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Biomedical subjects

Elizabeth A Gilpin

Publications and source records attributed to Elizabeth A Gilpin.

At least 37 records · Page 2Linked to original sources
PubMed2004

Is there a simple correction factor for comparing adolescent tobacco-use estimates from school- and home-based surveys?

School surveys conducted to monitor the prevalence of adolescent smoking generally yield higher estimates than home-based surveys. Our goal was to examine the consistency of this mode effect over age for different measures of adolescent smoking behavior. If consistent, it would be feasible to define a simple adjustment factor for comparing overall results across survey modes. We identified three pairs of school- and home-based surveys (two national pairs and one California pair), each pair conducted in the same year, that allowed us to compare three key measures of adolescent smoking across age: (a) Ever tried, (b) smoking in past 30 days, and (c) regular smoking. We also examined male experimentation with smokeless tobacco, for which a mode effect has not been investigated. School surveys yielded higher estimates than in-home surveys for all the tobacco-use measures examined. In general, the mode effect was greater in younger age groups. Estimates for the two modes appeared closer for current and regular smoking measures compared with the ever-tried measure. Considering report of smoking in the past 30 days, the mode effect was much greater for infrequent smoking (1-9 days) than for more frequent (10+ days) smoking. Finally, school surveys yielded much higher estimates for male smokeless tobacco use than did home surveys. Because mode effects were related to age and level of reported use, no simple correction factor for comparing across modes is feasible. Social desirability bias of self-reported behavior in the different settings may account in part for the observed mode effects.

Adolescent↗
PubMed2004

How did the Master Settlement Agreement change tobacco industry expenditures for cigarette advertising and promotions?

The 1998 multistate Master Settlement Agreement (MSA) with the tobacco industry restricted cigarette advertising and promotions. The MSA monetary settlement was also associated with an average cigarette price increase of U.S.$1.19/pack between 1998 and 2001 to fund, in part, industry payments to the states. We examined Federal Trade Commission reports on how the tobacco industry spends its cigarette advertising and promotional dollars to see if changes expected as a result of the MSA occurred. Expected changes included reduced total expenditures and reductions for outdoor advertising, specialty promotional items identified with a brand (e.g., caps, t-shirts, lighters), and public entertainment. However, tobacco industry spending for advertising and promotions increased 96% between 1995 and 2001, with large increases in 1998 and 1999, as the MSA took effect. Between 1997 and 2001, outdoor advertising declined 98%, expenditures for specialty promotional items decreased 41%, although public entertainment increased 45%. However, in 2001, these categories represented only a small fraction of the total budget. Expenditures for retail-value-added increased 344% between 1997 and 2001 (to 42.5% of total), perhaps to mitigate increased cigarette prices. In 2001, the incentives-to-merchants and retail-value-added categories comprised more than 80% of total expenditures. To adequately monitor tobacco industry expenditures as they adapt to the MSA and other tobacco control efforts, more refined reporting categories are essential.

Advertising↗
PubMed2004

Population receptivity to tobacco advertising/promotions and exposure to anti-tobacco media: effect of Master Settlement Agreement in California: 1992-2002.

Tobacco marketing contributes to adolescent smoking initiation, and the Master Settlement Agreement (MSA), therefore, included relevant restrictions. We analyzed data from large population surveys of Californians, conducted in 1992 (11,905 adults, ages 18 years and older), 1993 (5,531 adolescents, ages 12 to 17 years), and 1996 (6,252 adolescents, 18,616 adults) before the MSA, and in 1999 (6,090 adolescents, 14,729 adults) and 2002 (5,857 adolescents, 20,525 adults) following its implementation. Camel lost favorite-advertisement popularity after 1996, and between 1999 and 2002, there were large increases in the percentages declining to name a favorite advertisement. Ownership of tobacco promotional items declined from its peak in 1996. Furthermore, in 2002, close to 90% of adolescents and young adults reported seeing anti-tobacco messages on television in the past month, significantly higher than 1996. These trends indicate less receptivity to tobacco advertising and promotions following the MSA but leave room for additional restrictions to further reduce receptivity.

Adolescent↗
PubMed2004

Has there been a delay in the age of regular smoking onset among African Americans?

BACKGROUND: It is not clear whether the decline in African American adolescent smoking in the 1980s reflected a delay in age of onset of regular smoking initiation rather than success in preventing initiation completely. PURPOSE: The purpose of this study is to identify whether the marked reductions in African American adolescent smoking in the 1980s were offset by increased initiation in young adults. METHODS: We combined data from the Tobacco Use Supplements of the 1992-1993, 1995-1996, and 1998-1999 Current Population Surveys (n = 512,258), and reconstructed year of smoking initiation and calculated age-specific incidence of initiation from 1970 to 1992. We then compared detailed age-specific rates of initiation for two 5-year periods selected to be before and after the documented large declines in African American adolescent smoking. RESULTS: In the time period after marked declines in African American adolescent smoking (1987-1991), the incidence of initiation of regular smoking decreased for African Americans ages 14 to 16 and increased for ages 18 to 20. Such a delay was not as evident among non-Hispanic Whites. The delay that was slight in regular smoking initiation among African Americans relative to non-Hispanic Whites in 1975-79 had increased substantially by 1987-91. CONCLUSIONS: Reductions in African American adolescent smoking in the 1980s were offset by increased initiation among young adults ages 18 to 20 during this time period and suggest that the window for uptake of regular smoking shifted to older ages for African Americans more so than non-Hispanic Whites. Efforts to combat smoking should remain aggressive into young adulthood, when the tobacco industry's efforts to gain new smokers intensify.

Adolescent↗
PubMed2004

Do favorite movie stars influence adolescent smoking initiation?

OBJECTIVES: We sought to determine whether adolescents whose favorite movie stars smoke on-screen are at increased risk of tobacco use. METHODS: During interviews, adolescent never smokers taking part in the California Tobacco Survey nominated their favorite stars. We reviewed popular films released during 1994 through 1996 to determine whether stars smoked on-screen in at least 2 films. RESULTS: One third of never smokers nominated a star who smoked on-screen, which independently predicted later smoking risk (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.02, 1.82). The effect was strong among girls (OR = 1.86; 95% CI = 1.26, 2.73). Among boys, there was no independent effect after control for receptivity to tobacco industry promotions. CONCLUSIONS: Public health efforts to reduce adolescent smoking must confront smoking in films as a tobacco marketing strategy.

Adolescent↗
PubMed2004

The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts.

A nine-membered panel of experts was asked to determine expert opinions of mortality risks associated with use of low-nitrosamine smokeless tobacco (LN-SLT) marketed for oral use. A modified Delphi approach was employed. For total mortality, the estimated median relative risks for individual users of LN-SLT were 9% and 5% of the risk associated with smoking for those ages 35 to 49 and > or =50 years, respectively. Median mortality risks relative to smoking were estimated to be 2% to 3% for lung cancer, 10% for heart disease, and 15% to 30% for oral cancer. Although individual estimates often varied between 0% and 50%, most panel members were confident or very confident of their estimates by the last round of consultation. In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of LN-SLT use. The risks of using LN-SLT products therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past. Importantly, the overall public health impact of LN-SLT will reflect use patterns, its marketing, and governmental regulation of tobacco products.

Adult↗
PubMed2003

Evaluation of the American Stop Smoking Intervention Study (ASSIST): a report of outcomes.

BACKGROUND: The National Cancer Institute funded an 8-year, nonrandomized demonstration project for tobacco prevention and control, the American Stop Smoking Intervention Study (ASSIST). To evaluate ASSIST, we compared changes in adult smoking prevalence, per capita cigarette consumption, and tobacco control policies between the 17 ASSIST states and the 33 non-ASSIST states and the District of Columbia. METHODS: The strength of tobacco control index was used to measure state-level program elements directed at tobacco control, and the initial outcomes index (IOI) was used to measure states' tobacco control policy outcomes. Prevalence data were obtained from the Tobacco Use Supplement to the Current Population Survey, and consumption data were obtained from the Tobacco Institute's bimonthly sales figures for cigarette packs moved from wholesale warehouses. Two-stage regression and mixed-effects linear modeling were used to analyze the various outcomes. Statistical analyses for testing individual regression coefficients were one-sided. RESULTS: ASSIST states had a greater decrease in adult smoking prevalence than non-ASSIST states, with an adjusted difference of -0.63% (P =.049). Per capita cigarette consumption was not statistically significantly different between ASSIST and non-ASSIST states. However, an increase in the IOI of a state from the 25th to the 75th percentile was associated with a reduction in per capita cigarette consumption by 0.57 packs per person per month. State IOI was also inversely, albeit not statistically significantly, associated with smoking prevalence (regression coefficient = -0.11;P =.06). CONCLUSIONS: The reduction in adult smoking prevalence associated with ASSIST could have translated into approximately 278 700 fewer smokers nationwide if all states had implemented ASSIST. Investment in building state-level tobacco control capacity and promoting changes in tobacco control policies are effective strategies for reducing tobacco use.

Adolescent↗
PubMed2003

Concurrent use of tobacco products by California adolescents.

BACKGROUND: To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age. METHODS: Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use. RESULTS: Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use. CONCLUSIONS: Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Adolescent↗
PubMed2003

Changes in youth smoking participation in California in the 1990s.

OBJECTIVE: To identify which key transitions in the adolescent smoking uptake process changed during periods of increasing and decreasing adolescent smoking participation in California. METHODS: Age groups (12-14 and 15-17 years) from longitudinal surveys of California adolescents, conducted in 1993-1996 (prevalence increasing) and in 1996-1999 (prevalence declining), allowed comparisons of transition rates across these periods for: never smokers (committed and susceptible) to any smoking, experimenters to established smokers, and current established smokers to former smokers (15-17-year-olds only). Analyses adjusted for demographics and other baseline environmental influences on adolescents to smoke, with a variable for 'time period' included to test for differential period transition rates. RESULTS: Adjusted analyses indicated a time period effect (1993-1996 versus 1996-1999) on all transitions examined for 12-14-year-olds. For 15-17-year-olds, the time period effect was significant for the transition from committed never smoker to any smoking, but only marginally significant for experimenter to established smoker and from current established to former smoker. CONCLUSION: Adolescent smoking participation appeared to decline at all phases in the smoking uptake process, with generally larger declines in younger adolescents. Intensified public health measures to curb adolescent smoking beginning in the mid 1990s may have been responsible.

Adolescent↗
PubMed2003

Cancer risk factor assessment among Chamorro women.

BACKGROUND: Little is known about the health of Chamorros residing in the United States. METHODS: The Chamorro Directory International and CDC's Behavioral Risk Factor Surveillance System were used to assess behavioral risk factors and health needs of San Diego's Chamorro women. RESULTS: Of 128 Chamorro women, 42.2% reported having a total frequency of five or more fruits and vegetables daily, 54.5% reported being current on their colorectal cancer screening, and 9.4% smoke. CONCLUSIONS: While this sample of Chamorro women reported higher rates of healthpromoting practices than nationwide averages, significant health improvement opportunities remain.

Adult↗
PubMed2002

Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation.

CONTEXT: Successful smoking cessation is a major public health goal. In controlled clinical trials, nicotine replacement therapy (NRT) and the antidepressant bupropion have been shown to significantly increase cessation rates only for moderate to heavy smokers (> or = 15 cigarettes/d). Nicotine replacement therapy is heavily promoted to the general population by both the pharmaceutical industry and tobacco control advocates. OBJECTIVE: To examine trends in smoking cessation, pharmaceutical cessation aid use, and success in cessation in the general California population. DESIGN, SETTING, AND PARTICIPANTS: The large population-based California Tobacco Surveys of 1992, 1996, and 1999, including 5247 (71.3% response rate), 9725 (72.9% response rate), and 6412 (68.4% response rate) respondents, respectively. MAIN OUTCOME MEASURES: Rates of cessation attempts (> or = 1 day) among smokers in the last year, use of pharmaceutical aids (mostly over-the-counter products since 1996), and cessation success. RESULTS: Between 1992 and 1999, cessation attempts among California smokers increased 61.4% (from 38.1% to 61.5%), and NRT use among quitters increased 50.5% (from 9.3% to 14.0%). A total of 17.2% of quitters used NRT, an antidepressant, or both as an aid to cessation in 1999. In 1996 and 1999, the median duration of aid use (14 days) was much less than recommended, and only about 20% of users had adjuvant one-on-one or group behavioral counseling. Use of NRT increased short-term cessation success in moderate to heavy smokers in each survey year. However, a long-term cessation advantage was only observed before NRT became widely available over-the-counter (August 1996). In 1999, no advantage for pharmaceutical aid users was observed in either the short or long term for the nearly 60% of California smokers classified as light smokers (<15 cigarettes/d). CONCLUSION: Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.

Adult↗
PubMed2002

A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study.

The Women's Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.

Adult↗
PubMed2002

Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking?

OBJECTIVE: The tobacco industry contends that parenting practices, not marketing practices, are critical to youth smoking. Our objective was to examine whether tobacco-industry marketing practices undermine the protective effect of recommended authoritative parenting against adolescent smoking. DESIGN AND SETTING: Receptivity to tobacco advertising and promotions was assessed in 1996 from a representative sample of California adolescent never-smokers aged 12 to 14 years. A follow-up survey of 1641 of these adolescents was conducted in 1999 that included measures of the key components of authoritative parenting: parental responsiveness, monitoring, and limit setting. MAIN OUTCOME MEASURE: Smoking initiation in adolescents. RESULTS: Adolescents in families with more-authoritative parents were half as likely to smoke by follow-up as adolescents in families with less-authoritative parents (20% vs 41%, p <0.0001). In families with more-authoritative parents, adolescents who were highly receptive to tobacco-industry advertising and promotions were significantly more likely to smoke (odds ratio=3.52, 95% confidence interval =1.10-11.23), compared to those who were minimally receptive. This effect was not significant in adolescents in families with less-authoritative parents. The overall attributable risk (adjusted for exposure to peer smokers) of smoking from tobacco-industry advertising and promotions was 25%. However, an estimated 40% of adolescent smoking in families with more-authoritative parents was attributable to tobacco-industry advertising and promotions; this was five times the attributable risk seen in families with less-authoritative parents (8%). CONCLUSION: The promotion of smoking by the tobacco industry appears to undermine the capability of authoritative parenting to prevent adolescents from starting to smoke.

Adolescent↗
PubMed2002

Demographic differences in patterns in the incidence of smoking cessation: United States 1950-1990.

PURPOSE: Current measures of successful quitting are insensitive to changes induced by tobacco control activities. We evaluated whether changes in the incidence of successful quitting, a new measure of cessation, can inform policy makers how population subgroups responded. METHODS: Smokers from National Health Interview Surveys (NHIS) (1965 through 1992, n = 140,199) were used to determine the number of current smokers eligible to quit at the beginning of each year from 1950 through 1990. Incidence of quitting, computed for different demographic subgroups, was the ratio of those newly successfully quit each year to those eligible to quit. RESULTS: Overall, incidence increased over fivefold, from < 1% in 1950 to a still low 5% in 1990. When the health risks of smoking were first disseminated, middle-aged men had the highest quitting incidence. Gender differences in younger smokers occurred following the beginning of the public health campaign of the mid 1960s, as the dangers of smoking to the fetus were documented. Younger adult smokers appeared to increase quitting markedly in the 1970s, around the beginning of the nonsmokers' rights movement. Quitting patterns in middle-aged African Americans were similar to whites, although at much reduced levels. Younger African Americans had low quitting incidence until 1989. Incidence differed by educational attainment; regardless of age, during the 1970s and 1980s, those with some college increased their quitting incidence markedly. CONCLUSION: Incidence of quitting is a sensitive indicator of relatively short-term changes in successful quitting in population subgroups and should facilitate evaluation efforts.

Adult↗
PubMed2002

The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers.

Harm reduction for continuing smokers has been suggested as a public health priority. We evaluated whether tobacco control programs might reduce cigarette consumption among current smokers through strategies aimed primarily at protecting nonsmokers from secondhand smoke (SHS). Data were from adult (18+ years) respondents to multiple (1990, 1992, 1996, 1999), large, cross-sectional, population-based surveys of smoking behavior, conducted to evaluate the California Tobacco Control Program. Adult daily smoking prevalence decreased from 15.9 +/-0.4%(+/-95% confidence interval) of the California adult population in 1990 to 13.0 +/-0.3% in 1999. Concurrently, moderate-to-heavy daily smoking (>or= 15 cigarettes/day) decreased from 10.3 +/-0.4% in 1990 to 7.4 +/-0.3% in 1999, and heavy daily smoking (>or= 25 cigarettes/day) from 3.4 +/- 0.2% in 1990 to 1.9 +/- 0.1% in 1999. Decreased daily smoking was observed in all demographic subgroups except young adults. Among college graduates, the daily smoking prevalence in 1999 was 6.4 +/- 0.4%, a level previously observed only among U.S. physicians. In 1999, nearly 30% of current smokers did not smoke daily, and more than 60% said they now smoked less than previously. In 1999, self-reported cigarette consumption was inversely related to believing SHS is harmful to nonsmokers, having a smoke-free workplace, and living in a smoke-free home. In California, tobacco control strategies that educated the population about SHS and resulted in smoking restrictions may have led continuing smokers to smoke less, which should reduce the harm from smoking to the public health in the long term.

Adolescent↗