Long-term Quit Rates in Fax-Referred as Compared to Self-Referred Tobacco Quitline Registrants.

INTRODUCTION: To increase the use of quitlines for treating tobacco use and dependence, quitline referral interventions are recommended for healthcare systems and providers. Research is limited as to whether fax-referred smokers have quit outcomes similar to those of traditional self-callers to quitlines. METHODS: Oklahoma Tobacco Helpline registration data from March 2013 to October 2014 and 7-month follow-up data were used to compare hospital- and clinic-based fax-referred registrants (n=537) to self-callers (n=2,577). Contingency table chi-square tests and relative risks were used to identify differences in 30-day point prevalence abstinence at 7-month follow-up. Two-sided p-values <0.05 were considered statistically significant. Analyses were conducted in 2015. RESULTS: Fax-referred registrants versus self-callers were significantly more likely to be older (49.4 vs 47.6 years), white (70.6% vs 59.1%), non-Hispanic (96.8% vs 94.2%), and to have smoked fewer than one pack of cigarettes per day (54.0% vs 44.9%). Self-callers versus fax-referred registrants were significantly more likely to be uninsured (36.5% vs 29.4%) and have received nicotine-replacement therapy from the Helpline (92.3% vs 79.9%). At 7-month follow-up, a similar proportion of fax-referred registrants reported not using tobacco in the past 30 days as compared to self-callers (29.3% vs 31.8%, p=0.2945). CONCLUSIONS: Although differences in sociodemographics, tobacco use behavior, and Helpline services were observed between fax-referred registrants and self-callers, quit outcomes at follow-up did not differ. This observational study has important implications for tobacco control initiatives as it shows patients fax-referred by hospitals and clinics to quitlines may be as successful as self-callers in quitting smoking.

Cancer among American Indians - Identifying Priority Areas in Oklahoma.

BACKGROUND: We describe and compare cancer incidence and mortality among American Indians (AI/ANs) and whites in nine Indian Health Service (IHS) Service Units in Oklahoma. METHODS: Using data from the Oklahoma Central Cancer Registry and the web-based OK2SHARE database, we obtained age-adjusted cancer incidence rates from 1997 to 2012 and cancer mortality rates from 1999 to 2009 for AI/ANs and whites in Oklahoma. We examined differences in primary site, percentage of late stage diagnoses, and trends over time. RESULTS: AI/ANs consistently had higher cancer incidence and mortality compared to whites in Oklahoma. The magnitude of disparity for cancer incidence and mortality varied by IHS Service Unit and by gender. The top three cancer sites were the same for all Service Units. The percentage of late stage diagnosis also varied by region. CONCLUSIONS: We identify priority areas where cancer disparity challenges exist among AI/ANs in Oklahoma.

Health-related quality of life in current smokers with COPD: factors associated with current smoking and new insights into sex differences.

Findings from studies that examined the association between health-related quality of life (HRQOL) and smoking status among COPD patients have been mixed. Moreover, factors associated with current smoking in COPD patients and differences by sex have not been fully elucidated. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System was used in this study. Four HRQOL indicators were examined in this study: general health, physical health, mental health, and activity limitations. General health was dichotomized into two groups: "excellent/very good/good" and "fair/poor", and the other three HRQOL indicators were dichotomized into <14 (infrequent) and ≥14 (frequent) unhealthy days in the past 30 days. To examine HRQOL indicators in association with current versus former smoking and identify factors associated with current smoking, logistic regression models were used. Sex differences were explored. In COPD patients, current smokers compared to former smokers had significantly poor HRQOL on all subdomains: "fair/poor" general health (adjusted odds ratio [AOR]: 1.2 [95% confidence interval {CI}: 1.1-1.5]); poor physical health (AOR: 1.3 [CI: 1.1-1.5]); poor mental health (AOR: 1.8 [CI: 1.4-2.2]); and poor activity limitations (AOR: 1.5 [CI: 1.3-1.9]). HRQOL subdomains affected by current smoking differed by sex except activity limitations. General health (AOR: 1.5 [CI: 1.1-2.0]) and activity limitations (AOR: 1.6 [95% CI: 1.2-2.2]) in males and physical health (AOR: 1.3 [CI: 1.0-1.6]), mental health (AOR: 2.1 [CI: 1.7-2.6]), and activity limitations (AOR: 1.5 [CI: 1.2-1.9]) in females were significantly impaired due to current smoking. Factors associated with current smoking differed by sex except being unmarried and having less than a college degree, which were associated with current smoking in both males and females. These findings have important implications for health care providers in designing more effective interventions which tailor to and target specific subgroups for smoking cessation.

Lifestyle behaviors among US cancer survivors.

PURPOSE: We describe and compare lifestyle behaviors, including smoking, physical activity, alcohol consumption, and nutrition, among cancer survivors to individuals with no cancer. METHODS: Data from the 2013 Behavior Risk Factor Surveillance System were used for this cross-sectional study. Weighted analysis was performed, and associations were examined by adjusted prevalence ratios (APRs) and 95 % confidence intervals (CIs). RESULTS: Comparing survivors to individuals with no cancer history, differences were found for a smoking quit attempt (APR 1.08; CI 1.04, 1.12), physical inactivity (APR 1.11; CI 1.07, 1.15), and binge drinking (APR 0.89; CI 0.83, 0.95). An interaction with gender was observed when examining smoking and heavy drinking. Smoking was lower (APR 0.85; CI 0.79, 0.92) among male survivors than males with no cancer history, while higher (APR 1.25; CI 1.18, 1.32) among female survivors compared to females with no cancer history. Heavy drinking (APR 0.85; CI 0.73, 0.98) was lower among male survivors than males with no cancer history, while cancer survivorship was not associated with heavy drinking among females. No differences existed for fruit and vegetable consumption or body mass index. CONCLUSIONS: US cancer survivors are not more likely than the general population to engage in all healthy lifestyle behaviors. Interventions, including improved physician communication, to reduce physical inactivity among all cancer survivors and cigarette smoking among female survivors are needed. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors are at increased risk for comorbid conditions, and acceptance of healthy behaviors may reduce dysfunction and improve long-term health. Ultimately, opportunities exist for clinicians to promote lifestyle changes that may improve the length and quality of life of their patients.

Trends in lung cancer incidence rates, Oklahoma 2005-2010.

PURPOSE: Lung cancer is the second most frequently diagnosed cancer among men and women in the United States. With cigarette smoking causing the majority of cases, patterns in lung cancer are often monitored to understand the impact of anti-tobacco efforts. The purpose of this research was to investigate trends in lung cancer incidence rates for the period 2005-2010 in Oklahoma. METHODS: Data on Oklahoma's incident cases of lung cancer (2005-2010) were obtained from the Centers for Disease Control and Prevention WONDER system. Annual percent change (APC) was calculated by linear regression to characterize trends in lung cancer incidence rates over time for the overall population, by gender, by age group, and by age group within gender. Rates were considered to increase or decrease if the p-value for trend was <0.05. RESULTS: From 2005 through 2010, lung cancer incidence rates declined from 81.96 to 68.19 per 100,000 population, with an APC of -3.58% (p-value: 0.0220). When subgroups were examined, declines were observed among all males (APC: -4.25%; p-value: 0.0270), males <65 years (APC: -5.32%; p-value: 0.0008), females <65 years (APC: -4.85%; p-value: 0.0044), and persons aged 55-64 years (APC: -6.38%; p-value: 0.0017). CONCLUSIONS: Declines in lung cancer incidence rates occurred during 2005-2010 among the overall population and within select demographic groups in Oklahoma. Although trends were stable for several demographic groups, rates of lung cancer incidence were lower in 2010 compared to 2005. Continued evidence-based tobacco control efforts are needed to ensure further reductions in lung cancer incidence rates in the state of Oklahoma.

Race and Gender Disparities in Lung Cancer Incidence Rates, 2001-2010.

OBJECTIVE: Despite progress to reduce the burden of tobacco, disparities in tobacco-related morbidity and mortality remain. This research examines trends in lung cancer incidence rates by race and by gender within race during 2001-2010 in Oklahoma. METHODS: Incident cases of lung cancer were obtained from the Oklahoma State Department of Health public use database. Cases were linked to the Indian Health Service database to reduce misclassification of American Indian race. Annual percent change (APC) was estimated by race and by gender within race to describe rates over time. Rates were considered to increase or decrease if the p-value for trend was < 0.05. RESULTS: Average lung cancer incidence rates were highest among American Indians (105.52 per 100,000) and lowest among whites (78.64 per 100,000). Lung cancer incidence rates declined among the overall white (APC: -2.17%; p = 0.001) and African American (APC: -2.95%; p = 0.003) populations, as well as white (APC: -3.02%; p < .001) and African American males (APC: -3.39%; p = 0.007). Rates increased among American Indian females (APC: 2.20%; p = 0.03). CONCLUSION: Analysis of lung cancer incidence data reveals an inequality in tobacco-related morbidity among American Indians, especially American Indian females. This research suggests a need for more evidence-based tobacco control interventions within the American Indian population.

An Ecological Analysis of Tobacco Use and Oral Cavity and Pharynx Cancers in U.S. Males.

BACKGROUND: As the 8th most frequently diagnosed cancers among U.S. males, cancers of the oral cavity and pharynx are a significant component of the cancer burden among U.S. males. Avoidance of tobacco products is critical for the prevention of oral cavity and pharynx cancers. The objective of this brief report was to describe state-specific incidence rates of oral cavity and pharynx cancers and to examine the correlation between state-specific prevalences of tobacco use and oral cavity and pharynx cancer incidence rates among U.S. adult males. METHODS: Secondary surveillance data were used to conduct this ecological analysis. Incidence rates of oral cavity and pharynx cancers during 2009 through 2011 among males were obtained from the Centers for Disease Control and Prevention (CDC) WONDER system. Prevalences of cigarette smoking and smokeless tobacco use during 1995 and 1996 among males were obtained from the CDC STATE System. Relations were examined by calculating Pearson correlation coefficients and by performing linear regression analysis. Statistical significance was considered at alpha < 0.05. RESULTS: Current cigarette smoking prevalence was significantly correlated (r = 0.57; r2 = 0.33; p-value = < .0001) with the incidence rate of oral cavity and pharynx cancer; while there was a non-statistically significant correlation (r = 0.22; r2 = 0.05; p-value = 0.1147) between smokeless tobacco use and oral cavity and pharynx cancer. A 1% increase in the prevalence of current cigarette smoking was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.52 per 100,000 males. Although non-statistically significant, a 1% increase in the prevalence of smokeless tobacco use was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.18 per 100,000 males. CONCLUSION: Among U.S. males, a statistically significant positive correlation was observed between cigarette smoking and oral cancer, but not between smokeless tobacco use and oral cancer. Moreover, current cigarette smoking was estimated to predict one-third of the total variability in oral cancer. These findings contribute to the body of literature and provide further evidence that cigarette smoking is an important behavioral risk factor for oral cavity and pharynx cancer among U.S. males.

COPD in a nationally representative sample: sociodemographic factors and co-morbidity, diagnosis method, and healthcare utilization.

INTRODUCTION: In 2011, the Centers for Disease Control and Prevention for the first time ever collected nationally representative prevalence data on chronic obstructive pulmonary disease (COPD), spirometry diagnosis, and healthcare utilization factors related to COPD. This research reports on that data and describes characteristics of adults with COPD who reported diagnosis by spirometry compared to those who did not report diagnosis by spirometry. Variables examined included basic elements of healthcare utilization such as emergency room visits, hospitalization or personal physician utilization. METHODS: This is a cross-sectional study using novel data from the 2011 Behavioral Risk Factor Surveillance System COPD Module. Weighted multivariable logistic regression examined factors associated with (n = 13,484) and without spirometry (n = 3,131). RESULTS: Spirometry to diagnose COPD was reported by 78% of adults and increased with age. In multivariable modeling, spirometry was more likely in: Black, non-Hispanic compared to white non-Hispanic; current and former compared to never smokers; adults with co-morbidity including asthma, depression, and cardiovascular disease; adults with a doctor; and those who had been to emergency room/hospital for COPD. Those less likely to receive a spirometry were: Hispanic and reported exercise in the past 30 days. CONCLUSIONS: This study identified that adults diagnosed with COPD without a spirometry tended to be Hispanic, younger, healthier, and had less utilization of medical resources. This study is a first step in understanding the potential impact of COPD diagnosis made without spirometry.

Clinical and individual factors associated with smoking quit attempts among adults with COPD: do factors vary with regard to race?

Only half of adults with chronic obstructive pulmonary disease (COPD) report a smoking quit attempt in the past year. Adults with COPD have frequent encounters with the healthcare system that are opportunities for health behavior interventions that support quit attempts. The purpose of this research was to examine individual- and clinical-level factors associated with smoking quit attempts in adults with COPD. Cross-sectional data were from the 2011 Behavioral Risk Factor Surveillance System. Race-stratified, weighted logistic regression examined factors associated with quit attempt among current smokers with COPD. Overall, quit attempt was reported by 65% (95% confidence interval (CI): 61.9, 67.5) of adults and was more likely among blacks than whites (p < 0.0001). Among whites with COPD quit attempt was associated with: Female gender (adjusted odds ratio (AOR) = 1.3; CI: 1.0, 1.7), exercise (AOR = 2.0; CI: 1.5, 2.5), and medications for COPD (AOR = 1.6; CI: 1.3, 2.2). Among black adults with COPD quit attempt was associated with: Having a partner (AOR = 4.5; CI: 1.3, 15.0), exercise (AOR = 3.7; CI: 1.6, 8.7), spirometry (AOR = 9.5; CI: 3.2, 28.7), and having a personal doctor (AOR = 6.4; CI: 1.8, 22.5). Individual and clinical-factors associated with quit attempt varied by race. These findings suggest an impact of the healthcare system that supports quit attempts in blacks but not whites with COPD.

Influenza vaccination in adults with chronic obstructive pulmonary disease: the impact of a diagnostic breathing test on vaccination rates.

INTRODUCTION: Influenza vaccination rates are low in adults with chronic obstructive pulmonary disease (COPD). A diagnostic breathing test in adults with COPD may increase vaccination rates; however, research has not demonstrated this relationship. The purpose of this research was to determine if adults with COPD diagnosed by a breathing test were more likely to have had an influenza vaccination during the past 12 months when compared to those with COPD diagnosed without a breathing test. METHODS: This was a cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System. Logistic regression examined the relationship between influenza vaccination among adults with COPD diagnosed with a breathing test (n = 13,201) compared to those diagnosed without a breathing test (n = 3,108), after controlling for all potential confounders. RESULTS: Overall, 49% of respondents with COPD received an influenza vaccination within the past 12 months and 78% reported their COPD was diagnosed by a breathing test. The prevalence of influenza vaccination in the past 12 months was greater in those with COPD diagnosed by a breathing test (53%) compared to those diagnosed without a breathing test (36%). In adjusted analysis, adults with COPD who had a breathing test were 31% (confidence interval 1.1, 1.6) more likely to have received an influenza vaccination in the past 12 months compared to those without a breathing test. DISCUSSION: A diagnostic breathing test for COPD was associated with increased likelihood of having had an influenza vaccination in the past 12 months. This may be an indicator of the relationship between knowledge of lung function and the need for preventative care, a sign of quality healthcare, or good health-seeking behaviors in patients with COPD. This research is the first to use a nationally representative sample to suggest that spirometry diagnosis of COPD may increase rates of influenza vaccination.