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K M Cummings

Publications and source records attributed to K M Cummings.

At least 73 records · Page 4Linked to original sources
PubMed1997

Comparison of recent trends in adolescent and adult cigarette smoking behaviour and brand preferences.

OBJECTIVE: To compare trends in smoking behaviour and use of cigarette brands by adults and adolescents. DESIGN: Data analysed in this paper come from tobacco use surveys of adults and teenagers conducted in 18 communities in the United States, as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. Data on adult smoking behaviour were obtained from two cross-sectional telephone surveys, one conducted from January to May 1988 (n = 99348), and the second conducted between August 1993 and January 1994 (n = 79890). Data on adolescent smoking behaviour were obtained from two school-based surveys of ninth-grade students (aged 13-16 years), one conducted in autumn 1990 (n = 7097), and the second conducted in autumn 1992 (n = 7277). OUTCOME MEASURES: Adult cigarette smoking prevalence was estimated as the percentage of adults (18+ years) who were identified either by interview or by proxy as a current smoker. Among adolescents, current smokers were defined as those who reported having smoked on one or more of the 30 days preceding the interview. Cigarette brand use by adults was measured by asking current smokers to report the six digit UPC code on the side of the pack of their current cigarettes. A master list of UPC code numbers was developed so that reported codes could be associated with specific brand names. Among adolescents, cigarette brand use was measured by asking current smokers who reported that they usually buy their own cigarettes: "What brand do you usually buy?" RESULTS: In ninth-grade students, smoking prevalence rates increased between 1990 and 1992 in 13 of the 18 communities. Among adults, smoking rates declined between 1988 and 1993 in 17 out of 18 communities. Within the same communities, cigarette brand use was found to be much more tightly concentrated in adolescent smokers compared with adults, with teenage smokers more likely to report using the most heavily advertised cigarette brands--Marlboro, Newport, and Camel. CONCLUSIONS: Smoking prevalence rates have increased among teenagers, but have dropped among adults in the same communities. Among adolescents who smoke, and buy their own cigarettes, the three most heavily advertised brands--Marlboro, Camel, and Newport--have a substantially higher market concentration than among adult smokers.

Adolescent↗
PubMed1997

Discrepancies in cigarette brand sales and adult market share: are new teen smokers filling the gap?

OBJECTIVE: To examine the extent and type of cigarette brand switching by adult smokers. To evaluate discrepancies between actual and projected cigarette brand sales based on changes in adult smoking patterns. DESIGN: Data analysed come from a cohort tracking survey of 11966 cigarette smokers aged 25-64 years from 20 communities in the United States who were followed between 1988 and 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. OUTCOME MEASURES: Respondents were asked about their current cigarette brand in 1988 and 1993. Brand switching was inferred when a smoker reported a different cigarette brand in 1988 and 1993. Company switching was defined as brand switching for whom a different parent company was identified for the 1993 brand compared with the brand used in 1988. A ratio measure was computed to reflect gains in market share from brand switching and losses from brand switching, quitting, and death, for specific cigarette brands, between 1988 and 1993. This ratio measure was used to estimate the projected unit sales for top-selling premium brands in 1993 and was compared with actual unit sales for the same year. RESULTS: We estimate that an average of 9.5% of smokers switched cigarettes brands and 7.6% switched companies each year. Most of those who did switch cigarette brands changed from a premium brand to a discount or generic brand. Between 1988 and 1993, top-selling premium brands such as Marlboro, Camel, and Newport, lost about four times as many adult smokers as they gained. Whereas premium brand cigarettes lost some smokers to discount and generic cigarettes, over 50% of losses were due to smokers quitting or dying. Actual unit sales were substantially higher than projected sales (based on adult market share) for Marlboro and Camel, but not for other brands. CONCLUSIONS: Most smokers are brand loyal. Price seems to be an important factor motivating brand switching among adult smokers. It appears that recruitment of new customers among the ranks of non-smokers is necessary for premium cigarette brands such as Marlboro and Camel to maintain sales comparable to previous years.

Adolescent↗
PubMed1997

Relationship of worksite smoking policy to changes in employee tobacco use: findings from COMMIT. Community Intervention Trial for Smoking Cessation.

OBJECTIVE: To report data on the impact of worksite smoking policies on employee smoking behaviour from a large and heterogeneous sample of smokers and worksites in 22 different communities across North America participating in the COMMIT trial. DESIGN AND SUBJECTS: Data from a population-based survey of 8271 employed adult smokers who completed surveys in 1988 and 1993. Surveys included questions on tobacco use behaviours, personal/demographic characteristics, and smoking policy and cessation resources at the workplace. RESULTS: After controlling for potential confounding factors, regression analyses revealed that employees who worked in a smoke-free worksite were over 25% more likely to make a serious quit attempt between 1988 and 1993, and over 25% more likely to achieve cessation than those who worked in a worksite that permitted smoking. Among continuing smokers, employees in smoke-free worksites consumed an average of 2 3/4 fewer cigarettes per day compared with those who worked in places with a non-restrictive smoking policy. A smoke-free worksite policy was not associated with a greater likelihood of using smokeless tobacco. CONCLUSION: These data, from one of the largest and longest smoking cessation studies to date, add support to the conclusion that smoke-free worksite policies help employees to reduce or discontinue use of tobacco.

Adult↗
PubMed1997

Predictors of smoking cessation in a cohort of adult smokers followed for five years.

OBJECTIVE: To identify variables predictive of smoking cessation in a cohort of cigarette smokers followed for five years. DESIGN: Data analysed in this paper come from a cohort tracking telephone survey of 13415 cigarette smokers aged 25-64 years from 20 American and two Canadian communities who were interviewed in 1988 and re-interviewed in 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. Predictors of smoking cessation evaluated in this study included measures of past and current smoking behaviour, past quit attempts, stated desire to quit smoking, and demographic characteristics. OUTCOME MEASURES: Smoking cessation was based on self report. A "quitter" was defined as a cohort member who, at the final annual contact in 1993, reported not smoking any cigarettes for the preceding six months or longer. Any smoker who reported having made a serious quit attempt between 1988 and 1993 was asked to indicate reasons that contributed to their decision to try to stop smoking. RESULTS: 67% of smokers reported making at least one serious attempt to stop smoking between 1988 and 1993 and, of these, 33% were classified as having quit smoking in 1993. The most common reasons given for quitting smoking were concern over health (91%), expense (60%), concern about exposing others to secondhand smoke (56%), and wanting to set a good example for others (55%). Statistically significant predictors of smoking cessation included male gender, older age, higher income, less frequent alcohol intake, lower levels of daily cigarette consumption, longer time to first cigarette in the morning, the use of premium cigarettes, initiation of smoking after age 20, history of past quit attempts, a strong desire to stop smoking, and the absence of other smokers in the household. Predictor variations with the largest relative risks for smoking cessation were those associated with nicotine dependence such as amount smoked daily and time to first cigarette in the morning. CONCLUSIONS: Despite the fact that most smokers expressed a strong desire to stop smoking in 1988, the majority, especially the most dependent heavy smokers (>25 cigarettes/day), struggled unsuccessfully to achieve this goal.

Adult↗
PubMed1997

Use of the nicotine skin patch by smokers in 20 communities in the United States, 1992-1993.

OBJECTIVE: To measure the characteristics of smokers associated with the use of the nicotine skin patch in the general population and to evaluate whether use of the patch is associated with successful smoking cessation. DESIGN: Data from two surveys conducted in 20 communities in the United States as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT) study. Nicotine patch prevalence was estimated using data from a 1993 cross-sectional survey of 13691 current and former smokers. The effectiveness of the nicotine skin patch as a smoking cessation aid was evaluated adjusting for other covariants using data from a cohort tracking study of 9809 smokers who were followed between 1988 and 1993. As the nicotine patch was not available to consumers until January 1992, analyses were restricted to respondents who reported themselves to be current smokers in 1993 or former smokers who reported quitting after January 1992. OUTCOME MEASURES: Current and former smokers who reported having made a serious effort to stop smoking in the past five years were asked to indicate whether they had used the nicotine skin patch to help them stop smoking. Those answering "Yes", were classified as nicotine patch users. Smoking cessation was based on self-report. A "quitter" was defined as someone who had been a smoker as of January 1992 who reported in 1993 not smoking any cigarettes for the preceding six months or longer. RESULTS: The prevalence of nicotine patch use by smokers averaged across the 20 study communities was 12.8%, making the patch one of the most popular cessation methods used by smokers. Compared with non-users, patch users were more likely to be female, white, have higher annual household incomes, be more motivated to stop smoking, and to smoke more heavily. Among low-income smokers (annual household income below US$10000), nicotine patch use was significantly higher among those who lived in a state where the public insurance programme (Medicaid or Medi-Cal) included the patch as a benefit (12.1% vs 7.7%). Among those who made an attempt to quit smoking, the likelihood of successful quitting was more than twice as high among patch users compared with non-users. Among patch users, the highest quit rates were observed among those who used the patch for between one and three months. CONCLUSIONS: The nicotine skin patch is a popular and effective means of smoking cessation. Use of the nicotine patch, especially by low-income smokers, could be increased by reducing the out-of-pocket expenditure required for smokers to get the product.

Administration, Topical↗
PubMed1997

Patterns of use of a free nicotine patch program for Medicaid and uninsured patients.

This study assessed the use and effectiveness of a free nicotine patch program among Medicaid and uninsured smokers. Patterns of patch use, associated behaviors with quit attempt, side effects, and self-reported abstinence from smoking for 6 months were evaluated prospectively among patients from five urban family practice offices and a nicotine dependence clinic located in a comprehensive cancer center in Western New York. Results indicated that the majority of participants used the program as intended, and 90% of the participants found the patch useful in their quit attempt. Fourteen percent of participants were abstinent for 6 months or more. We found no support for inappropriate use of transdermal nicotine patches among patients with no health insurance or those on Medicaid. Transdermal nicotine patches are an effective cessation aid for smokers. Given the tall of the consequences of smoking on health costs, barriers to access to effective treatment for smoking cessation among individuals covered by Medicaid for health insurance need to be eliminated.

Administration, Cutaneous↗
PubMed1997

What should be the elements of any settlement with the tobacco industry?

Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti-tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.

Adolescent↗
PubMed1995

Trends in smoking initiation among adolescents and young adults--United States, 1980-1989.

The evaluation of efforts to prevent tobacco use among adolescents requires accurate surveillance of both smoking prevalence and smoking initiation rates. Although several surveillance systems provide timely data about adolescent smoking prevalence (1), data characterizing rates of smoking initiation among adolescents have been limited. To improve characterization of trends in smoking initiation among young persons, data from the Tobacco Use Supplement of the 1992 and 1993 Current Population Surveys (CPS) (2) were used to estimate smoking initiation rates for persons who were adolescents (aged 14-17 years) or young adults (aged 18-21 years) during 1980-1989. This report summarizes the results of that analysis.

Adolescent↗
PubMed1995

Influence of smoking on the development of lung metastases from breast cancer.

BACKGROUND: This study examined the association between cigarette smoking status and the development of lung metastases in a group of 835 women diagnosed with primary malignant unilateral breast cancer. METHOD: Female patients with breast cancer diagnosed between 1982 and 1991 at Roswell Park Cancer Institute (RPCI) in Buffalo, New York, who provided information on their cigarette smoking history at the time of their diagnosis were included. The subsequent disease status of patients was monitored by the RPCI Tumor Registry. The Cox regression model was used to estimate the relationship between smoking status and the development of lung metastases, adjusting for the patient's age, stage of disease at diagnosis, and body weight. RESULTS: Of those patients who developed lung metastases, 8.7% were nonsmokers, 14.1% were former smokers, and 14.3% were current smokers. Tests showed that nonsmokers had significantly fewer lung metastases than either of the two smoking groups (P < 0.01). The estimated relative rates of lung metastases developing adjusting for age, stage, and body weight in women who smoked less than 10,000, between 10,001 and 20,000, and more than 20,000 packs over their lifetimes compared with nonsmokers were 1.06 (95% CI, 0.51-2.20), 3.10 (95% CI, 1.5-6.3), and 3.73 (95% CI, 1.6-8.9) respectively. The Cox regression model showed that every 1000 packs of cigarettes consumed over a lifetime increased a woman's risk of developing lung metastases by about 3% to 7% (P < 0.001). CONCLUSION: This study found a significant association between cigarette smoking history and risk of lung metastases developing in women diagnosed with primary invasive unilateral breast cancer. The risk of lung metastases developing increased as the number of cigarettes smoked in a lifetime increased.

Adolescent↗
PubMed1995

Evaluation of health education programs: current assessment and future directions.

Recently there has been an increase in the different types of strategies used in health education interventions, including an emphasis on broadening programs focused on individual behavior change to include larger units of practice. There has also been an increasing critique of the traditional physical science paradigm for evaluating the multiple dimensions inherent in many interventions. Additionally, there is a growing recognition of the importance of involving multiple stakeholders in designing, implementing, and evaluating interventions. Each of these factors carries specific evaluation challenges. With the overall aim of strengthening the evaluation of health education programs, this article aims to (a) present conceptual and technical design issues and options, (b) describe different approaches to evaluation, (c) highlight evaluation approaches that have been effective, (d) critique the limitations of traditional evaluation approaches, (e) examine promising approaches and implications for future evaluations, and (f) provide recommendations for evaluation designs, data collection methods, roles, responsibilities, and principles for evaluating interventions.

Forecasting↗
PubMed1995

Tobacco, alcohol, and other drug use behaviors among adolescents in Erie County, New York.

This article provides estimates of the prevalence of tobacco, alcohol, and other drug use behaviors of ninth-grade students enrolled in public and parochial schools in Erie County, New York. A computer-scannable survey consisting of 50 questions was completed by 7,891 students in the fall of 1992. Survey findings show that tobacco and alcohol are the drugs used most often by ninth-grade students. Results also indicate that cigarette use is strongly associated with other drug use behaviors such as getting drunk, using marijuana, and other illegal drugs. A report detailing findings from the survey has been widely disseminated to school officials and community leaders throughout Erie County. Our experience in conducting this survey suggests that collecting information on the drug use behaviors of adolescents at the local level is both feasible and worthwhile.

Adolescent↗
PubMed1994

Biochemical changes, early brain growth suppression and impaired detour learning in nicotine-treated chicks.

Fetal growth suppression associated with chronic maternal intake of cigarette smoke is frequently observed in humans and studies using animal models suggest that in utero nicotine exposure is an important component of this growth suppression. The developing fetal central nervous system (CNS) is sensitive to the growth inhibitory effect of nicotine and morphological as well as functional CNS deficits may result from fetal nicotine exposure. The studies presented here show that nicotine exposure during early embryonic development ultimately inhibits the ability of 7-11 day old chicks to learn a detour task. The brain growth suppression caused by nicotine is paralleled by a failure of the early embryo brain to express the normal developmental increase in ornithine decarboxylase (ODC) activity. This biochemical change may be germane to the mechanism of nicotine-induced growth inhibition and/or nicotine-induced behavioral changes because the appropriate expression of ODC activity is essential to normal growth and differentiation in the fetal CNS. In the chick embryo, nicotine exposure alters several important signaling pathways that regulate ODC expression. For example, nicotine exposure lowers embryonic brain glucose levels and causes significant decreases in whole brain cyclic adenosine 3',5'-monophosphate (cyclic AMP) levels and in cyclic AMP binding proteins (protein kinase-A regulatory activity). Also, in cultured chick cells, nicotine inhibits the ability of a potent mitogen (insulin) to induce ODC activity, but, paradoxically, in ovo nicotine exposure increased insulin binding and stimulated insulin receptor autophosphorylation in brain membranes.

Animals↗
PubMed1994

Involving older Americans in the war on tobacco. The American Stop Smoking Intervention Study for Cancer Prevention.

The American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) is a collaborative effort of the National Cancer Institute, the American Cancer Society, state health departments, and other public and private organizations to develop comprehensive tobacco use control programs in 17 states. The two main goals of the project are to reduce adult smoking prevalence to 15% or less and to reduce the rates of smoking initiation among adolescents by 50% by the year 2000. There is strong consensus within the tobacco-control field of what needs to be done to accomplish these goals. The key elements of a comprehensive tobacco control effort include (1) an excise tax policy based on raising the real price of tobacco, (2) a ban on all forms of tobacco advertising and promotion, (3) product regulation to reduce the harmful constituents found in tobacco and enforce the use of strong and prominent package warnings, (4) the enactment of policies that protect nonsmokers from inhaling tobacco smoke, (5) comprehensive efforts to eliminate minors' access to tobacco products, (6) ongoing and adequately funded efforts to educate the public about the harmful effects of tobacco, (7) the availability of cessation assistance to persons interested in discontinuing the use of tobacco, and (8) the ending of all financial assistance to the tobacco-growing industry. Because older Americans represent a growing and political influential segment of our society, the enactment of effective tobacco control policies depends in part on generating support for such measures among older citizens. This article outlines several ways in which organizations such as American Association of Retired Persons and the American Cancer Society can work together to advocate meaningful tobacco control policies (e.g., higher excise taxes, clean indoor air laws, etc.).

Adolescent↗
PubMed1994

Use and effectiveness of transdermal nicotine in primary care settings.

OBJECTIVE: To assess the use and effectiveness of transdermal nicotine patches by smokers receiving care in primary care settings. DESIGN: Telephone survey of a convenience sample of patients. SETTING: Primary care settings in western New York. SUBJECTS: Two hundred eighty-four adult members of an independent practice association health maintenance organization who received a prescription for transdermal nicotine between January 1, 1992, and June 30, 1992. MAIN OUTCOMES: Patient reports regarding advice received from physicians about the use of the nicotine patch, cessation methods used in addition to the patch, usual daily use of the patch, side effects experienced while wearing the patch, and smoking behavior while using the patch and after discontinuing therapy. RESULTS: Most patients reported getting proper advice from their physician about how to use the nicotine patch and possible side effects. The majority of those who used the patch said they used it every day for 24 hours. Side effects associated with using the patch were common but did not cause many subjects to discontinue therapy. Half of the patients who had completed patch therapy were not smoking, including 43% of patients who had not been using the patch for 4 months or longer. CONCLUSION: Transdermal nicotine patches appear to be an effective cessation aid for smokers receiving care outside specialized smoking cessation programs. Proper pretreatment screening to identify patients who are motivated to stop smoking is critical to the success of nicotine patch therapy.

Administration, Cutaneous↗
PubMed1994

The illegal sale of cigarettes to US minors: estimates by state.

Data available from recent national surveys on the cigarette consumption and purchasing practices of teenage smokers were used to generate state-specific estimates of the number of teenage smokers and cigarette sales to minors. In 1991, approximately 2.7 million teenage cigarette smokers consumed an average of 28.3 million cigarettes per day (516 million packs per year). An estimated 255 million packs of cigarettes were sold illegally to minors in 1991. To make cigarettes and other tobacco products less accessible to minors, policymakers should consider implementing various legislative and economic measures such as banning cigarette vending machines and raising tobacco excise taxes.

Adolescent↗
PubMed1993

Lung cancer histologic types and family history of cancer. Analysis of histologic subtypes of 872 patients with primary lung cancer.

BACKGROUND: Previous research has demonstrated that there is clustering of cancer among relatives of patients with lung cancer and that women may be at a greater risk than men, regardless of their smoking histories. METHODS: The authors conducted a study to test the hypotheses that this predisposition varies by the histologic type of tumor and that women with particular histologic types will report more first-degree relatives with cancer than will men with the same cell type. The analyses were based on 872 patients with histologically confirmed lung cancer who had been admitted to Roswell Park Cancer Institute, Buffalo, New York, between 1982 and 1987. RESULTS: More patients with squamous and large cell carcinomas reported two or more relatives with cancer, and overall, women reported more family history of cancer. Among patients with squamous cell carcinoma, this difference between men and women was significant (P < 0.05). Among patients younger than 57 years, those with squamous cell were the most likely to report a family history of cancer (P < 0.01). A similar trend was observed for smoking. Persons with small cell and squamous cell carcinomas who were nonsmokers or had smoked 1-20 years had three times the risk of a family history of cancer than did those with large cell and adenocarcinomas (odds ratio [OR] = 3.01; confidence interval [ci] = 1.38-6.63), in contrast to those who had smoked more than 20 years (OR = 0.85; ci = 0.62-1.62). CONCLUSIONS: Squamous cell carcinoma is most associated with familial clustering of cancer, particularly among women, persons younger than 57 years, and individuals who smoked for fewer than 20 years.

Adenocarcinoma↗