and Food Services United States,

Current Cigarette Smoking Among Workers in Accommodation and Food Services United States, Current Cigarette Among Workers in Accommodation and Food Services United States, 2011 2013 Girija Syamlal, MPH 1 ; Ahmed Jamal, MBBS 2 ; Jacek M. Mazurek, MD 1 (Author affiliations at end of text) Tobacco

More information

How Well Are We Protected? Secondhand Smoke Exposure and Smokefree Policies in Missouri

How Well Are We Protected? Secondhand Smoke Exposure and Smokefree Policies in Missouri How Well Are We Protected? Secondhand Smoke Exposure and Smokefree Policies in Missouri July 11 How Well Are We Protected? Secondhand Smoke Exposure and Smokefree Policies in Missouri July 11 Prepared

More information

General Biostatistics Concepts

General Biostatistics Concepts General Biostatistics Concepts Dongmei Li Department of Public Health Sciences Office of Public Health Studies University of Hawai i at Mānoa Outline 1. What is Biostatistics? 2. Types of Measurements

More information

Diabetes and Tobacco: A Harmful Combination

Diabetes and Tobacco: A Harmful Combination Diabetes and Tobacco: A Harmful Combination IDPH Satellite Teleconference, May 5, 2009 Sandra Drozdz Burke, PhD, RN, CDE Clinical Assistant Professor and Associate Director UIC College of Nursing, Central

More information

Changing People s Behavior. Larry Wissow Professor Health, Behavior and Society Johns Hopkins School of Public Health

Changing People s Behavior. Larry Wissow Professor Health, Behavior and Society Johns Hopkins School of Public Health This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Michele Clements-Thompson and Robert C. Klesges University of Memphis Prevention Center. Harry Lando University of Minnesota

Michele Clements-Thompson and Robert C. Klesges University of Memphis Prevention Center. Harry Lando University of Minnesota Journal of Consulting and Clinical Psychology 1998, Vol. 66, No 6, 1005-1011 Copyright 1998 by the Am n Psychological Association, Inc. 0022-006X/98/S3.0C Relationships Between Stages of Change in Cigarette

More information

Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals

Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals Literature Review (January 2009) Hormone Therapy for Women Women's Health

More information

ISSN: Asian Journal of Medical and Pharmaceutical Researches Asian J. Med. Pharm. Res. 4 (1): 24-29, 2014

ISSN: Asian Journal of Medical and Pharmaceutical Researches Asian J. Med. Pharm. Res. 4 (1): 24-29, 2014 \\\\ Received 4 Dec. 3 Accepted Jan. 4 ORIGINAL ARTICLE 4, Scienceline Publication www.science-line.com ISSN: 3-4789 Asian Journal of Medical and Pharmaceutical Researches Asian J. Med. Pharm. Res. 4 ():

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Gartlehner G, Patel SV, Feltner C, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: Evidence Report and Systematic Review for

More information

Impacts of Early Exposure to Work on Smoking Initiation Among Adolescents and Older Adults: the ADD Health Survey. David J.

Impacts of Early Exposure to Work on Smoking Initiation Among Adolescents and Older Adults: the ADD Health Survey. David J. Impacts of Early Exposure to Work on Smoking Initiation Among Adolescents and Older Adults: the ADD Health Survey David J. Lee, PhD University of Miami Miller School of Medicine Department of Public Health

More information

FACTORS ASSOCIATED WITH THE INTENTIONS TO QUIT AND WILLINGNESS TO QUIT AMONG WATERPIPE ADULT SMOKERS IN LEBANON

FACTORS ASSOCIATED WITH THE INTENTIONS TO QUIT AND WILLINGNESS TO QUIT AMONG WATERPIPE ADULT SMOKERS IN LEBANON FACTORS ASSOCIATED WITH THE INTENTIONS TO QUIT AND WILLINGNESS TO QUIT AMONG WATERPIPE ADULT SMOKERS IN LEBANON Souheil Hallit, Pharm.D., MSc, MPH, PhD candidate Director of Research- Psychiatric Hospital

More information

Youth Smoking. An assessment of trends in youth smoking through Wisconsin Department of Health and Family Services. Percent.

Youth Smoking. An assessment of trends in youth smoking through Wisconsin Department of Health and Family Services. Percent. Youth Smoking in Wisconsin: An assessment of trends in youth smoking through 24 United Wisco 7 6 5 4 Females Males 8 7 6 3 2 1993 2 21 22 2 6 5 4 65 64 66 62 63 58 53 55 51 53 5 4 3 2 2 21 22 23 24 12

More information

RADM Patrick O Carroll, MD, MPH Senior Advisor, Assistant Secretary for Health, US DHSS

RADM Patrick O Carroll, MD, MPH Senior Advisor, Assistant Secretary for Health, US DHSS Ending the Tobacco Epidemic RADM Patrick O Carroll, MD, MPH Senior Advisor, Assistant Secretary for Health, US DHSS Tim McAfee, MD, MPH Senior Medical Officer, Office on Smoking and Health, CDC www.nwcphp.org/hot-topics

More information

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults ORIGINAL INVESTIGATION C-Reactive Protein Concentration and Incident Hypertension in Young Adults The CARDIA Study Susan G. Lakoski, MD, MS; David M. Herrington, MD, MHS; David M. Siscovick, MD, MPH; Stephen

More information

Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L

Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L Record Status This is a critical abstract of an economic

More information

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN)

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN) NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia Produced by: National Cardiovascular Intelligence Network (NCVIN) Date: August 2015 About Public Health England Public Health England

More information

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Biases in clinical research Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Learning objectives Describe the threats to causal inferences in clinical studies Understand the role of

More information

American Medical Women s Association Position Paper on Principals of Women & Coronary Heart Disease

American Medical Women s Association Position Paper on Principals of Women & Coronary Heart Disease American Medical Women s Association Position Paper on Principals of Women & Coronary Heart Disease AMWA is a leader in its dedication to educating all physicians and their patients about heart disease,

More information

School of Health Science & Nursing, Wuhan Polytechnic University, Wuhan , China 2. Corresponding author

School of Health Science & Nursing, Wuhan Polytechnic University, Wuhan , China 2. Corresponding author 2017 International Conference on Medical Science and Human Health (MSHH 2017) ISBN: 978-1-60595-472-1 Association of Self-rated Health Status and Perceived Risk Among Chinese Elderly Patients with Type

More information

Cardiovascular Risk Assessment and Management Making a Difference

Cardiovascular Risk Assessment and Management Making a Difference Cardiovascular Risk Assessment and Management Making a Difference Norman Sharpe March 2014 Numbers and age-standardised mortality rates from all causes, by sex, 1950 2010 Death rates halved Life expectancy

More information

Secondhand tobacco smoke and multi-unit Housing: Translating research into public policy

Secondhand tobacco smoke and multi-unit Housing: Translating research into public policy Secondhand tobacco smoke and multi-unit Housing: Translating research into public policy Karen Wilson, MD, MPH Debra and Leon Black Professor and Division Chief of General Pediatrics and Vice-Chair for

More information

Data Highlights from the 2013 Hawai'i Youth Tobacco Survey (YTS) and Comparisons with Prior Years

Data Highlights from the 2013 Hawai'i Youth Tobacco Survey (YTS) and Comparisons with Prior Years Data Highlights from the Hawai'i Youth Tobacco Survey (YTS) and Comparisons with Prior Years Tobacco Prevention and Control Program Chronic Disease Management and Control Branch Tobacco Settlement Project

More information

ORIGINAL ARTICLES. Factors associated with smoking cessation in South Africa. Methods. Olalekan A Ayo-Yusuf, Ben Szymanski

ORIGINAL ARTICLES. Factors associated with smoking cessation in South Africa. Methods. Olalekan A Ayo-Yusuf, Ben Szymanski Factors associated with smoking cessation in South Africa Olalekan A Ayo-Yusuf, Ben Szymanski Objectives. To determine the factors associated with attempting to quit smoking and successfully doing so,

More information

Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women

Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women 07/14/2010 Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women First Author: Wang Short Title: Dietary Fatty Acids and Hypertension Risk in Women Lu Wang, MD, PhD, 1 JoAnn E.

More information

RE: FR-5597-N-01 Request for Information on Adopting Smoke-Free Policies in PHAs and Multifamily Housing

RE: FR-5597-N-01 Request for Information on Adopting Smoke-Free Policies in PHAs and Multifamily Housing Office of the Assistant Secretary for Housing Department of Housing and Urban Development RE: FR-5597-N-01 Request for Information on Adopting Smoke-Free Policies in PHAs and Multifamily Housing November

More information

SMOKING BEHAVIOUR OF CZECH ADOLESCENTS: RESULTS OF THE GLOBAL YOUTH TOBACCO SURVEY IN THE CZECH REPUBLIC, 2002

SMOKING BEHAVIOUR OF CZECH ADOLESCENTS: RESULTS OF THE GLOBAL YOUTH TOBACCO SURVEY IN THE CZECH REPUBLIC, 2002 Cent Eur J Publ Health 2004; 12 (1): 26-31 SMOKING BEHAVIOUR OF CZECH ADOLESCENTS: RESULTS OF THE GLOBAL YOUTH TOBACCO SURVEY IN THE CZECH REPUBLIC, 2002 Sovinová H. 1, Csémy L. 2 1 National Institute

More information

T obacco use has been identified by the World Health

T obacco use has been identified by the World Health iii19 RESEARCH PAPER Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey D Hammond, G T

More information

Why Is Theory Important?

Why Is Theory Important? Health Behavior Theories: Applying Theory to Practice Why Is Theory Important? Theory gives planners tools for moving beyond intuition. Consistent with the current emphasis on using evidence-based interventions

More information

Tobacco Use Percent (%)

Tobacco Use Percent (%) Tobacco Use 1 8 6 2 23 25 27 Lifetime cigarette use 64.8 62. 59.9 Current cigarette smoker 3.2 25.7 24.2 Current cigar smoker 19.4 21.3 18.9 First cigarette before age 13 24.7 2. 18. Current spit tobacco

More information

Introduction. Behavior Surveillance System (YRBSS),

Introduction. Behavior Surveillance System (YRBSS), 2015 Prepared for the Colorado Department of Education, Colorado Department of Human Services, and Colorado Department of Public Health & Environment by the University of Colorado Anschutz Community Epidemiology

More information

The Gender Divide Women, Men and Heart Disease February 2017

The Gender Divide Women, Men and Heart Disease February 2017 The Gender Divide Women, Men and Heart Disease February 2017 Nandita S. Scott, MD FACC Co-Director MGH Heart Center Corrigan Women s Heart Health Program Massachusetts General Hospital Heart Disease For

More information

GATS Highlights. GATS Objectives. GATS Methodology

GATS Highlights. GATS Objectives. GATS Methodology GATS Objectives GATS Highlights The Global Adult Tobacco Survey (GATS) is a global standard for systematically monitoring adult tobacco use (smoking and smokeless) and tracking key tobacco control indicators.

More information

REPORT ON GLOBAL YOUTH TOBACCO SURVEY SWAZILAND

REPORT ON GLOBAL YOUTH TOBACCO SURVEY SWAZILAND REPORT ON GLOBAL YOUTH TOBACCO SURVEY 2009 - SWAZILAND Introduction The tobacco epidemic Tobacco use is considered to be the chief preventable cause of death in the world. The World Health Organization

More information