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PubMed2004

The marketing of menthol cigarettes in the United States: populations, messages, and channels.

This commentary looks at the marketing menthol cigarettes to various targeted populations--women, middle school youth and Asian/Pacific Islander immigrants as well as African Americans. The authors take the position that "ethnic awareness" as evidenced in the advertising of menthol cigarette brands to African Americans is just one of four distinct messages that tobacco marketers have used for what they have termed the "coolness" category. The other messages are: healthy/medicinal; fresh/refreshing/cool/clean/crisp; and youthfulness/silliness and fun. The commentary poses three questions: (a) Are new population segments being steered toward menthol cigarettes using marketing approaches that are similar to what has occurred with African Americans and women? (b) What exactly is the relationship between the marketing of menthol cigarettes and subsequent use of menthol tobacco products by specific population subgroups? (c) Are there lessons to be learned from the marketing of menthol cigarettes that can be used to improve the public health and medical communities' smoking cessation and tobacco use prevention communications efforts?

Adolescent↗
PubMed2005

Quit and Win contests for smoking cessation.

BACKGROUND: Quit and Win contests were developed in the 1980s by the Minnesota Heart Health Program, and have been widely used since then as a population-based smoking cessation intervention at local, national and international level. Since 1994 an international contest has been held every two years in as many as 80 countries (2002). OBJECTIVES: To determine whether quit and win contests can deliver higher long-term quit rates than baseline community quit rates. To assess the impact of such programmes, we considered both the quit rates achieved by participants, and the population impact, which takes into account the proportion of the target population entering the contest. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group specialized register, with additional searches of MEDLINE (January 1966 to September 2004), EMBASE (180 to 2004/8), CINAHL (1982 to 2004/8) and PsycINFO (1872 to 2004/6). Search terms included competition*, quit and win, quit to win, contest*, prize*. SELECTION CRITERIA: We considered randomized controlled trials, allocating individuals or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. DATA COLLECTION AND ANALYSIS: Data were extracted by one author and checked by the second. We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking for at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. We decided against performing a meta-analysis, because of the heterogeneity of the included studies, and the small number of scientifically valid studies. MAIN RESULTS: Four studies met our inclusion criteria. Three demonstrated significantly higher quit rates (8% to 20%) for the quit and win group than for the control group at the 12-month assessment. However, the population impact measure, where available, suggests that the effect of contests on community prevalence of smoking is small, with fewer than one in 500 smokers quitting because of the contest. Levels of deception, where they could be quantified, were high. Although surveys suggest that international quit and win contests may be effective, especially in developing countries, the lack of controlled studies precludes any firm conclusions from this review. AUTHORS' CONCLUSIONS: Quit and win contests at local and regional level appear to deliver quit rates above baseline community rates, although the population impact of the contests seems to be relatively low. Contests may be subject to levels of deception which could compromise the validity of the intervention. International contests may prove to be an effective mechanism, particularly in developing countries, but a lack of well-designed comparative studies precludes any firm conclusions.

Awards and Prizes↗
PubMed1990

Type II diabetes and its complications in Mexican Americans.

The prevalence and incidence of type II diabetes are substantially higher in Mexican Americans than in non-Hispanic whites. This, combined with its earlier age of onset and the younger age structure of the Mexican American population, makes diabetes a major public health problem in this ethnic group and one which to a greater extent than in non-Hispanics strikes people in the prime of life. Both genetic and environmental factors undoubtedly contribute to this epidemic. The environmental factors would appear to be those commonly associated with the phenomenon of "modernization" or "westernization", namely, dietary change and adoption of sedentary lifestyles. As such, they are potentially modifiable and amenable to clinical and public health action. There is as yet no proof from clinical trials that modification of any or all of these environmental factors will in fact prevent diabetes. When clinical trials are performed, high-risk populations such as Mexican Americans should be considered as potential target populations, because of both the public health relevance and the lower sample size requirements in such populations. Further advances in identifying genetic susceptibles would also facilitate the design and execution of such trials. The increased risk of microvascular complications in Mexican American diabetics puts this population in "double jeopardy", i.e., they have a greater risk of acquiring diabetes in the first instance, and, having acquired it, they have a greater risk of suffering from its complications. It is still not clear whether the increased risk of complications in this ethnic group stems from an intrinsically more severe biological process or barriers to adequate medical care and/or poor compliance. Prospective data currently being gathered should help to resolve this issue. Assuming that medical care plays a role, a major opportunity--and challenge--exists to reduce substantially the morbidity, mortality, and economic burden associated with type II diabetes and its complications in the Mexican American population.

Diabetes Mellitus, Type 2↗
PubMed2002

Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination.

Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.

Adult↗
PubMed2003

Sexually transmitted infections in men.

The diagnosis and treatment of STDs is a common problem in primary care practice; however, newer diagnostic and therapeutic alternatives require physicians to be aware of evidence-based guidelines that are continuing to evolve. The treatment of STDs in men, in particular, is an area of evolving evidence because much of what is known is based on the treatment of STDs in women. Men represent unique challenges in diagnosis, evaluation, and follow-up that need to be considered in the treatment of urethritis, epididymitis, herpes genitalis, condyloma, prostatitis, and other syndromes. Screening for asymptomatic STDs is currently not recommended in the general population, but selected criteria can be used to identify a target population for screening in high-risk areas.

Chlamydia Infections↗
PubMed2000

The effect of geographic origin on the frequency of HLA antigens and their association with ageing.

The association between HLA antigens and ageing is not clear. Ageing in women was associated with B40 and DR5 in a recent study, but other studies yielded conflicting results. In none of the studies, however, did the young and elderly samples originate from the same homogeneous population. Homogeneity is dependent on geographic origin. The aim of this study was to investigate whether differences in geographic origin between age groups could explain the age-associated differences in the frequencies of B40 and DR5. The authors used the new design of a 'birth-place-restricted comparison' in which the origin of all subjects was ascertained. The total study population comprised 1010 young women aged 25-40 years and 660 elderly women aged 85 years and older. The 'birth-place-restricted comparison' included 66 young and 285 elderly women from one geographic area (Leiden, the Netherlands). Men were not included because ageing in men was not associated with HLA antigens in a recent study. In the total population, the frequency of B40 in young women of different origin varied between 16 and 28%, and the frequency of DR5 between 11 and 23%. Similar differences were observed in the elderly women. In the 'birth-place-restricted comparison', the frequency of B40 was 15% in the young women and 11% in the elderly women (difference 4%, 95% confidence interval, -5 to 13%). The frequency of DR5 was 20% in the young women, and 28% in the elderly women (difference 8%, 95% confidence interval, -4 to 19%). Thus, marked differences in HLA antigen frequency were found between populations of various geographic origins. Definition and ascertainment of the target population are therefore necessary in genetic studies of ageing. In such a 'birth-place-restricted comparison', the authors confirmed that ageing in women was negatively associated with HLA-B40 and positively associated with HLA-DR5.

Adult↗
PubMed2002

Dose finding using the biased coin up-and-down design and isotonic regression.

We are interested in finding a dose that has a prespecified toxicity rate in the target population. In this article, we investigate five estimators of the target dose to be used with the up-and-down biased coin design (BCD) introduced by Durham and Flournoy (1994, Statistical Decision Theory and Related Topics). These estimators are derived using maximum likelihood, weighted least squares, sample averages, and isotonic regression. A linearly interpolated isotonic regression estimate is shown to be simple to derive and to perform as well as or better than the other target dose estimators in terms of mean square error and average number of subjects needed for convergence in most scenarios studied.

Clinical Trials, Phase I as Topic↗
PubMed2006

[Influence of acculturation on self-perceived oral health among Japanese-Brazilian elderly].

Utilizing a qualitative methodology, this study aimed to evaluate the influence of acculturation on the elderly population and self-perception of their oral health. The target population included 40 individuals, divided into two groups: first- and second-generation Japanese immigrants. Through recorded interviews, acculturation level was assessed for each group, as was its influence on attention to oral health and self-evaluation of oral health status and time elapsed since the last dental appointment. Acculturation affected both groups, although to a greater degree in second-generation Japanese-Brazilians. However, it does not interfere in self-perception of oral health by this population. The main individual care with their oral health included brushing, flossing, and soaking dentures in antiseptic solutions. In self-assessed oral health, the main complaints related to wearing dentures, and the time elapsed since the last dental appointment was 1.4 years for the non-edentulous and 6.3 years for the edentulous.

Acculturation↗
PubMed1999

[Impact of an information campaign on cardiovascular risk factors. 5-year results at the study town Epernon].

OBJECTIVES: Information campaigns are implemented to improve knowledge of cardiovascular disease and risk factors. The impact of these programs must be evaluated to determine whether they truly contribute to modifying risk factors in the population. METHODS: A 5-year information campaign on cardiovascular disease and risk factors was conducted in Epernon, France. The main objectives of the campaign focused on stopping smoking, regular physical exercise and balanced nutrition. Data were collected from a representative sample of the female and male population aged 20 to 65 years selected from the study town Epernon (500 subjects), and in control towns, Magny-en-Vexin and Moret-sur-Loing (200 subjects). The study town and control towns were comparable for population, demographic characteristics and geographic localization (distance from Paris). The subjects were invited to respond to a questionnaire on demographic data, attitudes toward health, risk factors and diet and underwent a clinical examination with blood tests. RESULTS: The initial sample included 961 subjects and 68.5% participated in the final survey. We were unable to evidence any significant difference in risk factors or the 10-year risk score calculated from the Framingham equation adapted to France. The information campaign was well accepted, the population not expression a feeling of lassitude. The campaign had a minimal effect on the way individuals relate to health. There was a fall in mean energy intake, mainly fat calories, which was similar in all three towns. CONCLUSION: No major modification in cardiovascular risk factors was observed in this low-risk population, suggesting that future information campaigns should be aimed at targeted populations with a higher risk profile using simple and selected messages.

Adult↗
PubMed2003

Participation in cancer trials: recruitment of underserved populations.

One approach to address cancer health disparities is to focus on the under-representation by minority populations in cancer trials. Recruitment strategies include: 1) characterizing the target populations, 2) involve members of the population in planning, 3) take the message to the population, 4) give something back to the community, 5) enhance credibility with a community spokesperson, 6) identify and remove barriers, 7) improve staff sensitivity, and 8) educate the population about the trial. To recruit minorities to clinical trials, we have developed the Accrual to Clinical Trials (ACT) framework for understanding and enhancing the recruitment of participants to cancer trials.

Clinical Trials as Topic↗
PubMed1985

Some considerations in the design of a nutrition intervention trial in Linxian, People's Republic of China.

Various issues pertaining to the design of a nutrition intervention trial in Linxian, a county in North Central China where esophageal cancer rates are extraordinarily high among a population with chronic deficiencies of multiple nutrients, are addressed. Two target populations are identified: One is a group of patients diagnosed with severe esophageal dysplasia, the other is the general population of the high-risk area. Interventions involving the supplementation of each group with vitamins and minerals are described, and a rationale is provided for the selection of nutrients and choice of dose levels. Several potential statistical designs are evaluated, with particular emphasis on the balancing of gains in specificity afforded by full and fractional factorial designs against their potential loss in sensitivity compared with the simplest design involving a placebo versus a multiple vitamin and mineral supplement.

Adult↗
PubMed2001

A novel technique for the fluorometric assessment of T lymphocyte antigen specific lysis.

The 51Cr release assay has traditionally been used to investigate effector cell cytotoxic function against labeled targets, but this method has inherent problems that include hazards associated with radioactivity, cell labeling and high spontaneous release. Here we describe a novel flow cytometric assay which addresses and improves upon the problems currently encountered with the 51Cr release assay. The fluorometric assessment of T lymphocyte antigen specific lysis (FATAL) assay employs dual staining (PKH-26 and CFSE) to identify and evaluate the target population. We found that the PKH-26/CFSE combination efficiently labeled target cells. Evaluation of the spontaneous leakage from dye labeled target cells was forty fold lower than the spontaneous leakage seen with the 51Cr release assay. The FATAL assay permitted a more accurate assessment of the effector: target ratio, and detected low levels of cytotoxic T lymphocyte (CTL) mediated lysis. There was a strong correlation between the 51Cr release and FATAL assays, when performed in parallel with identical effector and target cells (r(2)=0.998, P=<0.0001). This novel method of detecting cytolysis represents a qualitative and quantitative improvement over standard 51Cr release analysis. The FATAL assay will be of value to further investigate mechanisms of cytolysis by effector cell populations.

Antigens↗
PubMed2006

The Morse oscillator under time-dependent external fields.

A method to solve the equations for the Morse oscillator under intense time-dependent external fields is presented. Exact analytical formulas for the dipole matrix elements are calculated by the use of the hypergeometric algebra. The continuum is described by an expansion using Laguerre functions. The full algorithm for the calculation of wave functions can be controlled by the convergence of series and by the errors of a first order integration method. We apply our technique to the selective preparation of high overtones by femtosecond laser pulses. The population of the target state is optimized as a function of the intensity and frequency. Introducing a second simultaneous laser, we study the effects of relative frequency and phase over the target state population and dissociation channels. The calculations exhibit a rich interference pattern showing the enhancement and the suppression of the target population by varying the laser parameters.

Journal Article↗
PubMed1992

A mammographic screening pilot project in Victoria 1988-1990. The Essendon Breast X-ray Program Collaborative Group.

OBJECTIVE: To pilot and evaluate the feasibility and acceptability to women of population based mammographic screening in Victoria. DESIGN: Pilot intervention study in a geographically and demographically defined population. SETTING: Area of contiguous postcodes surrounding the Breast X-ray Unit at the Essendon Hospital. TARGET POPULATION: Women aged 50 to 69 years living in the target area. MAIN OUTCOME MEASURES: Attendance rates, satisfaction, screening rates, surgical biopsy rates, breast cancer detection rates, and surgical treatment. RESULTS: Forty-one per cent of eligible women in the denominator population attended the Breast X-ray Unit in the two-year period; 16,424 women were screened, including 141 women with previous breast cancer. Of every 1000 women screened, 74 were recalled because of mammograms that were suggestive of malignancy, 19 because of technically inadequate mammograms and 16 because of symptoms. All mammograms were read by two radiologists and consensus was required for 12% of films. Of every 1000 asymptomatic women screened, 12.7 had biopsies performed and in 7.1 cancers were detected. In asymptomatic women, the positive predictive value of an abnormal mammogram was 9.4%, and the positive predictive value of a recommendation for biopsy was 55.9%. A total of 131 malignancies were detected, of which 24 (18%) were carcinoma-in-situ. The benign to malignant biopsy ratio was 1:1.31. In 82% of women in whom cancer was detected the breast was conserved. CONCLUSIONS: The Program achieved good standards with respect to mammographic detection, clinical assessment and treatment of women with breast cancer.

Aged↗
PubMed1993

Prevalence of rheumatoid arthritis in the adult Indian population.

The prevalence of rheumatoid arthritis was studied in the adult Indian population. As the first step, a house-to-house survey of a rural population near Delhi was conducted by two trained health workers. The target population comprised 44,551 adults (over 16 years old). The health workers identified the possible cases of rheumatoid arthritis (RA) using a questionnaire. These cases were then further evaluated by the authors using the 1987 revised ARA criteria for the diagnosis of RA. A response rate of 89.5% was obtained and 3393 persons were listed as possible cases of RA by the health workers. Of these, 299 satisfied the revised ARA criteria for the diagnosis of RA, giving a prevalence of 0.75%. Projected to the whole population, this would give a total of about seven million patients in India. The prevalence of RA in India is quite similar to that reported from the developed countries. It is higher than that reported from China, Indonesia, Philippines and rural Africa. These findings are in keeping with the fact that the north Indian population is genetically closer to the Caucasians than to other ethnic groups.

Adolescent↗
PubMed1997

Depressive disorders among older residents in a Chinese rural community.

BACKGROUND: Two recent surveys of depression among Chinese elderly people sampled different populations, used different case ascertainment methods and resulted in a seven-fold difference in prevalence rates. The present study was conducted to compare prevalence rates obtained with two commonly used methods in the same population, and to examine the risk factors for depression. METHODS: The target population included all residents aged 65 years and over in a rural Chinese community. Participants were interviewed for demographic and medical information, examined by a neurologist and administered Chinese versions of the Geriatric Depression Scale-Short Form (GDS-S), the Cognitive Abilities Screening Instrument (CASI) and an Activities of Daily Living (ADL) form. Individuals who screened positive on the GDS-S were also interviewed by a psychiatrist for diagnosis according to the DSM-III-R criteria. RESULTS: Among the 1313 participants, 26% screened positive on the GDS-S and 13% were diagnosed as having a depressive disorder, including 6.1% with major depression. Individuals with depressive disorders were more likely to have poor ADL scores, lower CASI scores, and chronic physical illnesses. They were also more likely to be female, older, illiterate and without a spouse, but adding these variables did not increase the overall association with the GDS-S score. CONCLUSIONS: Depression was quite common in this Chinese rural geriatric population. The prevalence rate was twice as high when judged by depression symptomatology rather than clinical diagnosis. The critical risk factors were functional impairments, poor cognitive abilities and the presence of chronic physical illnesses.

Activities of Daily Living↗
PubMed1999

The balance of positive and negative effects of specific messages in the evaluation of interventions for preventing HIV infection.

The study objectives were to determine the effects of a large-scale school-based HIV prevention campaign, in terms of both positive and negative effects of each single message, and to identify sub-populations more at risk. Forty-six schools, randomly sampled from all schools in the Lazio region, were randomized to either an intervention or a control group. The study population consisted of 3866 students. Questionnaires on AIDS-related knowledge and risk perceptions were administered to students before and after the intervention. Odds ratios were calculated to represent the extent to which the intervention was associated with an improvement (OR+), and the extent to which it prevented a worsening (OR-). Overall, the intervention was successful in communicating important messages, such as the impossibility of transmitting HIV through social contacts (OR+ all significantly > 1 and OR- always< 1), the meaning of 'seropositivity' (OR+: 1.28, 95% CI: 0.99-1.64; OR-: 0.73, 95% CI: 0.58 0.91), and the lack of a resolutive cure for AIDS (OR+: 1.61, 95% CI: 1.10-2.36; OR-: 0.76, 95% CI: 0.57-1.02). The worst results were observed in vocational and art schools, where OR + > 1 were observed for only three questions and OR- values usually exceeded 1. This study highlights the necessity of remodelling the intervention, indicating which messages need to be modified. The low impact of educational programmes among students of vocational and art schools makes them a population more at risk, that should be considered as a priority target population for interventions.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevention of early childhood caries: a public health perspective.

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.

Child↗