Tobacco use among school personnel in Rajasthan, India

BACKGROUND: A very little information about tobacco use among school personnel is available. This is a step to have cross country and within country data using standardized methodology. AIMS: To obtain baseline information about tobacco use prevalence, knowledge and attitude among school personnel. STUDY DESIGN: Two stage cluster sample. SETTING: A state of Rajasthan. MATERIALS AND MATERIALS AND METHODS: A cross-sectional study, using anonymous self-administered questionnaire. A sample of schools with probability proportional to the enrollment in grades 8-10. All school personnel in sampled schools were eligible to participate. STATISTICAL ANALYSIS: Percentage, 95% confidence interval. RESULTS: School response rate was 97.4% (75/77) and school personnel response rate was 67.2% (909/1352). Majority of school personnel (men 69%, women 31%) were school teachers (78.3%). The prevalence of ever any tobacco use was reported by 35.9%, more among men than women (46.2% vs. 13.0%). The prevalence of current daily smoking was reported by 14.4% (men 20.6%, women 0.8%) and occasional by 7.3%, where as current daily smokeless tobacco use was 11.7% (men 16.4%, women 1.1%) and occasional 13.6%. Current daily tobacco use was significantly more among men than women. Four out of nine reported their schools have a tobacco prohibiting policy for both students (48.4%) as well as for school personnel (44.4%) and about same (47.2%) reported their schools enforce its tobacco policy or rule. Over 85% of all school personnel strongly support the tobacco control policies and wanted training in tobacco cessation and prevention. CONCLUSION: First study from Rajasthan to report tobacco use among school personnel. School personnel not only strongly support the tobacco control policies but also ready to work for its successful implementation with proper training.     

Support for a Campus Tobacco-Free Policy among Non- Smokers: Findings from a Developing Country

Background: A tobacco-free workplace policy is identified as an effective means to reduce tobacco use and protect people from second-hand smoke; however, the number of tobacco-free policies (TFP) remains very low in workplaces in Malaysia. This study explored the factors affecting support for a tobacco-free policy on two healthcare campuses in Malaysia, prior to the implementation of TFP. Materials and Methods: This crosssectional study was conducted among 286 non-smokers from two healthcare training centres and two nearby colleges in Malaysia from January 2015 to April 2015. A standardized questionnaire was administered via staff and student emails. The questionnaire collected information on sociodemographic characteristics, support for a tobacco-free policy and perceived respiratory and sensory symptoms due to tobacco exposure. Bivariate and multivariate logistic regression analyses were performed to estimate the independent effects of supporting a tobacco-free campus. Results: The percentage of individuals supporting completely tobacco-free facilities was 83.2% (N=238), as opposed to 16.7% (N=48) in support of partially tobacco free facilities. Compared to the supporters of partially tobacco-free facilities, non-smokers who supported completely tobacco-free health facilities were more likely to be female, have higher education levels, to be very concerned about the effects of other people smoking on their health and to perceive a tobacco-free policy as very important. In addition, they perceived that tobacco smoke bothered them at work by causing headaches and coughs and, in the past 4 weeks, had experienced difficulty breathing. In the multivariate model, after adjusting for sociodemographic characteristics and other factors, only experiencing coughs and headaches increased the odds of supporting a completely tobacco-free campus, up to 2.5- and 1.9-fold, respectively. Conclusions: Coughs and headaches due to other people smoking at work enhances support for a completely tobacco-free campus among non-smokers.     

Cultural Competency and Tobacco Control Training in US Medical Schools: Many but Missed Opportunities

Tobacco-related morbidity and mortality disproportionately burdens America’s most vulnerable populations, and many physicians in the USA are untrained in smoking cessation skills with patients of various literacy levels and races and ethnicities. An anonymous survey was administered to 860 second year and 827 fourth year students at 12 medical schools. A faculty representative at each of the schools completed an assessment of the curriculum and rated medical students’ knowledge and skills for cultural competency. Report of experience in tobacco counseling for persons of various literacy levels and ethnicities rose from 42% (second year students) to 82% (fourth year students) and 48% (second year students) to 91% (fourth year students), respectively. However, only 37% of second year students and 40% of fourth year students reported that they had ever been taught to employ culturally competent strategies for tobacco cessation. This study found that almost two thirds of students in 12 medical schools reported no exposure to teaching about cultural competency and tobacco cessation, and approximately one third reported no practical experience with tobacco cessation counseling persons of various races and ethnicities. Effective cultural competency training for tobacco control should include teaching the social constructs of race, ethnicity, and socio-cultural concepts within a medical context. Additionally, students should receive supervised clinical opportunities to practice counseling, including opportunities to discuss and reflect on their experiences.     

Tobacco education in US physician assistant programs

Background. Few health degree programs incorporate sufficient tobacco cessation education in core curricula. Methods. A national survey of 132 PA programs assessed the extent to which tobacco is addressed, educational methods, perceived importance and adequacy of tobacco education, and perceived barriers to enhancing tobacco-related content. Results. Surveys (n=99; 75%) revealed a median of 150 minutes of tobacco education throughout the degree program. Key barriers to enhancing training are lack of curriculum time and lack of access to comprehensive, evidence-based resources. Two-thirds expressed interest in participating in a nationwide effort to enhance tobacco cessation training. Conclusions. Similar to other disciplines, enhanced tobacco education is needed in PA programs to adequately prepare graduates to address the primary known cause of preventable death in the United States.     

Impact of peritoneal cytology on survival of endometrial cancer patients treated with surgery and radiotherapy

Stage IIIA endometrial cancer includes patients with serosal or adnexal invasion and patients with positive peritoneal cytology only. In this study, we assessed the impact of peritoneal cytology on endometrial cancer survival. All endometrial cancer patients receiving surgery and radiotherapy at the Geneva University Hospitals between 1980 and 1993 were included. Stage IIIA cancers were categorised into 'cytological' stage IIIA (only positive peritoneal cytology) and 'histological' stage IIIA (serosal or adnexal infiltration). Survival rates were analysed by Kaplan-Meier method and compared using log-rank test. The prognostic importance of peritoneal cytology was analysed by multivariate regression analysis. This study included 170 endometrial cancers (112 stage I, 17 cytological stage IIIA, 18 histological stage IIIA, 9 stage IIIB+). Disease-specific survival of cytological stage IIIA was not different from stage I (94 vs 88% respectively, P=0.5) but better than histological stage IIIA (94 vs 51% respectively, P<0.01). Histological stage IIIA patients were at increased risk to die from cancer compared to stage I patients (HR 2.7, 95% CI 1.0-7.7), while cytological stage IIIA patients were not (HR 0.3, 95% CI 0.3-2.0). Cytological stage IIIA endometrial cancer has similar prognosis as stage l and better prognosis than histological stage IIIA. Additional research, definitively separating stage and cytology is warranted.     

Evaluation of a Specially Designed Tobacco Control Program to Reduce Tobacco Use among School Children in Kerala

Background: Smoking and smokeless tobacco use are almost always initiated and established duringadolescence. More than 80% of adult smokers begin smoking before 18 years of age. The main objective of thepresent study is to assess the feasibility of preventing adolescent tobacco use with the help of a specially designedtobacco control program. Materials and Methods: A cross sectional survey on tobacco use and related healtheffects was conducted using a structured questionnaire in 13 randomly selected schools in Kannur district ofKerala. These students were followed for a period of one academic year with multiple spaced interventions suchas anti-tobacco awareness classes, formation of anti-tobacco task forces, inter-school competitions, supplyingIEC (information, education and communication) materials and providing a handbook on tobacco control forschool personnel. Final evaluation was at the end of one year. Results: There were 4,144 school children whoparticipated in the first phase of the study. The prevalence of tobacco smoking and chewing habits were 9.85%and 2.24% respectively. Ninety-one percent had parental advice against tobacco use and only 3.79% expresseddesire for future tobacco use. The final evaluation witnessed a sharp decline in the current tobacco use as 4.68%.We observed a statistically significant difference towards the future use of tobacco (p<0.001) and awarenessabout the ill effects of passive smoking (p<0.001) among boys and girls. Further a significantly increasedknowledge was observed among boys compared to girls about tobacco and oral cancer (p=0.046). Conclusions:The comprehensive school based tobacco control project significantly reduced the tobacco use pattern in thetarget population. School tobacco projects incorporating frequent follow ups and multiple interventions appearmore effective than projects with single intervention.     

Videotaped simulated interviews to improve medical students' skills in disclosing a diagnosis of cancer

Objective: To assess the performance of the training course on the disclosure of a diagnosis of cancer intended for fifth year medical students of the University of Nantes. Methods: The course comprised three sessions: (1) a group discussion that taught a six‐point protocol (SPIKES) for delivering a diagnosis, (2) a videotaped simulated interview to assess protocol implementation and communication skills, and (3) feedback from a senior physician. The learning objectives were memorisation and implementation of the protocol, use of appropriate communication techniques to deal with the patient's response, and identifying one's own reactions in a stressful situation. Two types of assessments were performed before and after each session: self‐assessments by the students and a quantitative and qualitative external assessment by a psychologist and senior physician. In addition, recall of the six‐point protocol was assessed during the end‐of‐the‐year examination. Results: Overall, 108 students took part in the course during the 2004–2005 academic year. They felt that their competence improved after each session in terms of the three learning objectives. However, recall of the six‐point protocol was inadequate. It was best among students who considered they had progressed most. Conclusions: Our training course on communication techniques helps students acquire confidence in their skills in breaking bad news by backing theory with practice and feedback. The students make progress despite the psychological stress generated by simulated real‐life conditions. Copyright © 2009 John Wiley & Sons, Ltd.     

Lung cancer in patients under age 40

A retrospective review of patients <40 years (n=91) seen at the Dana-Farber Cancer Institute and Brigham and Women's Hospital from January 1, 1983-January 1, 1993 was carried out. Of 91 patients, there were 43 men and 48 women with a median age of 36 years (range 28-39). Eighty percent of patients were cigarette smokers for a median of 25 pack years (range 2-68). Ninety-one percent were symptomatic at presentation. The ECOG performance status (PS) was 0 or 1 in 83%. At the time of diagnosis 15% had stage I/II, 17% stage IIIA, 22% stage IIIB and 45% stage IV disease. The most common histopathology was adenocarcinoma (46%), followed by small cell carcinoma (14%), squamous cell carcinoma (12%), large cell undifferentiated (8%) and other types (20%). The median survival for all 91 patients was 1 year with 2 and 5 year survivals of 30% and 18% respectively. Five year survival was related to stage of disease: 60% for patients with stage I, 58% for stage II, 36% for stage IIIA, 10% for stage IIIB, and 3% for stage IV disease. Factors that had no significant effect on overall survival included gender, histologic subtype, degree of differentiation, presence or absence of symptoms, and sites of metastases. Factors that adversely affected survival by univariate analysis included advanced stage of disease, poor PS, duration of symptoms for more than 3 months, and 5% or greater body weight loss. By multivariate analysis only stage (P<0.001) and weight loss (P=0.02) affected survival. This data plus results of other published studies show that young patients under age 40 with lung cancer, compared to the more common older patients, have an increased percentage of women, have a longer duration of symptoms, more often have adenocarcinoma with lower frequency of squamous cell carcinoma and sometimes small cell carcinoma, and more often present with advanced disease. Despite these differences, overall patient survival remains poor and is similar to that of older patients.     

Tobacco Cessation Scenarios Among Healthcare Profession Students: A Multidisciplinary Study

Background: It is acknowledged that the most effective means to contain the tobacco epidemic is to involvehealthcare providers across various disciplines. The present study was undertaken to gain a comprehensive insightinto various factors that determine the efficacy of multidisciplinary approaches in tobacco control. Methods: A crosssectional study design using a structured, pretested and self-administered questionnaire was employed in the present study,conducted among medical and dental interns and final year nursing students. Respondent demographics, knowledge,attitude, behaviour, perceived effectiveness and barriers, and willingness to participate in tobacco cessation were assessed.Results: A total of 268 subjects participated, with mean knowledge, attitude, behaviour, perceived effectiveness andbarrier scores of 69. 7%, 89.0%, 72.0%, 80.6% and 88.6% respectively. There were significant differences among themean scores of the study domains across the 3 disciplines. The majority (92.91%) of the respondents were willing toparticipate in tobacco cessation activities, but only 14.2% had previously received relevant training. Regression analysisrevealed that the significant predictors of behaviour scores were gender, course, attitude and perceived effectiveness;those for willingness to undertake tobacco cessation activities were course, attitude, behaviour and perceived barriers.Conclusions: The study highlighted the willingness but low previous training among the participants and also identifiedfactors that determine t behaviour and willingness to undertake tobacco cessation activities. The study emphasizes theneed for modification in the policies pertaining to curricula of medical, dental and nursing training programs.     

Improving patient safety in the radiation oncology setting through crew resource management

PurposeThis paper demonstrates how the communication patterns and protocol rigors of a methodology called crew resource management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. CRM training was introduced to our comprehensive radiation oncology department in the autumn of 2009. With 34 full-time equivalent staff, we see 100-125 patients daily on 2 hospital campuses. We were assisted by a consulting group with considerable experience in helping hospitals incorporate CRM principles and practices. Implementation steps included developing change initiative skills for key leaders, providing training in teamwork and communications, creating site-specific tools for safety and efficiency, and collecting data to document results.Methods and materialsOur goals were to improve patient safety, teamwork, communication, and efficiency through the use of tools we developed that emphasized teamwork and communication, cross-checking, and routinizing specific protocols. Our CRM plan relies on the following 4 pillars: patient identification methods; “pause for the cause”; enabling all staff to halt treatment and question decisions; and daily morning meetings. We discuss some of the hurdles to change we encountered.ResultsOur safety record has improved. Our near-miss rate before CRM implementation averaged 11 per month; our near-miss rate currently averages 1.2 per month. In the 5 years prior to CRM implementation, we experienced 1 treatment deviation per year, although none rose to the level of “mis-administration.” Since implementing CRM, our current patient treatment setup and delivery process has eliminated all treatment deviations. Our practices have identified situations where ambiguity or conflicting documentation could have resulted in inappropriate treatment or treatment inefficiencies. Our staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety and have spoken up when they considered something potentially unsafe. We have increased our efficiency (and profitability); in 2012, our units of service were up 11.3% over 2009 levels with the same staffing level.ConclusionsThe rigor and standardization introduced into our practice, combined with the increase in communication and teamwork have improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting.     

Key Drivers to Implement an Evidence-based Tobacco Control Programme in Schools of India: A Mixed-Methods Study

Background: Adolescence is an influential stage in students’ lives when lifelong behaviours such as tobacco use are formed. During these years, school teachers are important role models for tobacco control among students. A study was conducted among school personnel and administrators to understand the key drivers for implementing an evidence-based school tobacco control program. Methodology: A cross-sectional, mixed-method study was conducted in five districts of Assam, India. The quantitative study was conducted among 565 school personnel across 40 Government-aided schools. Data was collected by means of an anonymous, self-administered questionnaire. Qualitative data was generated from 15 focus group discussions (FGDs) among 146 participants - District Program Officers, Block Education Officers, Cluster Coordinators, Headmasters and Teachers. Results: While the prevalence of smoked tobacco was low (3%), the use of smokeless tobacco was higher (40%), and the prevalence of use of areca nut without tobacco (65%) was still higher among school personnel. They were aware of the school policies prohibiting the use of tobacco among students within or outside school buildings or during school-sponsored activities (81%); they had rather limited knowledge about policy for themselves (58%). There was lack of access to training materials about prevention of tobacco use among youth. The FGDs amongst school personnel resulted in several constructive suggestions on tobacco control in schools mainly in training school teachers, monitoring the program and incentives for execution of the program. However, there was a reluctance to implement a smokeless tobacco control programme since many were current users of smokeless tobacco and areca nut. Conclusion: Tobacco control policies as well as training school personnel in schools need to improve and further measures must be taken to prohibit use of areca nut, which contains carcinogens. The existing system of the education department can be utilised to implement tobacco control programmes effectively.     

Adoption and Implementation of Tobacco Control Policies in Schools in India: Results of the Bihar School Teachers Study

Implementation of no tobacco policies in schools is associated with lower tobacco use among teachers and students. In this study we assessed the extent that a school-based intervention for teachers resulted in adoption and implementation of tobacco control policies. From a random sample of government schools (8th-10th), 72 were randomized into intervention and control conditions. Intervention included health education programs for teachers and support for tobacco control policy implementation. Adoption and implementation of policies were assessed at baseline and immediately after intervention. All 36 intervention and one control school adopted a tobacco-control policy. Higher enforcement of tobacco-control policy was at post intervention (OR=3.26; CI: 2.35, 4.54) compared to baseline in intervention schools. Some 64% of intervention and 28% control schools showed “improvement” in policy implementation. Adoption and implementation of no tobacco policies was positively impacted by intervention. This study provides support for scaling up of school-based tobacco control interventions to promote school tobacco control policies.     

Effectiveness of School based Awareness Programmes against Tobacco among Users and Non- Users– A Cross- Sectional Study from Rural Kerala,India

Background: Known is the fact that adult tobacco users mostly had their initiation into the habit during the adolescence period. The current study was conducted to evaluate the impact of awareness programmes among adolescent students in rural Kerala, India, in terms of knowledge enhancement on tobacco hazards. Methods: A total of 10 high schools and higher secondary schools from one educational sub district were selected using multi stage sampling design. Male students in the age group 13-19 years studying in class IX and X (high school category) and class XI and XII (higher secondary school) were included in the study. The effectiveness was assessed using pre and post training evaluation forms based on mean knowledge scores. Results: 1,114 students participated by filling both the forms (mean age 15.6, SD 1.3). The response rate was 92.8%. The prevalence of ‘current users’ in the study was 4.3% (95% CI 3.11- 5.49). Overall difference in mean knowledge scores among study subjects was evident when pre and post training responses were compared (p<0.001). The difference in knowledge scores was evident among ‘never users’ of tobacco before and after the awareness programmes (p<0.0001). However, no significant difference in mean scores was observed among ‘ever users’ of tobacco (p = 0.584), age groups of ever users (p=0.208), students of high schools (p = 0.242) and higher secondary schools (p= 0.994). Comparison of never, ever and current users revealed significant difference between ‘never’ and ‘current’ users (p = 0.001). However, no such difference was observed between ‘ever’ and ‘current’ users (p =0.138) and ‘ever’ versus ‘never’ users (p =0.099). Conclusion: The study was useful to improve knowledge among school students in general. However, newer strategies have to be tested to understand the best possible measures for tobacco awareness training among adolescent tobacco users.     

Healthy Lungs: Cancer Education for Middle School Teachers Using a “Train and Equip” Method

Prevention of the initiation of tobacco use, which is associated with increased risk of developing cancer of the lung, the oral cavity, larynx, and emphysema, should target middle school-age children because that is where experimentation with tobacco use usually begins. Millions of children attending school do not receive proper education regarding the biological science of the human respiratory system coupled with the impact that tobacco use has at the cell, tissue, and organ levels of biological organization because their teachers are ill-prepared and ill-equipped to teach this normal and cancer-related content. The University of Arkansas for Medical Sciences has a statewide outreach program that provides middle school teachers training in a “Healthy Lungs” curriculum that covers the normal functional anatomy of the respiratory system as a basis for adding the effect of tobacco use and its associated cancers and emphysema. This training also provides each participant a resource kit of supplies, materials, and items of equipment. A long-term implementation survey identified a high degree of transference of content and use of the resource kit items into new classroom learning activities for the trainee’s students for both the normal functional anatomy of the human respiratory system and associated general and cell/tissue/organ-specific cancer biology.     

Cervical cancer in relation to tobacco and alcohol consumption in Lesotho, southern Africa

The patterns of tobacco and alcohol consumption were determined for 257 pairs of cervical cancer patients and controls in Lesotho, matched in terms of age, number of children, and home area. Four binary variables in 16 combinations were analysed: the use of tobacco in the form of cigarettes, pipe, or snuff, the use of indigenous alcohols, European drink, and sour porridges made from fermented sorghum or maize. A matched pairs analysis to evaluate crude relative risk according to Pike [7] and a logistic model fitted by maximum likelihood according to the method described by Cox [8] supported the conclusion that there was an elevated risk of cancer in the cervix among Lesotho women who consumed indigenous alcohols. In a previous report of cancer statistics of Lesotho [2] the authors employed a X2 analysis separately on each factor. The integrated method adopted in the present communication permits a much higher degree of difference between patients and controls and ascribes a much higher degree of significance to indigenous alcohol than to tobacco.     

Descriptive epidemiology of esophageal carcinoma in the Ohio Cancer Registry

Background: Etiologic factors and demographics in esophageal cancer have not been fully characterized at a population-level. This study aimed to compare incidence rates of esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) by race. Other aims were to evaluate the impact of race, age, gender, and histology on presenting stage, and to describe tobacco use history in EAC as documented in a cancer registry. Methods: Invasive esophageal cancer cases reported to Ohio's Cancer Registry 1998-2002 were identified. Incident staged EAC and ESCC cases were analyzed for factors associated with metastatic disease. Results: 930 ESCC and 1801 EAC cases were identified. African-Americans had higher ESCC incidence than whites (5.0 versus 1.3 cases/100,000/year). However, whites had higher EAC incidence (3.3 versus 0.8 cases/100,000/year). 77% of EAC cases with available tobacco history were reported in tobacco users. In univariate analyses, race, age, gender, and histology differed significantly by stage. 31% of patients aged ≥65 presented with distant stage, versus 26% of those <65 (p < 0.001). 32% of African-Americans had distant stage, versus 34% of whites (p = 0.048). In logistic regression modeling, male gender [OR 1.76, CI (1.15, 2.67)] and age <75 [OR 1.95, CI (1.21, 3.15)], but not race, predicted distant stage ESCC. Distant stage EAC was associated with age <56 [OR 1.82, CI (1.39, 2.38)] but not significantly associated with African-American race (p = 0.062) for the sample size available. Conclusions: Whites had higher EAC rates, and African-Americans had higher ESCC rates. African-Americans were not more likely than whites to present with metastatic ESCC.     

Compliance with Smoke-Free Policy and Challenges in Implementation: Evidence from Bengkulu,Indonesia

Background: Smoking is among the top contributors to deaths and disability-adjusted life years in Indonesia, particularly among males. In 2012, a presidential decree encouraged provinces and districts to implement a smoke-free policy (SFP). This study aims to evaluate compliance and explore the challenges in the implementation. Methods: Through a mixed-methods design, we used quantitative methods to examine the compliance with six criteria including signage, no active smoking, no selling, no advertisement, no smoke, and no ashtray at SFP facilities in Bengkulu city. We observed SFP compliance at 105 facilities, including health/educational facilities, places of worship, workplaces, and indoor/outdoor public facilities. We also used a qualitative method to explore challenges in the implementation through interviews with the government and legislators. Results: The compliance rate to all six criteria was 38% overall, ranging from 17% at outdoor public facilities to 67% at health facilities. We found no spatial patterning, as shown by non-significant differences in compliance rates between SFP facilities inside and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included lack of sensitization, lack of coordination, and limited budget. Conclusion: The compliance was relatively low due to several challenges, which could serve as a tobacco control policy lesson in a lower-middle-income country.     

Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)‐positive breast cancer by race/ethnicity and education within the National Comprehensive Cancer Network

BACKGROUND.

Trastuzumab for human epidermal growth factor receptor 2 (HER2)‐positive breast cancer is highly efficacious yet costly and time‐intensive, and few data are available about its use. The authors of this report examined receipt and completion of adjuvant trastuzumab by race/ethnicity and education for women with HER2‐positive disease.

METHODS.

The National Comprehensive Cancer Network Breast Cancer Outcomes Database was used to identify 1109 women who were diagnosed with stage I through III, HER2‐positive breast cancer during September 2005 through December 2008 and were followed for ≥1 year. The authors used multivariable logistic regression to assess the association of race/ethnicity and education with the receipt of trastuzumab and, among those women who initiated trastuzumab, with the completion of > 270 days of therapy.

RESULTS.

The cohort was 75% white, 8% black, and 9% Hispanic; and 20% of women had attained a high school degree or less. Most women (83%) received trastuzumab, and no significant differences were observed according to race/ethnicity or socioeconomic status. Among the women who initiated trastuzumab, 73% of black women versus 87% of white women (P = .007) and 70% of women with less than a high school education versus 90% of women with a college degree completed > 270 days of therapy (P = .006). In adjusted analyses, black women (vs white women) and women without a high school degree (vs those with a college degree) had lower odds of completing therapy (black women: odds ratio, 0.45; 95% confidence interval, 0.27‐074; white women: odds ratio, 0.27, 95% confidence interval, 0.14‐0.51).

CONCLUSIONS.

Differences in completing trastuzumab therapy were observed according to race and educational attainment among women who received treatment at National Comprehensive Cancer Network centers. Efforts to assure the appropriate use of trastuzumab and to understand treatment barriers are needed and may lead to improved outcomes. The authors report differences in the rate at which patients complete treatment with trastuzumab according to race and education among women who receive treatment at National Comprehensive Cancer Network centers. Efforts to assure the appropriate use of trastuzumab and to understand treatment barriers are needed and may lead to improved outcomes. Cancer 2013. © 2012 American Cancer Society.     

Descriptive epidemiology of esophageal carcinoma in the Ohio Cancer Registry

Background: Etiologic factors and demographics in esophageal cancer have not been fully characterized at a population-level. This study aimed to compare incidence rates of esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) by race. Other aims were to evaluate the impact of race, age, gender, and histology on presenting stage, and to describe tobacco use history in EAC as documented in a cancer registry. Methods: Invasive esophageal cancer cases reported to Ohio's Cancer Registry 1998–2002 were identified. Incident staged EAC and ESCC cases were analyzed for factors associated with metastatic disease. Results: 930 ESCC and 1801 EAC cases were identified. African-Americans had higher ESCC incidence than whites (5.0 versus 1.3 cases/100,000/year). However, whites had higher EAC incidence (3.3 versus 0.8 cases/100,000/year). 77% of EAC cases with available tobacco history were reported in tobacco users. In univariate analyses, race, age, gender, and histology differed significantly by stage. 31% of patients aged ≥65 presented with distant stage, versus 26% of those <65 (p < 0.001). 32% of African-Americans had distant stage, versus 34% of whites (p = 0.048). In logistic regression modeling, male gender [OR 1.76, CI (1.15, 2.67)] and age <75 [OR 1.95, CI (1.21, 3.15)], but not race, predicted distant stage ESCC. Distant stage EAC was associated with age <56 [OR 1.82, CI (1.39, 2.38)] but not significantly associated with African-American race (p = 0.062) for the sample size available. Conclusions: Whites had higher EAC rates, and African-Americans had higher ESCC rates. African-Americans were not more likely than whites to present with metastatic ESCC.     

Smoking prevalence and beliefs on smoking cessation among members of the Japanese Cancer Association in 2006 and 2010

Smoking is a significant contributing factor to disease-related deaths worldwide. Members of the Japanese Cancer Association (JCA) can play a leading role in helping people to live tobacco-free through social action. In 2010, this study assessed smoking prevalence among JCA members and their attitudes toward smoking, smoking cessation, and their responsibilities. Results of the 2010 survey were compared with those of a 2006 survey. Final response rates were 60.8% in the 2006 survey and 47.4% in the 2010 survey, and the current smoking rates were 9.0% and 5.3%, respectively. Regarding concern by current smokers over smoking cessation, the percentage of smokers who were ready to quit smoking within the next month increased from 4.9% to 6.3% between 2006 and 2010. Most JCA members agreed with antismoking actions such as smoking bans in all workplaces, public places, or while walking in the street, regulation restricting the sale and distribution of tobacco to children, tobacco education at school, use of tobacco tax for health, provision of information on tobacco, and smoking cessation support. Approximately 30% of responders disagreed on actions to raise the price of tobacco, regulations restricting the sale of tobacco, health warnings on tobacco packaging, bans on tobacco advertisement, and antismoking campaigns. Barriers to smoking cessation interventions identified were physician's time required to provide interventions, resistance of patients to smoking cessation advice, and lack of education on tobacco control. Not only antismoking actions but also support of smokers by health professionals through adequate education on smoking cessation treatment is needed in the future. (Cancer Sci 2012; 103: 1595-1599).