Cancer Control Research Program

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Liu Y.,Dartmouth College | Antwi-Boampong S.,Dartmouth College | BelBruno J.J.,Dartmouth College | Tanski S.E.,Cancer Control Research Program
Nicotine and Tobacco Research | Year: 2013

Introduction: The 2006 U.S. Surgeon General's Report found that there is no safe level of exposure to secondhand smoke (SHS). Many smokers attempt to protect others from exposure to SHS; however, it is difficult to assess effectiveness of these behavior changes. There is a need for personal monitoring devices that provide real-time SHS exposure data; at present, there is no device that measures ambient nicotine levels in real time. The development of such a sensor is the objective of this research. Methods: A nicotine sensing film comprising the conductive polymer polyaniline was linked with a reporting layer, recording changes in chemiresistance due to adsorption of nicotine. Experiments were carried out in a microprocessor-controlled smoking chamber using sidestream smoke from standard reference cigarettes; up to 10 cigarettes were smoked simultaneously. The exposure chamber was calibrated for total suspended particle, carbon monoxide, and nicotine concentrations. Results: We found significant real-time increases in the resistance of films upon exposure to SHS. The sensors were shown to be sensitive to the number of cigarettes consumed and ambient nicotine and demonstrated reasonable recovery between measurements. The sensors have sufficient sensitivity to detect off-gassing of nicotine or "thirdhand smoke." Conclusions: A sensing element has been developed that can reliably detect secondhand and thirdhand tobacco smoke in real time through the adsorption of ambient nicotine vapor. The device was calibrated to the number of smoked cigarettes and to nicotine concentration. Development of integrated personal sensors to record exposure to SHS using this technology is currently underwa. © The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.


Sargent J.D.,Cancer Control Research Program | Tanski S.,Cancer Control Research Program | Stoolmiller M.,University of Oregon | Hanewinkel R.,Institute for Therapy and Health Research
Addiction | Year: 2010

Aims This study examines the predictive validity of sensation seeking as a predictor of adolescent substance use, in order to optimize targeting for substance use prevention programs. Design Longitudinal study. Setting Random-digit dial telephone survey. Participants A total of 6522 US adolescents aged 10-14 years at baseline, resurveyed at 8-month intervals for three subsequent waves. Measurements Two outcomes were assessed - onset of binge drinking (more than five drinks in a short time) and established smoking (>100 cigarettes life-time). Sensation seeking level was assessed at baseline. Logistic regression was used to predict onset of substance use at any follow-up wave as a function of sensation seeking. The receiver operating characteristics curve was used to illustrate how well sensation seeking predicted substance use as a function of different cut-off points for defining high sensation seeking, and area under the receiver operating characteristics curve (AROC) was the metric of predictive validity. Findings Of 5834 participants with one or more follow-up assessments, 5634 reported no binge drinking and 5802 were not established smokers at baseline, of whom 717 (12.7% of 5634) reported binge drinking and 144 (2.5% of 5802) reported established smoking at one or more follow-up interviews. Sensation seeking predicted binge drinking moderately well [AROC = 0.71 (95% confidence interval 0.69, 0.73)] and was a significantly better predictor of established smoking onset [AROC = 0.80 (0.76, 0.83)]. For binge drinking, predictive validity was significantly lower in blacks; for established smoking it was significantly higher for Hispanics. Implications for two targeting interventions are discussed. Conclusions Sensation seeking works moderately well at identifying adolescents at risk for onset of binge drinking and established smoking. This study offers a guide for determining the appropriate targeting cut-off value, based on intervention efficacy, costs and risks. © 2010 Society for the Study of Addiction.


Hanewinkel R.,Institute for Therapy and Health Research IFT Nord | Isensee B.,Institute for Therapy and Health Research IFT Nord | Sargent J.D.,Cancer Control Research Program | Morgenstern M.,Institute for Therapy and Health Research IFT Nord
Addiction | Year: 2010

Aims: To assess the effect of an antismoking advertisement under real-world conditions. Design: Quasi-experimental study. Setting/participants: Multiplex cinema in Kiel, Germany; 4073 patrons were surveyed after having viewed a movie. Some 4005 patrons were ≥10 years old (28.7% between 10 and 17 years). A total of 654 subjects (16.3%) were smokers. Intervention: In the intervention condition (weeks 1 and 3), a 30-second antismoking advertisement - accentuating long-term health consequences of smoking and promoting cessation - was shown prior to all movies; in the control condition (weeks 2 and 4) no such spot was shown. Main outcome measures: (i) Awareness of smoking in the movie, (ii) approval of smoking in the movie, (iii) attitude towards smoking, (iv) intention to smoke in the future and (v) desire to smoke among smokers. Findings: Patrons who were exposed to the antismoking advertisement were more likely to be female, but did not differ with respect to smoking status. After controlling for gender differences, patrons exposed to the antismoking advertisement had (i) higher awareness of smoking in the movies, (ii) lower levels of approval of smoking in the movies, and (iii) a more negative attitude towards smoking in general compared with those not exposed. Among smokers, smoking in the movies increased urge to smoke, but there was no interaction between smoking in the movies and experimental condition. Conclusions: Study results suggest that placing an antismoking advertisement before movies can affect attitudes towards smoking, bolstering evidence in support of such policies. © 2010 Society for the Study of Addiction.


Morgenstern M.,Institute for Therapy and Health Research IFT Nord | Morgenstern M.,University of Kiel | Isensee B.,Institute for Therapy and Health Research IFT Nord | Sargent J.D.,Cancer Control Research Program | And 2 more authors.
Preventive Medicine | Year: 2011

Objective: Assessing the association between alcohol ad exposure and alcohol use in German adolescents, controlling for general ad exposure. Method: Cross-sectional survey of 3415 sixth to eighth graders (mean 12.5. years) from 29 schools in three German states (June 2008). Exposure to 9 alcohol and 8 non-alcohol advertisements was measured with masked ad images; students indicated contact frequency and brand recall. Main outcomes were ever drinking, current drinking, binge drinking, alcohol use intentions and outcome expectancies. Results: There was a bivariate association between both exposures (alcohol and non-alcohol ads) and all alcohol use measures. After adjustment for confounding, only alcohol ad exposure retained a significant association with outcomes. Multi-level logistic regressions revealed that compared with quartile one alcohol ad exposure, the adjusted odds ratios for quartile four were 2.4 (95% confidence interval 1.7-3.4) for trying drinking, 2.7 (1.8-3.9) for current drinking and 2.3 (1.6-3.5) for ever binge drinking. There was also an independent association between alcohol ad exposure and alcohol-related attitudes among never drinkers. Conclusion: This study demonstrates a positive association between exposure to alcohol advertising and multiple youth drinking outcomes, showing that the association is content-specific, not just a function of general ad exposure. © 2010 Elsevier Inc.


Hanewinkel R.,Institute for Therapy and Health Research IFT Nord | Isensee B.,Institute for Therapy and Health Research IFT Nord | Sargent J.D.,Cancer Control Research Program | Sargent J.D.,University of Southern New Hampshire | Morgenstern M.,Institute for Therapy and Health Research IFT Nord
American Journal of Preventive Medicine | Year: 2010

Background: Although most agree that the association between tobacco marketing and youth smoking is causal, few studies have assessed the specificity of this association. Purpose: This study aims to examine the specificity of the association between cigarette advertising and teen smoking. Methods: A cross-sectional survey of 3415 German schoolchildren aged 10-17 years was conducted using masked images of six cigarette brands and eight other commercial products in 2008. The exposure variable was a combination of contact frequency (recognition) and brand names (cued recall). Sample quartile (Q) exposure to advertisement exposure was calculated in 2009. Outcome variables were ever tried and current (monthly) smoking, and susceptibility to smoking among never smokers. Results: The prevalence of ever smoking was 31.1% and that of current smoking was 7.4%, and 35.3% of never smokers were susceptible to smoking. Ad recognition rates ranged from 15% for a regionally advertised cigarette brand to 99% for a sweet. Lucky Strike and Marlboro were the most highly recognized cigarette brands (with ad recognition rates of 55% and 34%, respectively). After controlling for a range of established influences on smoking behaviors, the adjusted ORs for having tried smoking were 1.97 (95% CI=1.40, 2.77) for Q4 exposure to cigarette ads compared with adolescents in Q1, 2.90 (95% CI=1.48, 5.66) for current smoking, and 1.79 (95% CI=1.32, 2.43) for susceptibility to smoking among never smokers. Exposure to ads for commercial products other than cigarettes was significantly associated with smoking in crude but not multivariate models. Conclusions: This study underlines the specificity of the relationship between tobacco marketing and youth smoking, with exposure to cigarette ads, but not other ads, being associated with smoking behavior and intentions to smoke. This finding suggests a content-related effect of tobacco advertisements. © 2010 American Journal of Preventive Medicine.


McClure A.C.,Cancer Control Research Program | Stoolmiller M.,University of Oregon | Tanski S.E.,Cancer Control Research Program | Engels R.C.M.E.,Radboud University Nijmegen | Sargent J.D.,Cancer Control Research Program
Alcoholism: Clinical and Experimental Research | Year: 2013

Background: Exposure to alcohol marketing is prevalent and is associated with both initiation and progression of alcohol use in underage youth. The mechanism of influence is not well understood, however. This study tests a model that proposes alcohol-specific cognitions as mediators of the relation between alcohol marketing and problematic drinking among experimental underage drinkers. Methods: This study describes a cross-sectional analysis of 1,734 U.S. 15- to 20-year-old underage drinkers, recruited for a national study of media and substance use. Subjects were queried about a number of alcohol marketing variables including TV time, Internet time, favorite alcohol ad, ownership of alcohol-branded merchandise (ABM), and exposure to alcohol brands in movies. The relation between these exposures and current (30-day) binge drinking was assessed, as were proposed mediators of this relation, including marketing-specific cognitions (drinker identity and favorite brand to drink), favorable alcohol expectancies, and alcohol norms. Paths were tested in a structural equation model that controlled for sociodemographics, personality, and peer drinking. Results: Almost one-third of this sample of ever drinkers had engaged in 30-day binge drinking. Correlations between mediators were all statistically significant (range 0.16 to 0.47), and all were significantly associated with binge drinking. Statistically significant mediation was found for the association between ABM ownership and binge drinking through both drinker identity and having a favorite brand to drink, which also mediated the path between movie brand exposure and binge drinking. Peer drinking and sensation seeking were associated with binge drinking in paths through all mediators. Conclusions: Associations between alcohol marketing and binge drinking were mediated through marketing-specific cognitions that assess drinker identity and brand allegiance, cognitions that marketers aim to cultivate in the consumer. © 2012 by the Research Society on Alcoholism.


Hanewinkel R.,Institute for Therapy and Health Research IFT Nord | Hanewinkel R.,University of Kiel | Isensee B.,Institute for Therapy and Health Research IFT Nord | Sargent J.D.,Cancer Control Research Program | And 2 more authors.
Pediatrics | Year: 2011

OBJECTIVE: To test the specificity of the association between cigarette advertising and adolescent smoking initiation. METHODS: A longitudinal survey of 2102 adolescents, aged 10 to 17 years at baseline, who never smoked was conducted by using masked images of 6 cigarette advertisements and 8 other commercial products with all brand information digitally removed. The exposure variable was a combination of contact frequency and cued recall of brands for cigarette and other advertisements. Multilevel mixed-effects Poisson regressions were used to assess smoking initiation 9 months after the baseline assessment as a function of cigarette-advertisement exposure, other advertisement exposure, and baseline covariates. RESULTS: Thirteen percent (n = 277) of students initiated smoking during the observation period. Although the incidence of trying smoking was associated with increased exposure to cigarette advertisements (10% in the low, 12% in the medium, and 19% in the high cigarette-advertisement exposure tertile initiated smoking), exposure to other advertisements did not predict smoking initiation. Compared with low exposure to cigarette advertisements, high exposure remained a significant predictor of adolescent smoking initiation after controlling for baseline covariates (adjusted relative risk: 1.46 [95% confidence interval: 1.08-1.97]; P < .05). CONCLUSIONS: Our results support the notion of a content-related effect of cigarette advertisements and underlines the specificity of the relationship between tobacco marketing and teen smoking; exposure to cigarette advertisements, but not other advertisements, is associated with smoking initiation. Copyright © 2011 by the American Academy of Pediatrics.


Hunt K.,MRC Social and Public Health science Unit | Henderson M.,MRC Social and Public Health science Unit | Wight D.,MRC Social and Public Health science Unit | Sargent J.D.,Cancer Control Research Program
Thorax | Year: 2011

Background: Evidence of high exposure of UK youth to images of smoking in films has led to calls for an 18 rating for films with smoking to reduce smoking in youth. However, the only study to date in the UK to test for an association showed no relation between film-smoking exposure and smoking among young adults. Objective: To assess whether there is an association between exposure to film images of smoking and own smoking among UK adolescents and whether repeated viewings of films has an impact. Design: Cross-sectional study. Participants 1999 pupils aged 15-16 years from 13 Scottish schools. Outcome: Smoked tobacco in the past year. Exposure measure: Film-smoking exposure was assessed using the Beach method; account for repeated viewings of films was then used to modify estimated exposure. Covariates included: media usage, parental restriction on and context of TV/film viewing, family connectedness, parental monitoring and friends' smoking. Results: Most (71%) students had not smoked in the past year. About half reported no parental restrictions on TV/film viewing. Many reported repeated viewings of films; accounting for this more than doubled exposure estimates and strengthened the association with smoking. Adolescents with high exposure to film smoking were more likely to have smoked than those with low exposure (adjusted odds ratio (AOR) 2.08, 95% CI 1.22 to 3.55). Additionally, adolescents who reported parental rules about TV/film watching were less likely to smoke (AOR 0.37 (0.27 to 0.52)) than those who did not. Adolescents who mainly watched films with friends had higher exposure to film smoking and were more likely to smoke (AOR 2.19 (1.10 to 4.38)). Conclusions: Exposure to film smoking is associated with smoking among Scottish adolescents. These data lend support to calls for an 18 rating for films with images of smoking.


Morden N.E.,Dartmouth College | Morden N.E.,Dartmouth Institute for Health Policy | Morden N.E.,Cancer Control Research Program | Chang C.-H.,Dartmouth Institute for Health Policy | And 9 more authors.
Health Affairs | Year: 2012

Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category. © 2012 Project HOPE-The People-to-People Health Foundation, Inc.


Morgenstern M.,Institute for Therapy and Health Research | Morgenstern M.,University Hospital Schleswig Holstein | Isensee B.,Institute for Therapy and Health Research | Sargent J.D.,Cancer Control Research Program | And 2 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objective: To test the hypothesis that changes in alcohol-related attitudes and expectancies mediate the effect of alcohol advertising on youth drinking. Design: Longitudinal survey with a 9-month interval. Setting: Twenty-nine public schools in 3 German states. Participants: A total of 2130 sixth- to eighth-grade students (age range, 11-17 years; mean, 12.2 years) who were nondrinkers at baseline. Main Exposures: Exposure to alcohol and nonalcohol advertising was measured at baseline with masked images of 17 commercial advertisements with all brand information digitally removed; students indicated contact frequency and brand names. Outcome Measures: Positive attitudes toward alcohol, current alcohol use, lifetime binge drinking. Results: A total of 581 of the students (28%) started to drink alcohol during the observation period. Alcohol use initiation was positively related to baseline alcohol advertisement exposure. This effect of alcohol advertisement exposure on alcohol use was partially mediated by a change in alcohol-related attitudes, which explained about 35% of the total effect after controlling for baseline covariates and exposure to other advertising contents. The analysis revealed similar results for binge-drinking initiation. Conclusion: More favorable attitudes about alcohol may be one path through which alcohol advertising exerts behavioral influence. ©2011 American Medical Association. All rights reserved.

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