Messages About Tobacco and Alcohol Co-users.

OBJECTIVE: People who use both alcohol and combustible tobacco have an increased risk of developing cancer. Few interventions have been developed to inform people about the risks of co-use. This study developed and tested messages about the risks of alcohol and combustible tobacco co-use among adults. METHOD: In June-July 2021, we surveyed 1,300 U.S. adults who used both alcohol and combustible tobacco products within the past 30 days. After reporting their awareness of diseases caused by tobacco and alcohol co-use, participants were randomly assigned to four between-subjects experiments that manipulated specific cancer health effects vs. the word "cancer"; cancer health effects vs. noncancer health effects; different descriptions of co-use (e.g., Using alcohol and tobacco…, Drinking alcohol and smoking tobacco…); and co-use vs. single-use messages. Participants saw one message for each experiment and rated each message using a validated perceived message effectiveness (PME) scale. RESULTS: Awareness of health effects caused by alcohol and tobacco co-use ranged from moderately high for throat cancer (65.4%) to moderately low for colorectal cancer (23.1%). Messages about cancer health effects increased PME more than messages about non-cancer health effects (B=0.18, p=0.01). Messages about some specific cancers-including oral cancer (B=-0.20, p=0.04) and colorectal cancer (B=-0.22, p=0.02) decreased PME more than messages with only the word "cancer." No significant differences were identified for descriptions of co-use or co-use vs. single-use messages. CONCLUSIONS: Messages about some cancer health effects of co-using alcohol and tobacco may be effective when communicating the harms of both drinking alcohol and using tobacco.

The evaluation of North Carolina's state-sponsored youth tobacco prevention media campaign.

In 2003, the state of North Carolina (NC) implemented a multi-component initiative focused on teenage tobacco use prevention and cessation. One component of this initiative is Tobacco.Reality.Unfiltered. (TRU), a tobacco prevention media campaign, aimed at NC youth aged 11-17 years. This research evaluates the first 5 years of the TRU media campaign, from 2004 to 2009, using telephone surveys of NC youth. Overall, TRU campaign awareness was moderate among youth in its first year, with awareness significantly increasing over time. The majority of youth who saw the advertisements reported that they were convincing, attention grabbing and gave good reasons not to smoke. In 2009, logistic regression models revealed awareness of the TRU advertisements was associated with decreased odds of current smoking and experimenting with cigarettes for at-risk NC youth. Results from this research may help other states to define, evaluate and modify their own media campaigns, especially within financially or politically constraining environments.

Survivors of tobacco-related diseases and advocacy for tobacco control.

Survivors and victims of tobacco-related diseases can and should play significant roles in tobacco control advocacy efforts. This article describes one example of how to successfully incorporate their talents into a statewide programme.

Diagnosis and management of malignant melanoma.

The incidence of malignant melanoma has increased in recent years more than that of any other cancer in the United States. About one in 70 people will develop melanoma during their lifetime. Family physicians should be aware that a patient with a changing mole, an atypical mole or multiple nevi is at considerable risk for developing melanoma. Any mole that is suggestive of melanoma requires an excisional biopsy, primarily because prognosis and treatment are based on tumor thickness. Staging is based on tumor thickness (Breslow's measurement) and histologic level of invasion (Clark level). The current recommendations for excisional removal of confirmed melanomas include 1-cm margins for lesions measuring 1.0 mm or less in thickness and 2-cm margins for lesions from 1.0 mm to 4.0 mm in thickness or Clark's level IV of any thickness. No evidence currently shows that wider margins improve survival in patients with lesions more than 4.0 mm thick. Clinically positive nodes are typically managed by completely removing lymph nodes in the area. Elective lymph node dissection is recommended only for patients who are younger than 60 years with lesions between 1.5 mm and 4.0 mm in thickness. In the Eastern Cooperative Oncology Group Trial, interferon alfa-2b was shown to improve disease-free and overall survival, but in many other trials it has not been shown to be effective at prolonging overall survival. Vaccine therapy is currently being used to stimulate the immune system of melanoma patients with metastatic disease.

Mycotic infections. Effective management of conditions involving the skin, hair, and nails.

Superficial mycotic infections of the skin, hair, or nails are recurring presentations in the geriatric primary care setting. The most common infections are those caused by dermatophytes. The genus Trichophyton gives rise to most of the tinea dermatophytoses, including tinea capitis, tinea pedis, and tinea unguium (onychomycosis). Part of the diagnostic challenge lies in distinguishing the mycotic lesions from those caused by cutaneous diseases such as psoriasis, eczema, dyshidrosis, and contact dermatitis. Because environmental conditions play a major role in fungal infection onset, clinical management should include patient education about conditions conducive to fungal propagation. Oral agents are the primary mode of treatment for fungal infections of the scalp and nails, whereas topical treatments are frontline agents for other superficial skin conditions.

Tobacco and alcohol use in G-rated children's animated films.

CONTEXT: Tobacco and alcohol use among youth are major public health problems, but the extent to which children are routinely exposed to tobacco and alcohol products in children's films is unknown. OBJECTIVE: To identify the prevalence and characteristics associated with tobacco and alcohol use portrayed in G-rated, animated feature films. Design All G-rated, animated feature films released between 1937 and 1997 by 5 major production companies (Walt Disney Co, MGM/United Artists, Warner Brothers Studios, Universal Studios, and 20th Century Fox) that were available on videotape were reviewed for episodes of tobacco and alcohol use. MAIN OUTCOME MEASURES: Presence of tobacco and alcohol use in each film, type of tobacco or alcohol used, duration of use, type of character using substance (bad, neutral, or good), and any associated effects. RESULTS: Of 50 films reviewed, 34 (68%) displayed at least 1 episode of tobacco or alcohol use. Twenty-eight (56%) portrayed 1 or more incidences of tobacco use, including all 7 films released in 1996 and 1997. Twenty-five films (50%) included alcohol use. Smoking was portrayed on screen by 76 characters for more than 45 minutes in duration; alcohol use was portrayed by 63 characters for 27 minutes. Good characters use tobacco and alcohol as frequently as bad characters. Cigars and wine are shown in these films more often than other tobacco or alcohol substances. CONCLUSIONS: More than two thirds of animated children's films feature tobacco or alcohol use in story plots without clear verbal messages of any negative long-term health effects associated with use of either substance.

Predictors of state legislators' intentions to vote for cigarette tax increases.

BACKGROUND: This study analyzed influences on state legislators' decisions about cigarette tax increase votes using a research strategy based on political science and social-psychological models. METHODS: Legislators from three states representing a spectrum of tobacco interests participated in personal interviews concerned with tobacco control legislation (n = 444). Measures of potential predictors of voting intention were based on the consensus model of legislative decision-making and the theory of planned behavior. Multiple logistic regression methods were used to identify social-psychological and other predictors of intention to vote for cigarette tax increases. RESULTS: General attitudes and norms concerning cigarette tax increases predicted legislators' intention to vote for cigarette tax increases. More specific predictors included perceptions of public health impact and retail sales impact of cigarette tax increases. Constituent pressure was the strongest perceived social influence. Political party and state also were strong predictors of intention. Results were consistent with related research based on political science models. CONCLUSIONS: Legislators' votes on cigarette tax increases may be influenced by their perceptions of positive and negative outcomes of a cigarette tax increase and by perceived constituent pressures. This research model provides useful insights for theory and practice and should be refined in future tobacco control research.

Counting the cost of an NRSA Primary Care Research Fellowship Program.

BACKGROUND AND OBJECTIVES: Concerns are often raised about the potential financial and logistical burdens that fellows (even those who receive federal funding) add to departmental budgets. METHODS: We collected data on patient care income, financial values of teaching, on-call and attending duties, and departmental costs for patient care overhead, administration, and supervision over a 1-year period for six fellows in the National Research Service Award (NRSA) Primary Care Research Fellowship Program at the University of North Carolina at Chapel Hill. RESULTS: Net receipts for clinical services ranged from $4,023 to $15,742, which, when adjusted for overhead costs, led to financial loss. However, assuming an academic dollar value of $15/hour, teaching, precepting, and on-call coverage were worth from $3,330 to $9,780 to a department, depending on level and specialty of the fellow. Overall, NRSA fellows imposed a financial burden consisting of practice-related costs and uncompensated faculty supervision and administration. Three factors can modify the estimate of this burden, including the calculation of patient care overhead, the estimated value of academic work, and whether fellows provide "replacement" or "additive" clinical functions to their departments. CONCLUSIONS: The NRSA Fellowship Training Program can be a cost-neutral but valuable resource for developing highly trained primary care researchers and new faculty. Increased administrative funding for these programs would be a low-cost strategy to compensate faculty time and program management in generalist departments.

State legislators' attitudes and voting intentions toward tobacco control legislation.

OBJECTIVES: This study describes state legislators' knowledge, attitudes, and voting intentions with regard to tobacco-related issues. METHODS: A cross-sectional survey of state legislators was conducted in North Carolina, Texas, and Vermont in 1994. RESULTS: Most legislators agreed that secondhand smoke can cause lung cancer in nonsmokers, and a majority believed that smokers are addicted to nicotine. More than 75% stated that they would support a measure to enforce laws preventing tobacco sales to youth. A majority of Texas and Vermont legislators supported an increase in the state cigarette excise tax; 43% of North Carolina legislators would support an increase if revenues were directed toward tobacco farmer diversification. CONCLUSIONS: State legislators believe tobacco to be addictive, and they support policies to protect youth from tobacco. Support for other legislative measures differs significantly across states.

State legislators' intentions to vote and subsequent votes on tobacco control legislation.

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development.

State legislators' perceptions of lobbyists and lobbying on tobacco control issues.

OBJECTIVE: To determine state legislators' perceptions about health and tobacco lobbyists, their frequency of contact with these lobbyists, and the amount of campaign contributions from health professional organisations and the tobacco industry. DESIGN: Cross-sectional study. SUBJECTS: State legislators from North Carolina, Texas, and Vermont (USA), serving in 1994. MAIN OUTCOME MEASURES: Perceptions about lobbyists representing the tobacco industry, non-profit health organisations, and state medical societies with respect to their credibility, importance as sources of information, and persuasiveness; extent of lobbying activities; campaign contributions from health professional organisations and the tobacco industry. RESULTS: Almost all legislators reported that medical society and non-profit health organisation lobbyists are credible on tobacco issues and just over half believed that these lobbyists are important sources of information. More legislators said they could be persuaded by medical and health lobbyists than by tobacco lobbyists. Although health professional Political Action Committees (PACs) gave campaign contributions to more state legislators, and gave higher amounts on average, than tobacco PACs, legislators reported less contact with medical society lobbyists than tobacco lobbyists about tobacco issues. CONCLUSIONS: State legislators have positive attitudes toward lobbyists for non-profit health organisations and state medical societies regarding tobacco issues. These groups may be an underused resource for educating legislators about tobacco control measures.

State tobacco lobbyists and organizations in the United States: crossed lines.

OBJECTIVES: This research took a quantitative look at state-level tobacco lobbying in the United States. METHODS: Publicly available lobbying data were collected from all states during 1994. Data were compiled on tobacco industry lobbyists, their tobacco employers, health lobbyists, and factors associated with such lobbying. RESULTS: In 1994, 450 tobacco industry lobbyists lobbied at a state level. Most lobbying was on behalf of four organizations: Philip Morris (34%), the Tobacco Institute (21%), RJ Reynolds (17%), and the Smokeless Tobacco Council (15%). Approximately one half of all tobacco lobbyists also lobbied for a health-related organization (e.g., state medical association, hospital, physician association). CONCLUSIONS: All US states have tobacco lobbyists. Many health organizations knowingly or unknowingly employ lobbyists who also lobby for the tobacco industry.

Consent form readability in university-sponsored research.

BACKGROUND: Consent forms are required in most biomedical research involving human subjects. In recent years, a number of studies from different disciplines have reported problems related to consent form readability. METHODS: We analyzed 284 consent forms submitted to and approved by five institutional review boards (IRBs) (schools of Medicine, Nursing, Academic Affairs, Dentistry, and Public Health) at one university and one IRB at another. We examined consent form readability scores and factors that might relate to readability. RESULTS: The average reading level of all consent forms was high: 12.2, which corresponds roughly to a 12th-grade reading level. Less than 10% of all consent forms were written at a 10th grade reading level or below. Thirty-two percent of all consent forms had no evidence of revisions, and less than 2% of consent forms were revised more than once. Readability scores were not related to consent form revisions, the type of IRB, the year of study, or the university where the research was conducted. CONCLUSIONS: Poor readability of consent forms probably occurs in all university-related research. We recommend that IRBs require readability checks for research consent forms before researchers submit their proposals to an IRB.