Non-smoking lung cancer and environmental exposure

While lung cancer mortality has been decreasing in many countries due to tobacco control efforts, at least one quarter of global lung cancer cases occur among non-smokers. There is growing attention to the role of environmental exposures, such as radon and air pollution, in lung cancer. Additionally, recent research efforts have sought to elucidate the distinct characteristics of and mechanisms involved in lung cancer among never smokers. Continued research on non-smoking lung cancer is critical to identifying new opportunities for intervention and addressing the global burden of lung cancer.

Two Surgeon General's reports on smoking and cancer: a historical investigation of the practice of causal inference

BACKGROUND: The epidemiologic literature is replete with conceptual discussions about causal inference, but little is known about how the causal criteria are applied in public health practice. The criteria for causal inference in use today by epidemiologists have been shaped substantially by their use over time in reports of the U.S. Surgeon General on Smoking and Health. METHODS: We reviewed two classic reports on smoking and health from expert committees convened by the US Surgeon General, in 1964 and 1982, in order to evaluate and contrast how the committees applied causal criteria to the available evidence for the different cancer sites at different time periods. We focus on the evidence for four cancer sites in particular that received detailed reviews in the reports: lung, larynx, esophagus and bladder. RESULTS: We found that strength of association and coherence (especially dose-response, biological plausibility and epidemiologic sense) appeared to carry the most weight; consistency carried less weight, and temporality and specificity were apparently not applied at all in some cases. No causal claim was made for associations with a summary odds ratio of less than 3.0. CONCLUSION: Our findings suggest that the causal criteria as described in textbooks and the Surgeon General reports can have variable interpretations and applications in practice. While the authors of these reports may have considered evidential factors that they did not explicitly cite, such lack of transparency of methods undermines the purpose of the causal criteria to promote objective, evidence-based decision making. Further empirical study and critical examination of the process by which causal conclusions are reached can play an important role in advancing the practice of epidemiology by helping public health scientists to better understand the practice of causal inference

Monitoring harm perceptions of smokeless tobacco products among U.S. adults: Health Information National Trends Survey 2012, 2014, 2015

Introduction: Changes to the U.S. smokeless tobacco landscape in recent years include a change to health warnings on packages, the implementation of bans in some stadiums, and the launch of a federal youth pre- vention campaign. It is unclear whether such changes have impacted consumer beliefs about smokeless tobacco. This study examines relative harm perceptions of smokeless tobacco compared to cigarettes among adults and assesses changes in smokeless tobacco harm perceptions over time. Methods: We analyzed data from three cycles (2012, 2014, 2015) of the Health Information National Trends Survey (HINTS). Using 2015 data, we assessed bivariate associations between smokeless tobacco harm per- ceptions and tobacco use, beliefs, information seeking, and demographics. Using 2012, 2014, and 2015 data, we assessed whether smokeless tobacco harm perceptions changed over time within demographic groups using chi- square tests. We then used a weighted multinomial logistic regression to assess the association between smo- keless tobacco perceptions and survey year, adjusting for covariates. Results: When asked whether smokeless tobacco products are less harmful than cigarettes, the majority of re- spondents across cycles said “no.” The percent of respondents who selected this response option decreased over time. Findings showed significant differences in relative harm perceptions of smokeless tobacco versus cigarettes for specific demographic subgroups. Among subgroups, these shifts did not occur with a discernible pattern. Conclusions: Understanding factors associated with perceptions of smokeless tobacco can inform tobacco control efforts. Additional monitoring of these trends may provide researchers with a deeper understanding of how and why smokeless tobacco harm perceptions change

Prevalence of PgR, ER and HER2+ receptors among women with breast cancer by age in Poland

Introduction. Prevalence of estrogen (ER), progesterone (PgR) and human epidermal growth factor receptors (HER2) vary by age among women with breast cancer (BC). Such variation has a large significance for the prognosis and treatment process. This study characterizes the prevalence of breast cancer subtypes by age in a hospital sample in Poland. Material and methods. The study population included 735 women with BC aged 27–91 years old (ICD-10: C50) and treated in the years 2009–2011 in the Military Institute of Medicine in Warsaw. Subjects were divided into 2 age categories — 27–44 and 45+ — which included 66 (9%) and 669 (91%) women respectively. In each group prevalence of PgR, ER and HER2+ receptors was investigated. Results. In both age groups the most frequent BC subtype was luminal A (hormone dependent BC — with PgR and ER receptor expression) — 27–44 years old — 44% and 45+ years old — 56%. The lowest number of cases in the age group 27–44 was luminal B (triple positive breast cancer) — about 15% of cases and for 45+ age group — HER2+ BC — about 11%. Discussion. Performed research shows relationship between growing age of diagnosis and presence of more desirable features of BC among women aged 55 and more, such as expression of steroid receptors or lack of expression of HER2 receptors, which is a good prognostic indicator for treatment outcomes. In the same time, many studies suggest that more aggressive types of breast cancer (basal-like — triple negative) are more characteristic for younger age groups (under 45 years old and younger women in perimenopausal age). Same results have been obtained in own study. Conclusions. A high incidence of BC in older age groups (45+) and more frequent occurrence of aggressive types of BC among younger women (27–44 years old) indicate the need to educate women from both age groups about risk factors and early symptoms of the disease. As we still have not recognized all BC risk factors, education about well-known agents, such as alcohol intake, overweight and obesity, play significant role in decrease of BC incidence and mortality

Smoke-free air laws and quit attempts: evidence for a moderating role of spontaneous self-affirmation

Background: In addition to their primary goal of protecting nonsmokers from secondhand smoke, smoke-free air laws may also encourage intentions to quit smoking, quit attempts, and cessation among smokers. However, laws may not encourage quitting if smokers feel threatened by them and react defensively. Objective: This study examined whether spontaneous self-affirmation - the extent to which people think about their values or strengths when they feel threatened - may reduce smokers' reactance to smoke-free laws, enhancing the ability of the laws to encourage quitting. Method: We linked state-level information on the comprehensiveness of U.S. smoke-free laws (compiled in January, 2013 by the American Lung Association) with data from a U.S. health survey (Health Information National Trends Survey) collected from September-December, 2013 (N = 345 current smokers; 587 former smokers). Results: Smoke-free laws interacted with self-affirmation to predict quit attempts in the past year and intentions to quit in the next six months: Smokers higher in self-affirmation reported more quit attempts and quit intentions if they lived in states with more comprehensive smoke-free laws. There was some evidence of a "boomerang" effect (i.e., less likelihood of making a quit attempt) among smokers low in self-affirmation if living in states with more comprehensive smoke-free laws, but this effect was significant only among smokers extremely low in self-affirmation. For quit intentions, there was no evidence for a boomerang effect of smoke-free laws even among smokers extremely low in self-affirmation. More comprehensive smoke-free laws were not associated with smoking status (former vs. current smoker) or average amount smoked per day, nor did they interact with self-affirmation to predict these outcomes. Conclusions: The impact of smoke-free policies on quit attempts and quit intentions may be moderated by psychological characteristics such as the tendency to spontaneously self-affirm. Follow-ups should experimentally manipulate self-affirmation and examine effects of smoke-free laws in controlled contexts

Surveillance indicators for potential reduced exposure products (PREPs): developing survey items to measure awareness

<p>Abstract</p> <p>Background</p> <p>Over the past decade, tobacco companies have introduced cigarettes and smokeless tobacco products (known as Potential Reduced Exposure Products, PREPs) with purportedly lower levels of some toxins than conventional cigarettes and smokeless products. It is essential that public health agencies monitor awareness, interest, use, and perceptions of these products so that their impact on population health can be detected at the earliest stages.</p> <p>Methods</p> <p>This paper reviews and critiques existing strategies for measuring <it>awareness </it>of PREPs from 16 published and unpublished studies. From these measures, we developed new surveillance items and subjected them to two rounds of cognitive testing, a common and accepted method for evaluating questionnaire wording.</p> <p>Results</p> <p>Our review suggests that high levels of awareness of PREPs reported in some studies are likely to be inaccurate. Two likely sources of inaccuracy in awareness measures were identified: 1) the tendency of respondents to misclassify "no additive" and "natural" cigarettes as PREPs and 2) the tendency of respondents to mistakenly report awareness as a result of confusion between PREPs brands and similarly named familiar products, for example, Eclipse chewing gum and Accord automobiles.</p> <p>Conclusion</p> <p>After evaluating new measures with cognitive interviews, we conclude that as of winter 2006, awareness of reduced exposure products among U.S. smokers was likely to be between 1% and 8%, with the higher estimates for some products occurring in test markets. Recommended measurement strategies for future surveys are presented.</p