Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern

Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.     

Correlating atmospheric and biological markers in studies of secondhand tobacco smoke exposure and dose in children and adults

OBJECTIVE: We sought to directly compare secondhand smoke (SHS) atmospheric markers to each other and to SHS dosimetric biomarkers, permitting intercomparison of clinical and atmospheric studies. METHODS: We used atmospheric and pharmacokinetic (PK) models for the quantitative estimation of SHS exposure and dose for infants, children, and adults, based on building smoker density and air exchange rate, and from exposure duration, default PK parameters, and respiration rates. RESULTS: We estimate the SHS serum cotinine doses for the typical and most-exposed individuals in the U.S. population; predictions compare well to measurements on a national probability sample. Using default respiration rates, we estimate serum cotinine dose from SHS nicotine exposure for 40 adults exposed to SHS in an environmental chamber; predictions agreed with observations. We correlate urine cotinine and hair nicotine levels for 127 infants exposed to parental smoking, and estimate corresponding atmospheric nicotine exposure via PK modeling. CONCLUSIONS: Our "Rosetta Stone" Equations allow the SHS atmospheric markers, respirable particles, nicotine, and carbon monoxide, to be related to the SHS biomarkers, cotinine in blood, urine, and saliva and nicotine in hair, permitting intercomparison of clinical and atmospheric studies of SHS for the first time.     

Curcumin content of turmeric and curry powders

Curcumin, derived from the rhizome curcuma longa, is one of the primary ingredients in turmeric and curry powders that are used as spices in Middle Eastern and Asian countries, especially on the Indian subcontinent. More recently, laboratory studies have demonstrated that dietary curcumin exhibits various biological activities and significantly inhibits colon tumorigenesis and tumor size in animals. Curcumin displays both anti-inflammatory and antioxidant properties, giving it the potential to be considered in the development of cancer preventive strategies and applications in clinical research. Experimental studies have shown the biological activities of the compound, but much more information on pharmacokinetics, bioavailability, and food content are needed. Whether the amount of curcumin in turmeric and curry powders is sufficient to suggest effects on biological activities and cancer risk is unknown. To determine and compare the quantitative amounts of curcumin that are present in several brands of turmeric and curry powders, a high performance liquid chromatography technique was used to analyze 28 spice products described as turmeric or curry powders and two negative controls. Pure turmeric powder had the highest curcumin concentration, averaging 3.14% by weight. The curry powder samples, with one exception, had relatively small amounts of curcumin present, and the variability in content was great. The curcumin content of these seasoning products that are consumed as a component of the diet should be considered in evaluating baseline tissue concentration and response to curcumin supplementation, which is under study in chemoprevention trials.     

Resilience and Mental Health Among Syrian Refugee Children in Jordan

Refugee populations are at high risk of experiencing trauma and developing negative mental health outcomes. The resilience of Syrian refugee children is not well established as far as modifying the association between trauma and mental illness. A total of 339 Syrian refugee children aged 10 to 17 were surveyed to assess resilience, depression and history of trauma. All children reported exposure to at least one traumatic event, 48.6% reported exposure to highly salient traumatic events such as being held hostage, kidnapping or imprisonment. High rates of suicidal ideation and depression symptomatology were found. Resilience was strongly inversely related to depression. Relational support was found to be the most protective resilience factor and was the most highly correlated with less depressive symptomatology. Empowering children and families to build resilience through social support may be a viable prevention and management approach to other unaffordable or unavailable treatments for mental illnesses.

     

Toenail nicotine levels as predictors of coronary heart disease among women

The authors assess the ability of toenail nicotine levels as a biomarker to predict incident coronary heart disease (CHD). A nested case-control study was carried out among 62,641 women aged 36-61 years in the Nurses' Health Study cohort who provided toenail clippings in 1982. Between 1984 and 1998, 905 incident CHD cases were diagnosed and matched with two controls by age and date of toenail collection. Using multivariate logistic regression analyses, the authors found a statistically significant dose-response association between increasing toenail nicotine levels and risk of CHD (p(trend) < 0.0001); women in the highest quintile had a relative risk of 3.44 (95% confidence interval (CI): 2.56, 4.62) compared with women in the lowest quintile. With each increase in the log-transformed unit of continuous toenail nicotine levels, there was a 42% increase in the risk of CHD (relative risk = 1.42, 95% CI: 1.33, 1.52). The association remained significant when the number of cigarettes smoked and passive smoking were included as covariates (relative risk = 1.12, 95% CI: 1.01, 1.24). In conclusion, toenail nicotine levels are predictive of CHD among women independent of other risk factors and remained significant even after adjustment for history of cigarette smoking.     

Reliability of plasma carotenoid biomarkers and its relation to study power

BACKGROUND: The reliability of biomarkers profoundly impacts validity of their use in epidemiology and can have serious implications for study power and the ability to find true associations. We assessed reliability of plasma carotenoid levels over time and how it could influence study power through sample size and effect-size. METHODS: Plasma carotenoid levels were measured in a cohort study of 1323 women participating in the control arm of the Women's Healthy Eating and Living Study. We compared mean plasma levels at baseline, year 1, and year 4 of the study for alpha-carotene, beta-carotene, lycopene, lutein, and beta-cryptoxanthin. Reliability of these levels over time was assessed by Spearman correlations and intraclass correlation. RESULTS: We found limited variation in mean levels between any 2 time points. Variation did not exceed 8% for lycopene, lutein, and beta-cryptoxanthin, 15% for alpha-carotene, and 18% for beta-carotene. Spearman correlations for individual carotenoids over time varied between 0.50 and 0.80, with lycopene having the lowest correlation. Intraclass correlations ranged from 0.47 to 0.66 for carotenoids. CONCLUSION: Intraclass correlations for plasma carotenoids over a period of several years are acceptable for epidemiologic studies. However, such variation is enough to decrease statistical power and increase the sample size needed to detect a given effect.     

Increase in Cruciferous Vegetable Intake in Women Previously Treated for Breast Cancer Participating in a Dietary Intervention Trial

Consumption of cruciferous vegetables has been associated with reduced breast cancer risk mechanistically and in population-based studies, although evidence has been inconsistent. This inconsistency may be related to limitations in quantifying and qualifying cruciferous vegetable exposure using standard instruments for dietary assessment (for example, food-frequency questionnaires, FFQs) or due to low levels of intake demonstrated among U.S. population samples. Cruciferous vegetable intake data are presented from a longitudinal study of a high-vegetable dietary intervention to reduce breast cancer recurrence among breast cancer survivors (n = 1,156; 536 intervention and 620 comparison group subjects). Intake was assessed using repeat administration of an FFQ and cross-sectional administration of a cruciferous vegetable–specific FFQ (CVFFQ). Mean intake in the intervention group assessed using the standard FFQ was 37.7 g/day at baseline and increased to 57.1 g/day at 12 mo (P = 0.0001) and was sustained through 48 mo. Broccoli and cabbage were the most commonly consumed cruciferous vegetables, regardless of the instrument used to assess intake. Differences in intake by group assignment were shown for raw cruciferous vegetables (30.2 g/day vs. 24.6 g/day, assessed using the CVFFQ), suggesting increased exposure to biologically active, cancer-preventive food constituents. These data suggest that this study population will be the first U.S. population sample to provide ample quantity and variety in cruciferous intake to examine whether these vegetables are protective against breast cancer recurrence.     

E-Cigarette Use in the Past and Quitting Behavior in the Future: A Population-Based Study

Objectives. We examined whether smokers who used e-cigarettes are more likely to quit after 1 year than smokers who had never used e-cigarettes.Methods. We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up.Results. Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97).Conclusions. Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.The use of electronic cigarettes (e-cigarettes)—also known as electronic nicotine delivery systems, personal vaporizers, and vaping cigarettes—is a recent and rapidly expanding phenomenon. These names refer to a battery-operated device that electronically heats a liquid (sometime referred to as “e-juice”) containing nicotine and propylene glycol, plus flavors, to create a misty vapor mimicking cigarette smoke that is inhaled by the smoker (who is commonly known as the “vaper”). This increasing use of e-cigarettes has become a controversial issue among health professionals, policymakers, vapers, and the general public. According to the surgeon general’s recent recommendations, e-cigarettes need to be regulated and their use in the population closely monitored, especially given the doubling of use among youths within just 1 year (between 2011 and 2012).1The main controversy surrounding the use of e-cigarettes is whether they are of benefit to smokers, as an alternative to cigarettes and for harm reduction, or whether they cause more harm to society by introducing and propagating new forms of nicotine addiction.2 At present, there is a scarcity of data to help guide decisions regarding the potential harm versus benefits of e-cigarettes, a situation that has led to claims and counterclaims by opponents and proponents of e-cigarette use.3 If smokers quit traditional cigarettes and instead use e-cigarettes to maintain their nicotine addiction (but without the degree of exposure to known carcinogenic byproducts of tobacco combustion), this may be a viable harm reduction strategy that can become a powerful tool for tobacco control.Most of the evidence that users and proponents of e-cigarettes employ have been anecdotal and not scientifically validated; recently, however, more studies on this topic have appeared. One of the first, a pilot study funded by the manufacturers of an e-cigarette brand from Italy, included 40 smokers who were given e-cigarettes and followed up for 24 weeks. The authors reported a 22.5% rate of sustained abstinence from cigarettes among e-cigarette users, a rate comparable to the effects of nicotine replacement therapy in experimental settings.4 However, this study was underpowered because of the small number of participants. A more recent and larger 3-arm trial of e-cigarette use from New Zealand randomized participants to use e-cigarettes (nicotine or placebo) or nicotine patches to quit smoking. Abstinence rates at 6-month follow-up were low across conditions (4.1%–7.8%), with the highest rate found with nicotine e-cigarettes and the lowest with placebo e-cigarettes,5 but no significant differences emerged. In addition to its low statistical power, the study included a potential methodological bias because those in the e-cigarette arm of the trial were mailed the device and cartridges while those in the nicotine patch arm were mailed a voucher (thus requiring that they obtain the nicotine patches). The difference in dose of nicotine and type of e-cigarettes is an additional major limiting factor in interpreting these results across different studies.An earlier study of a convenience sample of 81 ever-users of e-cigarettes concluded that most participants were using them to quit smoking,6 but it provided no clear indication of how successful they were. A larger follow-up survey of e-cigarette users by the same authors indicated that almost all former smokers (96%) agreed that e-cigarettes helped them quit smoking and 57.7% of current smokers believed that e-cigarettes would help them quit or avoid relapsing.7 However, these studies were biased toward self-selected current users without any comparison groups, and the actual influence on quitting among ever-users versus never-users is unknown. More recently, a meta-analysis by Grana et al. found that all 4 prospective studies that assessed the influence of e-cigarette use on quitting behavior found that e-cigarette use did not assist smokers in quitting.8We prospectively assessed how ever using e-cigarettes, compared with never using them, affected abstinence and smoking habits among smokers in the general population. Given that previous data suggest that smokers mostly use e-cigarettes to quit smoking, we hypothesized that smokers in the general population who have tried or who currently use e-cigarettes are more likely to succeed in quitting than smokers who never used them, after controlling for level of addiction, quitting intentions, and smoking behavior.