A blueprint for assessing public support of citywide smoke-free legislation.

The tracking of public opinion can be a critical component of antitobacco campaigns, such as efforts to enact citywide Clean Indoor Air legislation. Grassroots tobacco control coalitions that work locally to promote smoke-free environments typically encompass individuals from a wide range of public health fields. Although knowledgeable, volunteer groups lack the financial resources to evaluate the impact of local efforts or determine their community's level of support for potential legislation. The steps taken by a grassroots organization to conduct a public opinion survey are outlined, including methodological, analytical issues, and resource requirements. A valid survey can be completed in 4 months with minimal financial resources. Individuals willing to voluntarily administer and analyze a survey can be identified at the local level. Results of a tobacco-related public opinion survey can be instrumental in the promotion of smoke-free environments and an effective tool in attracting media coverage.

Why do postmenopausal African-American women not benefit from overall breast cancer mortality decline?

BACKGROUND: An overall decline in U.S. female breast cancer mortality in the 1990s has been reported. However, several studies have shown that mortality trends are different for White women and African-American (AA) women. The purpose of this study was to assess differences in time trends and patterns of female breast cancer mortality among women by race and age in Ohio. MATERIAL AND METHODS: Joinpoint regression (JR) and age-period-cohort (APC) approaches were used to evaluate temporal changes in mortality and to assess period and birth generation impacts on observed patterns. Logistic regression was used to assess racial differences in tumor staging and grading among women diagnosed with breast cancer in Ohio from 1996 to 2000. Mortality data were obtained from NCHS (National Center for Health Statistics) via Surveillance Research Program, National Cancer Institute SEER*Stat software; Ohio incidence data were provided by the Ohio Cancer Incidence Surveillance System. RESULTS: Among women aged 30-74, a significant decline of 2.8% was noted since 1988 for White women. AA women in this age group have experienced significant decline (by 0.9%) since 1983. White women aged 30-39 years experienced a decline in mortality of 3.5% per year in the period 1986-2001, while decline by 2.3% was observed among Black women of that age since 1984. Among the age categories 40-49, 50-59, and 60-74, a decline in mortality rates was observed among White women in the 1990s. The decline was observed also among AA women aged 40-49, beginning in the mid 1980s, but not in the older AA age groups. Specifically, in AA women 60-74 and 75+, a mortality increase was observed within the entire study period (0.9% and 1.4%, respectively). CONCLUSIONS: Analysis of the data for Ohio suggests that AA women do not equally benefit from the overall decline in breast cancer mortality that is often sited. This is especially true for AA postmenopausal women who continue to experience an increase in breast cancer mortality. In light of existing literature and this analysis of data from the state of Ohio, we conclude that the reason for these differences lies mostly in disparities in access to care, as well as in differences in stage at diagnosis and biological determinants (grading) between White and Black women.

Comparison of male and female breast cancer incidence trends, tumor characteristics, and survival.

PURPOSE: To compare male and female breast cancer and to determine the predictors of tumor characteristics and survival in both genders. METHODS: Male (n = 2923) and female breast cancer cases (n = 442,500) from the Surveillance, Epidemiology and End Results (SEER) registry were analyzed. Joinpoint regression was performed to detect changes in incidence trends from 1973 to 2001. Multiple logistic regression was used to regress each of four outcome variables (STAGE, LATERALITY, ESTROGEN, and PROGESTERONE RECEPTOR STATUS) on four demographic variables. Cox proportional hazards regression modeling was used to determine significant predictors of death of breast cancer after adjusting for demographic factors. RESULTS: Both men and women aged less than 50 years were at higher risk for advanced breast cancers. Males were at higher risk than females for advanced tumors among non-whites. The risk of breast cancer death among all cases was lower for each 10-year increase in age by 2%, higher for those who are unmarried than for those who are married by 12% and 13% higher for non-whites than for whites. CONCLUSIONS: Some important gender differences were detected with respect to factors associated with tumor characteristics, but gender was not a significant predictor of survival after adjusting for the other demographic variables.

Screening for domestic violence in the pediatric office: a multipractice experience.

The purpose of our study was to screen for domestic violence (DV) in 4 different pediatric practice settings. Women who accompanied their children to well-child visits were eligible. The women were screened with a 6-question tool previously piloted by our group, which included questions on partner abuse, child abuse, and pet abuse. Over a 1-year period, 435 women were screened. Of these women, 95 (22%) described DV at some point in their lives. Sixty-nine (16%) reported abuse longer than 2 years before the screen and 26 (6%) reported more recent abuse. While 11 of 117 women screened in the more affluent private practice reported a history of past abuse, no women in that group reported DV occurring within 24 months. The proportion of women reporting violence did not differ significantly by site, but the proportion of patients reporting new violence was significantly lower at the private practice site by Chi-square analysis. In conclusion, women screened in a variety of pediatric settings will disclose DV. Recent abuse is more likely to be reported in settings with indigent patients. All pediatricians should be screening for DV and have protocols in place to offer women the services they need if DV is revealed.