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Biomedical subjects

D G Bal

Publications and source records attributed to D G Bal.

At least 19 recordsLinked to original sources
PubMed2001

California as a model.

One of every three persons who starts smoking falls ill and dies prematurely because he or she smoked. Smoking has been causally linked to heart disease, cancer, and respiratory diseases and continues to be the number one preventable cause of death in this country. To prevent these deaths and the incidence of these diseases, California's Tobacco Control Program was established in 1989 specifically to reduce tobacco use in the state. The strategy of the program is to "denormalize" tobacco. This strategy emphasizes three areas of programmatic activity: to counter pro-tobacco influences, to reduce exposure to environmental tobacco smoke, and to reduce access to tobacco products, with a focus on both social and commercial sources. A fourth priority area, cessation, is considered more of an outcome. California's Tobacco Control Program has touched the life of every Californian. Adult smoking prevalence in the state has gone from approximately 11% lower than the rest of the nation in 1988 to 20% lower in 1996. There are now approximately one million fewer smokers in California than would have been expected. Overall, per capita cigarette consumption has fallen by more than 50%. Seventy percent of adult smokers reported that they tried to quit in the last year. Exposure to secondhand smoke has plummeted. California's lung and bronchus cancer incidence is already declining at a significantly higher rate than that seen elsewhere in the nation. Youth smoking rates have also declined significantly. However, contrary to the message of its massive public relations campaign, the tobacco industry has not changed its stripes after the national tobacco settlement. They are still aggressively marketing their products to teenagers, ethnic minority groups, and young adults. They need to be combatted with renewed vigor by a vigilant health community.

Adolescent↗
PubMed1999

The American Cancer Society challenge goals. How far can cancer rates decline in the U.S. by the year 2015?

BACKGROUND: Cancer incidence and mortality rates both began to decline in the U. S. in the early 1990s. Recognizing the unprecedented potential benefits of accelerating this decline, the American Cancer Society (ACS) has set ambitious challenge goals for the American public for a 25% reduction in cancer incidence rates and a 50% reduction in cancer mortality rates by the year 2015. This analysis examined the feasibility of reaching those goals by estimating future changes in cancer rates that can result from past and future reductions in cancer risk factors. METHODS: Estimates for future declines in cancer risk factors in the U. S. under alternative scenarios were applied to conservative population-attributable risk estimates for cancer incidence and mortality rates in 1990 to estimate cancer rate trends in the year 2015. RESULTS: If the current trends toward a decline in the prevalence of cancer risk factors continue over the next decade, by the year 2015 one can expect a 13% decline in cancer incidence rates and a 21% decline in cancer mortality rates below their 1990 levels. With redoubled efforts to reduce the prevalence of known cancer risk factors further, by the year 2015 cancer incidence rates could be reduced by 19% and cancer mortality rates reduced by 29%. Such redoubled efforts would equate to approximately 100,000 cancer cases and 60,000 cancer deaths prevented each year by the year 2015. CONCLUSIONS: Past reductions in cancer risk factors in the U.S. population have led to recent declines in the rates of cancer incidence and mortality in the U.S. Redoubled efforts to act on current knowledge regarding how to prevent, detect, and treat cancer can result in attaining approximately 80% of the ACS challenge goal for cancer incidence rates and 60% of the ACS challenge goal for cancer mortality rates by the year 2015. New findings from cancer research are needed and will have to be applied quickly if the ACS challenge goals are to be met fully.

Forecasting↗
PubMed1998

Designing an effective statewide tobacco control program--California.

In this report, the author traces the history of the development of the first statewide tobacco control program, from its early obstacles and legislative-imposed deadline through the development of its three priority areas. Woven into this review is Dr. Bal's emphasis on the role of a cohesive leadership tied into the needs of the tobacco control constituency.

California↗
PubMed1996

The future of cancer control research and translation.

The future holds great promise for translating advances in cancer control research to populations at risk-much is known about how to prevent cancer. Within the Institute of Medicines overall framework of assessment, policy development, and assurance, this article summarizes 10 cancer control priorities. Important themes include evaluation, cost-effectiveness analysis, shrinking the "latency period" between elucidation of preventive technologies and widespread application, coalition building, and development of adequate cancer control resources. Despite increased cancer control efforts among public health agencies over the past decade, little measurable progress has been made in reducing overall cancer mortality. A renewed commitment to controlling cancer is needed from health policy makers and even the public health community.

Decision Making, Computer-Assisted↗
PubMed1994

Advocacy and government action for cancer prevention in older persons.

Government action and the advocacy activities that influence it are as important a concern for cancer control as they are for any other public issue. Policy advocacy strategies have proven themselves effective in cancer prevention efforts involving tobacco use and nutrition. Much of what has been learned from this experience can be applied with great effect in advocacy efforts for other cancer control measures. The implementation of Proposition 99, the 1988 tobacco tax initiative in California, illustrates the effectiveness of aggressive policy advocacy strategies such as provocative paid advertising, mobilization through coalitions, and community-level public relations, to bring about government action at all levels of government and in the private sector. Today, largely as a result of these activities, more than 70 of California's 471 cities have a 100% smokefree workplace and/or a 100% smokefree restaurant ordinance, and nearly 300 cities currently have ordinances that restrict smoking pollution and/or restrict youth access to cigarette vending machines. About 150 cities have ordinances that were either adopted or greatly strengthened since 1990 when the program hit the streets. Ironically, although the primary aim of these strategies has been to reduce uptake of tobacco use by adolescents, the program's gains so far--including the reduction in adult smoking prevalence from 26% in 1988 to 20% in 1993, for an estimated savings in 1993 alone of $386 million in direct medical costs in the state--have been the result of adult smokers quitting, especially those older than 50.

Adolescent↗
PubMed1994

Estimates of population smoking prevalence: self-vs proxy reports of smoking status.

OBJECTIVES: In the face of rising costs of surveillance systems, it is time to reexamine the feasibility of including proxy respondents in surveys designed to provide population estimates of smoking prevalence. METHODS: Data are from the California. Tobacco Surveys, which are random-digit dialed telephone surveys. One adult provided demographic information and smoking status for all household residents. Additionally, some adults were selected for in-depth interviews that also included smoking status questions. We matched information from proxy respondents and self-respondents and evaluated smoking status discrepancies between them relative to demographic and other factors (n = 2930 matched pairs) in 1992. We address the potential bias these discrepancies might introduce into the population estimate of smoking prevalence. RESULTS: Overall, the discrepancy between proxy report and self-report was 4.3%, and it increased particularly when the self-respondent reported nondaily smoking or recent quitting. Discrepancies acted in both directions, and the net bias was that the screener survey overestimated smoking prevalence by 0.1% in 1992 (0.3% in 1990). CONCLUSIONS: Smoking status questions can be added to ongoing surveys such as the census or labor force surveys; one adult could provide smoking status for all household members.

Adult↗
PubMed1993

Dietary strategies for cancer prevention.

BACKGROUND: Two-thirds of cancer cases are associated with two lifestyle practices: 35% with the typical American diet, and 30% with tobacco use. In contrast to the field of tobacco control, research and resources dedicated to the field of nutrition have been limited, in part because dietary change has been considered controversial and requires a more complex set of interventions. METHODS: This series of papers reviews the science base underlying diet as a cancer control strategy, including research about diet-cancer relationships, current nutrition policy recommendations, American dietary trends, models of dietary behavior change, and diet in health care delivery. The history of technology transfer of new knowledge into widespread application will be compared and contrasted with other cancer control measures. RESULTS: There is scientific and policy agreement about three priority dietary goals for the year 2000: increase fruit and vegetable consumption to 5 or more servings every day, increase breads, cereals, and legumes to 6 or more servings daily, and decrease fat to no more than 30% of total calories. Current data do not indicate that these goals will be reached. As yet there is no organized effort, with clearly identified steps, to translate research into practice. The parallel with delays in implementing other cancer control measures, including Papanicolaou testing, mammography, and tobacco intervention, is striking. CONCLUSION: Without resources dedicated to dietary modification in the general population, it is not likely that the potential savings of more than 300,000 new cases, 160,000 deaths, and the $25 billion in associated costs will be realized in the foreseeable future.

American Cancer Society↗
PubMed1992

First-year impact of the 1989 California cigarette tax increase on cigarette consumption.

We employed a time series design to evaluate the impact of the 1989 California cigarette tax increase on cigarette consumption in California. Adult per capita consumption data from 1980 to 1990 were analyzed for California and the United States. Trend data indicated a sharp drop in California cigarette consumption coincident with the tax increase. Time-series regression analyses support this observation, and suggest that a 5% to 7% decline in consumption is attributable to the tax increase.

California↗
PubMed1991

Changing the American diet. Impact on cancer prevention policy recommendations and program implications for the American Cancer Society.

In 1984, the American Cancer Society (ACS) determined that a substantial proportion of new cancer cases could be avoided if seven dietary guidelines were followed. Education programs were developed for the general public, young people, and the mass media. In 1989, a Working Group of the Society reviewed the guidelines and found them to be valid, the only change being to combine two of them. This paper summarizes recent dietary recommendations of other health authorities, describes progress in meeting ACS dietary recommendations, analyzes the barriers to and opportunities for dietary improvement, and proposes new leadership opportunities for the Society. Concern is expressed that the current guidelines lack the clarity and specificity needed for public education, and that they are inconsistent with recent dietary recommendations of other authorities such as the US Department of Health and Human Services and the National Academy of Sciences. Revisions to the ACS Dietary Recommendations and implications for ACS programs are proposed.

American Cancer Society↗
PubMed1991

Prevention and changing demographics. The underserved and cancer.

This paper illustrates the complexity of the "cancer control in the underserved" problem, especially as it is affected currently, and will be in the future, by the multiple demographic changes in the United States. It does so by extensively quoting from four rather different articles by authors from a variety of backgrounds in health, management, and economics. Another issue is that although the articles quoted refer mainly to secondary and tertiary prevention, they do apply equally to primary prevention and health promotion. Furthermore, the twin issues of priority and ethnic/cultural differences need to be addressed insofar as they affect health risks, risk reduction efforts, early diagnosis, treatment, and rehabilitation/disability reduction. Finally, the point is made that social and structural change of this magnitude cannot occur in the health care system and society at large without the allocation of discrete private and public sector resources.

Demography↗
PubMed1990

Reducing tobacco consumption in California. Development of a statewide anti-tobacco use campaign.

Cigarette smoking continues to be the leading preventable cause of death in California and the United States. Although substantial progress has been made over the past 25 years, there is growing recognition of the need for large-scale efforts to reduce tobacco use. Given their central roles in implementing public health programs and their ability to reach many of the groups most at risk of tobacco use uptake and tobacco-related disease, state health agencies have an important challenge before them. This article describes the development and operation of a statewide, publicly funded anti-tobacco use campaign currently undertaken by the California Department of Health Services under the auspices of the state's Tobacco Tax and Health Promotion Act of 1988 (Proposition 99), which increased excise taxes on cigarettes by 25 cents per pack sold in the state. A discussion of problems in implementation and operation being incurred may be relevant to the planning of similar campaigns elsewhere.

Adolescent↗
PubMed1990

The natural history of atherosclerosis: an ecologic perspective.

Virologic findings reported in recent atherosclerosis literature may have profound implications. To assess them, we have viewed atherosclerosis in a broad biologic context and against a background of environmental, behavioral, and social change. Reasonable grounds exist, we believe, for regarding atherosclerosis as a chronic, low-grade infectious macroangiopathy which is aggravated by hypercholesterolemia and other recognized risk factors. There are probably multiple infective pathogens and transmission routes. The putative agents that initiate atherosclerosis might include ubiquitous viruses that produce clinically unapparent infections in many animal species. Pathways for their transmission to humans may include the food chain and contaminated water. Food-chain transmission may have been largely responsible for the parallel increases of meat consumption and mortality from coronary heart disease in the United States during the middle third of the century. It provides a hypothetical basis for considering thermal intervention as a heretofore unrecognized factor that may actually best account for the surprising reversal of climbing heart disease mortality rates. Improved sanitation and food hygiene as well as improvements in diet, lifestyle, and medical care may have shaped the downward mortality curve. The virus hypothesis may reconcile apparent epidemiologic conflicts and elucidate the natural history of atherosclerosis.

Animals↗