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Int. J. Environ. Res. Public Health, Volume 6, Issue 1 (January 2009), Pages 1-413

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Research

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Open AccessArticle Effects of Youth Tobacco Access and Possession Policy Interventions on Heavy Adolescent Smokers
Int. J. Environ. Res. Public Health 2009, 6(1), 1-9; doi:10.3390/ijerph6010001
Received: 29 October 2008 / Accepted: 17 December 2008 / Published: 23 December 2008
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Abstract
This study evaluated the effects of tobacco PUP (Purchase, Use and Possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and [...] Read more.
This study evaluated the effects of tobacco PUP (Purchase, Use and Possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and reducing minors’ access to commercial sources of tobacco, and the condition for the control group involved only efforts to reduce minors’ access to commercial sources of tobacco. The present study found that adolescents in the control group had a significantly greater increase in the percentage of youth who smoked 20 or more cigarettes per day when compared to the experimental group. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessArticle Symptoms of Diminished Autonomy over Cigarettes with Non-Daily Use
Int. J. Environ. Res. Public Health 2009, 6(1), 25-35; doi:10.3390/ijerph6010025
Received: 3 November 2008 / Accepted: 20 December 2008 / Published: 23 December 2008
Cited by 21 | PDF Full-text (340 KB) | HTML Full-text | XML Full-text
Abstract
Data from a nationally representative sample of smokers (ages 12-22 years, n=2,091) was examined to investigate the prevalence of symptoms of diminished autonomy over cigarettes. Six symptoms were assessed: failed cessation, smoking despite a desire to quit, and a need or urge [...] Read more.
Data from a nationally representative sample of smokers (ages 12-22 years, n=2,091) was examined to investigate the prevalence of symptoms of diminished autonomy over cigarettes. Six symptoms were assessed: failed cessation, smoking despite a desire to quit, and a need or urge to smoke, irritability, restlessness, or disrupted concentration attributed to nicotine withdrawal. One or more of the six symptoms were present in 18.9% of subjects who smoked less often than once per week. Among subjects who had not smoked 20 cigarettes in their lifetime, 12.6% had symptoms of nicotine withdrawal, and 25% had made an unsuccessful quit attempt. Full article
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
Open AccessArticle Smoking at School: Views of Turkish University Students
Int. J. Environ. Res. Public Health 2009, 6(1), 36-50; doi:10.3390/ijerph6010036
Received: 7 November 2008 / Accepted: 17 December 2008 / Published: 23 December 2008
Cited by 6 | PDF Full-text (377 KB) | HTML Full-text | XML Full-text
Abstract
The recent interest in cigarette smoking among university students has brought attention to problems concerning opinions, attitudes, prevention, health education, policy formulation and implementation. This survey research tested five hypotheses on the views of college students about smoking in school hallways and [...] Read more.
The recent interest in cigarette smoking among university students has brought attention to problems concerning opinions, attitudes, prevention, health education, policy formulation and implementation. This survey research tested five hypotheses on the views of college students about smoking in school hallways and cafeteria, compliance with anti smoking laws, considering cigarette smoking as an expression of freedom of choice, teachers’ smoking in classrooms and in their offices, and school administration’s policy on enforcing the law. Hypothesized differences between students’ views on the issues according to gender, smoking status and years at school were investigated. Data were obtained from 3,659 students attending six universities in Ankara, Turkey. The study findings provided support for all the hypothesized differences (except a single issue). Males and females differed significantly on all the issues studied. The majority of nonsmoking students have anti-smoking views in regards of the studied issues as compared to regular and occasional smokers. Smokers and nonsmokers markedly disagree on banning cigarette smoking in the cafeteria and hallways. However, the majority of students are against teachers’ smoking in classrooms and in their offices with the doors open. Although most students want a smoke free environment, there is no active-anti smoking policy on smoking by universities. Findings point out the need for campus-wide effective smoking prevention programs, as well as cessation programs and services for the students. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessArticle Lead Poisoning: An Alarming Public Health Problem in Bangladesh
Int. J. Environ. Res. Public Health 2009, 6(1), 84-95; doi:10.3390/ijerph6010084
Received: 3 November 2008 / Accepted: 4 January 2009 / Published: 5 January 2009
Cited by 21 | PDF Full-text (691 KB) | HTML Full-text | XML Full-text
Abstract
To assess the risk of lead poisoning among preschool and school-aged children in Bangladesh, 345 children were screened for blood lead levels (BLLs) from one rural and two urban areas in Bangladesh from September 2007 through January 2008. An urban industrial area at Tongi was identified as a disaster area, where 99% (104/105) of those tested had BLLs ≥10 µg/dL. Industrial emissions and use of leaded gasoline by two-stroke engine vehicles were identified as possible sources of lead in that area. A rural nonindustrial area at Chirirbandar, Dinajpur was identified as another high-risk area, where 14% of the children screened had BLLs ≥10 µg/dL. BLLs at the urban industrial area were significantly higher than those at the rural and urban nonindustrial areas (24.58 ± 10.32, 7.24 ± 6.31, and 2.47 ± 3.32 µg/dL, respectively; p <0.001). Weight-for-age z-scores of the urban children were significantly lower than that of the rural children (-1.41 ± 1.88 vs. 0.20 ± 1.16, p <0.001). Children with elevated BLLs had poorer nutritional status (p = 0.05) than those with normal BLLs. Over 90% of the parents did not know that lead causes health problems. In conclusion, the problem of lead poisoning in children was found to be high in both urban and rural Bangladesh. A universal lead screening for preschool and school-aged children and a lead education program for parents are recommended for implementation in Bangladesh. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
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Open AccessArticle Smoking Cessation Counselling for Pregnant and Postpartum Women among Midwives, Gynaecologists and Paediatricians in Germany
Int. J. Environ. Res. Public Health 2009, 6(1), 96-107; doi:10.3390/ijerph6010096
Received: 29 October 2008 / Accepted: 23 December 2008 / Published: 5 January 2009
Cited by 5 | PDF Full-text (192 KB) | HTML Full-text | XML Full-text
Abstract
The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers.The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for [...] Read more.
The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers.The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers. Full article
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
Open AccessArticle Life Lost Due to Premature Deaths in New South Wales, Australia
Int. J. Environ. Res. Public Health 2009, 6(1), 108-120; doi:10.3390/ijerph6010108
Received: 20 November 2008 / Accepted: 24 December 2008 / Published: 6 January 2009
Cited by 2 | PDF Full-text (227 KB) | HTML Full-text | XML Full-text
Abstract
This study attempts to measure premature mortality, in addition to overall death rates, in order to provide more information that can be used to develop and monitor health programmes that are aimed at reducing premature (often preventable) mortality in New South Wales [...] Read more.
This study attempts to measure premature mortality, in addition to overall death rates, in order to provide more information that can be used to develop and monitor health programmes that are aimed at reducing premature (often preventable) mortality in New South Wales (NSW), Australia. Premature years of potential life lost (PYPLL) and valued years of potential life lost methods are applied for mortality data in NSW from 1990 to 2002. Variations in these measures for 2001 are studied further in terms of age, sex, urban/rural residence, and socio-economic status. PYPLL rates for all leading causes of death have declined. It is shown that the average male to female ratio of PYPLLs is highest for accidents, injury and poisoning (3.4:1) followed by mental disorders (2.7:1) and cardiovascular diseases (2.6:1). Although fewer women than men die of cardiovascular diseases, there is a greater proportionate importance of cerebrovascular mortality among women. In order to further reduce premature deaths, programs are required to improve the health of people living in lower socio-economic status areas, especially in rural NSW. Targeted regional or community level programs are required to reduce avoidable deaths due to accidents, injury and poisoning occasioned by motor vehicle accidents, poisoning and suicide among young adults. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Validity and Reproducibility of a Self-Administered Semi-Quantitative Food-Frequency Questionnaire for Estimating Usual Daily Fat, Fibre, Alcohol, Caffeine and Theobromine Intakes among Belgian Post-Menopausal Women
Int. J. Environ. Res. Public Health 2009, 6(1), 121-150; doi:10.3390/ijerph6010121
Received: 11 December 2008 / Accepted: 31 December 2008 / Published: 6 January 2009
Cited by 10 | PDF Full-text (521 KB) | HTML Full-text | XML Full-text
Abstract
A novel food-frequency questionnaire (FFQ) was developed and validated to assess the usual daily fat, saturated, mono-unsaturated and poly-unsaturated fatty acid, fibre, alcohol, caffeine, and theobromine intakes among Belgian post-menopausal women participating in dietary intervention trials with phyto-oestrogens. The relative validity of [...] Read more.
A novel food-frequency questionnaire (FFQ) was developed and validated to assess the usual daily fat, saturated, mono-unsaturated and poly-unsaturated fatty acid, fibre, alcohol, caffeine, and theobromine intakes among Belgian post-menopausal women participating in dietary intervention trials with phyto-oestrogens. The relative validity of the FFQ was estimated by comparison with 7 day (d) estimated diet records (EDR, n 64) and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 79). Although the questionnaire underestimated significantly all intakes compared to the 7 d EDR, it had a good ranking ability (r 0.47-0.94; weighted κ 0.25-0.66) and it could reliably distinguish extreme intakes for all the estimated nutrients, except for saturated fatty acids. Furthermore, the correlation between repeated administrations was high (r 0.71-0.87) with a maximal misclassification of 7% (weighted κ 0.33-0.80). In conclusion, these results compare favourably with those reported by others and indicate that the FFQ is a satisfactorily reliable and valid instrument for ranking individuals within this study population. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Vitamin D Status of Clinical Practice Populations at Higher Latitudes: Analysis and Applications
Int. J. Environ. Res. Public Health 2009, 6(1), 151-173; doi:10.3390/ijerph6010151
Received: 18 November 2008 / Accepted: 30 December 2008 / Published: 7 January 2009
Cited by 34 | PDF Full-text (284 KB) | HTML Full-text | XML Full-text
Abstract
Background: Inadequate levels of vitamin D (VTD) throughout the life cycle from the fetal stage to adulthood have been correlated with elevated risk for assorted health afflictions. The purpose of this study was to ascertain VTD status and associated determinants in three clinical practice populationsliving in Edmonton, Alberta, Canada -a locale with latitude of 53°30'N, wheresun exposure from October through March is often inadequate to generate sufficient vitamin D. Methods: To determine VTD status, 1,433 patients from three independent medical offices in Edmonton had levels drawn for 25(OH)D as part of their medical assessment between Jun 2001 and Mar 2007. The relationship between demographic data and lifestyle parameters with VTD status was explored. 25(OH)D levels were categorized as follows: (1) Deficient: <40 nmol/L; (2) Insufficient (moderate to mild): 40 to <80 nmol/L; and (3) Adequate: 80-250 nmol/L. Any cases <25 nmol/L were subcategorized as severely deficient for purposes of further analysis. Results: 240 (16.75% of the total sample) of 1,433 patients were found to be VTD "deficient" of which 48 (3.35% of the overall sample) had levels consistent with severe deficiency. 738 (51.5% of the overall sample) had "insufficiency" (moderate to mild) while only 31.75% had "adequate" 25(OH)D levels. The overall mean for 25(OH) D was 68.3 with SD=28.95. VTD status was significantly linked with demographic and lifestyle parameters including skin tone, fish consumption, milk intake, sun exposure, tanning bed use and nutritional supplementation. Conclusion: A high prevalence of hypovitaminosis-D was found in three clinical practice populations living in Edmonton. In view of the potential health sequelae associated with widespread VTD inadequacy, strategies to facilitate translation of emerging epidemiological information into clinical intervention need to be considered in order to address this public health issue. A suggested VTD supplemental intake level is presented for consideration. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Smoking Patterns in Ghanaian Civil Servants: Changes Over Three Decades
Int. J. Environ. Res. Public Health 2009, 6(1), 200-208; doi:10.3390/ijerph6010200
Received: 5 December 2008 / Accepted: 6 January 2009 / Published: 9 January 2009
Cited by 10 | PDF Full-text (224 KB) | HTML Full-text | XML Full-text
Abstract
The number of smokers in developing countries is expected to increase as markets in high income countries begin to decline and multinational tobacco companies shift their marketing efforts to lower income countries. We determined the prevalence and distribution of smoking in a [...] Read more.
The number of smokers in developing countries is expected to increase as markets in high income countries begin to decline and multinational tobacco companies shift their marketing efforts to lower income countries. We determined the prevalence and distribution of smoking in a cross-sectional study of 1,015 urban civil servants in Accra, Ghana (82.7% participation rate) in 2006. The results were compared to the findings from a previous study in 1976 of civil servants in Accra to estimate the changes in smoking patterns over a 30 year period. In our 2006 study, the smoking prevalence rate was 6.1% (95% CI: 4.8-8.9) and 0.3% (95% CI: 0.006-1.4) in men and women respectively. These figures were dramatically lower than the rates of 32% and 5.9% reported for men and women respectively in the previous study. Knowledge of the health risks associated with smoking may have contributed to the lower rates. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessArticle Smokeless Tobacco Use and Religiousness
Int. J. Environ. Res. Public Health 2009, 6(1), 225-231; doi:10.3390/ijerph6010225
Received: 3 November 2008 / Accepted: 7 January 2009 / Published: 12 January 2009
Cited by 4 | PDF Full-text (139 KB) | HTML Full-text | XML Full-text
Abstract
Although smoking shows a strong negative association with religiousness, no studies have appeared of use of smokeless tobacco (ST) and religiousness. To assess an association of use of ST and religiousness, data from 9,374 men aged 17 years and over with complete data on self-reported frequency of attendance at religious services and use of smokeless tobacco were analyzed. Among men aged 17-29 years, 4.9% of frequent attenders (>=24 times/y) and 9.4% of others (<24 times/y) were current users of ST (p=0.002). After adjusting for multiple confounders by logistic regression, infrequent attenders were twice as likely as frequent attenders to be ST users: odds ratio 2.09, 95% confidence limits 1.12-3.92, p=0.02. This negative association suggests a protective effect of early-life religiousness on ST use, which might be taken into account in planning ST prevention efforts. Full article
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
Open AccessArticle Trends in Percutaneous Coronary Interventions in New South Wales, Australia
Int. J. Environ. Res. Public Health 2009, 6(1), 232-245; doi:10.3390/ijerph6010245
Received: 29 October 2008 / Accepted: 8 January 2009 / Published: 12 January 2009
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Abstract
This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected [...] Read more.
This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected socio-demographic factors, the utilisation of angioplasties vis-a-vis stents, emergency admissions, and selected coexisting conditions which determine the disease status of PCI patients. Logistic regression models are used to study the medical conditions that require both PCI and coronary artery bypass graft (CABG). The PCI rate has grown rapidly at 12.1% per annum, with a particularly rapid increase for persons aged 75+. The rate of multiple stent utilisation increased at 4.6% per annum. Pacific-born and Middle-Eastern-born patients are more than twice as likely as the Australian-born to have diabetes. Factors affecting failure of PCI requiring CABG include perforation and multi-vessel disease. PCI services in public hospitals need to be increased to facilitate the availability of these procedures to all segments of the population, as do targeted community-level programmes to educate high-risk groups in the control of heart diseases. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Smoke-Free Medical Facility Campus Legislation: Support, Resistance, Difficulties and Cost
Int. J. Environ. Res. Public Health 2009, 6(1), 246-258; doi:10.3390/ijerph6010246
Received: 13 October 2008 / Accepted: 6 January 2009 / Published: 13 January 2009
Cited by 6 | PDF Full-text (189 KB) | HTML Full-text | XML Full-text
Abstract
Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113) were surveyed pre- and [...] Read more.
Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113) were surveyed pre- and post-implementation. Administrators reported more support and less difficulty than anticipated. Actual cost was 10-50% of anticipated cost. Few negative effects and numerous positive effects on employee performance and retention were reported. The results may be of interest to hospital administrators and demonstrate that state legislation can play a positive role in facilitating broad health-related policy change. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessArticle Tobacco Cessation Quitline Spending in 2005 and 2006: What State-Level Factors Matter?
Int. J. Environ. Res. Public Health 2009, 6(1), 259-266; doi:10.3390/ijerph6010259
Received: 20 November 2008 / Accepted: 8 January 2009 / Published: 13 January 2009
Cited by 3 | PDF Full-text (188 KB) | HTML Full-text | XML Full-text
Abstract
Tobacco cessation telephone quitlines are an effective population-wide strategy for smoking cessation, but funding for this service varies widely. State-level factors may explain this difference. Data from the 2005 and 2006 North American Quitline Consortium surveys and from publicly available sources were [...] Read more.
Tobacco cessation telephone quitlines are an effective population-wide strategy for smoking cessation, but funding for this service varies widely. State-level factors may explain this difference. Data from the 2005 and 2006 North American Quitline Consortium surveys and from publicly available sources were analyzed to identify factors that predict higher levels of per capita quitline funding. The best-fitting multivariate model comprised higher per capita tobacco control funding (2005 p = 0.004, 2006 p=0.000), not securitizing Master Settlement Agreement payments (2005 p = 0.008, 2006 p=0.01), and liberal political ideology (2005 p = 0.002, 2006 p=0.002). Select state-level factors appear to have influenced per capita quitline services funding. These findings can help inform advocates and policymakers as they advocate for quitlines and tobacco control funding. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessArticle Smoking Status, Changes in Smoking Status and Health-Related Quality of Life: Findings from the SUN (“Seguimiento Universidad de Navarra”) Cohort
Int. J. Environ. Res. Public Health 2009, 6(1), 310-320; doi:10.3390/ijerph6010310
Received: 29 October 2008 / Accepted: 15 January 2009 / Published: 19 January 2009
Cited by 13 | PDF Full-text (177 KB) | HTML Full-text | XML Full-text
Abstract
We aimed to evaluate the association between smoking, changes in smoking, and quality of life in a cohort of Spanish university graduates. Smoking habits were self-reported at baseline and four years later. Quality of life was assessed using the Short Form-36 (SF-36) [...] Read more.
We aimed to evaluate the association between smoking, changes in smoking, and quality of life in a cohort of Spanish university graduates. Smoking habits were self-reported at baseline and four years later. Quality of life was assessed using the Short Form-36 (SF-36) at year 4. Statistical differences in SF-36 scores between groups were determined using ANCOVA with age and sex as covariates. Out of 5,234 eligible participants over 2000-2006, there were 2,639 non-smoker participants, 1,419 ex-smokers, and 1,048 smokers. Within the previous four years, 435 participants became recent quitters and 205 starters. Comparing smoking and health status in year 4, non-smokers showed better scores than the other categories of ever smoking in all dimensions except in the vitality scale value, which was similar in non-smokers and in those smoking less than 15 cigarettes/day. Comparing changes in smoking and health in year 4, continuing smokers had statistically significant worse scores than non-smokers in general health, social functioning, role-emotional and mental health, whereas recent quitters showed statistically significant improvements in role-emotional and mental health over those who had continued smoking or those who became smokers. Our findings support a dose-response relationship between cigarette consumption and a worse quality of life in general and mental health in particular. They also support that changes in smoking have an impact on health. Full article
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
Open AccessArticle Parental Smoking and Smoking Status of Japanese Dental Hygiene Students: A Pilot Survey at a Dental Hygiene School in Japan
Int. J. Environ. Res. Public Health 2009, 6(1), 321-328; doi:10.3390/ijerph6010321
Received: 20 November 2008 / Accepted: 16 January 2009 / Published: 19 January 2009
Cited by 3 | PDF Full-text (194 KB) | HTML Full-text | XML Full-text
Abstract
This study aimed to determine the frequency of smoking and to explore factors associated with the smoking habits of female students at a dental hygiene school in Japan. Questionnaires regarding cigarette smoking were given to 168 female students. The response rate was [...] Read more.
This study aimed to determine the frequency of smoking and to explore factors associated with the smoking habits of female students at a dental hygiene school in Japan. Questionnaires regarding cigarette smoking were given to 168 female students. The response rate was 97.6%. The prevalence of smoking, including current and occasional smokers, was 20.3%. Among family members, only the smoking status of their mother significantly influenced the smoking status of the students. The odds ratio for smoking among dental hygiene students whose mothers were smokers in comparison to students whose mothers were not smokers was 5.1 (95% confidence interval 2.1-12.2, p=0.000). Decision tree analysis showed that the smoking habit of dental hygiene students was correlated with their mothers’ smoking history, as well as the smoking status of junior high school teachers, the smoking habits of close friends and a history of participating in a smoking prevention program when in elementary school. The increased smoking rate of young females, including dental hygienists, is a growing problem in Japan. The smoking statuses of dental hygiene students might be closely influenced by their mothers' smoking status. Full article
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
Open AccessArticle New Concepts in Breast Cancer Emerge from Analyzing Clinical Data Using Numerical Algorithms
Int. J. Environ. Res. Public Health 2009, 6(1), 329-348; doi:10.3390/ijerph6010347
Received: 6 November 2008 / Accepted: 10 January 2009 / Published: 20 January 2009
Cited by 7 | PDF Full-text (320 KB) | HTML Full-text | XML Full-text
Abstract
A small international group has recently challenged fundamental concepts in breast cancer. As a guiding principle in therapy, it has long been assumed that breast cancer growth is continuous. However, this group suggests tumor growth commonly includes extended periods of quasi-stable dormancy. [...] Read more.
A small international group has recently challenged fundamental concepts in breast cancer. As a guiding principle in therapy, it has long been assumed that breast cancer growth is continuous. However, this group suggests tumor growth commonly includes extended periods of quasi-stable dormancy. Furthermore, surgery to remove the primary tumor often awakens distant dormant micrometastases. Accordingly, over half of all relapses in breast cancer are accelerated in this manner. This paper describes how a numerical algorithm was used to come to these conclusions. Based on these findings, a dormancy preservation therapy is proposed. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Ethyl Carbamate in Alcoholic Beverages from Mexico (Tequila, Mezcal, Bacanora, Sotol) and Guatemala (Cuxa): Market Survey and Risk Assessment
Int. J. Environ. Res. Public Health 2009, 6(1), 349-360; doi:10.3390/ijerph6010349
Received: 19 December 2008 / Accepted: 16 January 2009 / Published: 20 January 2009
Cited by 29 | PDF Full-text (279 KB) | HTML Full-text | XML Full-text
Abstract
Ethyl carbamate (EC) is a recognized genotoxic carcinogen, with widespread occurrence in fermented foods and beverages. No data on its occurrence in alcoholic beverages from Mexico or Central America is available. Samples of agave spirits including tequila, mezcal, bacanora and sotol (n=110), and of the sugarcane spirit cuxa (n=16) were purchased in Mexico and Guatemala, respectively, and analyzed for EC. The incidence of EC contamination was higher in Mexico than in Guatemala, however, concentrations were below international guideline levels (<0.15 mg/L). Risk assessment found the Margin of Exposure (MOE) in line with that of European spirits. It is therefore unlikely that EC plays a role in high rates of liver cirrhosis reported in Mexico. Full article
(This article belongs to the Special Issue Environmental Research on Alcohol: Public Health Perspectives)
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Open AccessArticle Engagement and Action for Health: The Contribution of Leaders’ Collaborative Skills to Partnership Success
Int. J. Environ. Res. Public Health 2009, 6(1), 361-381; doi:10.3390/ijerph60100361
Received: 29 December 2008 / Accepted: 20 January 2009 / Published: 21 January 2009
Cited by 3 | PDF Full-text (263 KB) | HTML Full-text | XML Full-text
Abstract
A multi-site evaluation (survey) of five Kellogg-funded Community Partnerships (CPs) in South Africa was undertaken to explore the relationship between leadership skills and a range of 30 operational, functional and organisational factors deemed critical to successful CPs. The CPs were collaborative academic-health [...] Read more.
A multi-site evaluation (survey) of five Kellogg-funded Community Partnerships (CPs) in South Africa was undertaken to explore the relationship between leadership skills and a range of 30 operational, functional and organisational factors deemed critical to successful CPs. The CPs were collaborative academic-health service-community efforts aimed at health professions education reforms. The level of agreement to eleven dichotomous (‘Yes/No’) leadership skills items was used to compute two measures of members’ appreciation of their CPs’ leadership. The associations between these measures and 30 CPs factors were explored, and the partnership factors that leadership skills explained were assessed after controlling. Respondents who perceived the leadership of their CPs favourably had more positive ratings across 30 other artnership factors than those who rated leadership skills less favourably, and were more likely to report a positive cost/benefit ratio. In addition, respondents who viewed their CPs’ leadership positively also rated the operational understanding, the communication mechanisms, as well as the rules and procedures of the CPs more favourably. Leadership skills explained between 20% and 7% of the variance of 10 partnership factors. The influence of leaders’ skills in effective healthfocussed partnerships is much broader than previously conceptualised. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessArticle Relative Validity and Reproducibility of a Food-Frequency Questionnaire for Estimating Food Intakes among Flemish Preschoolers
Int. J. Environ. Res. Public Health 2009, 6(1), 382-399; doi:10.3390/ijerph6010382
Received: 26 December 2008 / Accepted: 21 January 2009 / Published: 22 January 2009
Cited by 36 | PDF Full-text (302 KB) | HTML Full-text | XML Full-text
Abstract
The aims of this study were to assess the relative validity and reproducibility of a semi-quantitative food-frequency questionnaire (FFQ) applied in a large region-wide survey among 2.5-6.5 year-old children for estimating food group intakes. Parents/guardians were used as a proxy. Estimated diet records (3d) were used as reference method and reproducibility was measured by repeated FFQ administrations five weeks apart. In total 650 children were included in the validity analyses and 124 in the reproducibility analyses. Comparing median FFQ1 to FFQ2 intakes, almost all evaluated food groups showed median differences within a range of ± 15%. However, for median vegetables, fruit and cheese intake, FFQ1 was > 20% higher than FFQ2. For most foods a moderate correlation (0.5-0.7) was obtained between FFQ1 and FFQ2. For cheese, sugared drinks and fruit juice intakes correlations were even > 0.7. For median differences between the 3d EDR and the FFQ, six food groups (potatoes & grains; vegetables Fruit; cheese; meat, game, poultry and fish; and sugared drinks) gave a difference > 20%. The largest corrected correlations (>0.6) were found for the intake of potatoes and grains, fruit, milk products, cheese, sugared drinks, and fruit juice, while the lowest correlations (<0.4) for bread and meat products. The proportion of subjects classified within one quartile (in the same/adjacent category) by FFQ and EDR ranged from 67% (for meat products) to 88% (for fruit juice). Extreme misclassification into the opposite quartiles was for all food groups < 10%. The results indicate that our newly developed FFQ gives reproducible estimates of food group intake. Overall, moderate levels of relative validity were observed for estimates of food group intake. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)

Review

Jump to: Research

Open AccessReview Is Smokeless Tobacco Use an Appropriate Public Health Strategy for Reducing Societal Harm from Cigarette Smoking?
Int. J. Environ. Res. Public Health 2009, 6(1), 10-24; doi:10.3390/ijerph6010010
Received: 22 November 2008 / Accepted: 20 December 2008 / Published: 23 December 2008
Cited by 29 | PDF Full-text (284 KB) | HTML Full-text | XML Full-text
Abstract
Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is [...] Read more.
Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a “gateway” for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessReview A Review of Economic Evaluations of Tobacco Control Programs
Int. J. Environ. Res. Public Health 2009, 6(1), 51-68; doi:10.3390/ijerph6010051
Received: 26 November 2008 / Accepted: 23 December 2008 / Published: 28 December 2008
Cited by 22 | PDF Full-text (204 KB) | HTML Full-text | XML Full-text
Abstract
Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually.In an effort to reduce this burden, many states, the federal government, and several [...] Read more.
Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually.In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT) and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, school-based programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessReview Fighting Tobacco Smoking - a Difficult but Not Impossible Battle
Int. J. Environ. Res. Public Health 2009, 6(1), 69-83; doi:10.3390/ijerph6010069
Received: 15 December 2008 / Accepted: 31 December 2008 / Published: 5 January 2009
Cited by 10 | PDF Full-text (272 KB) | HTML Full-text | XML Full-text
Abstract
According to the World Health Organization (WHO), tobacco-related disease is the single largest preventable cause of death in the world today, killing around 5.4 million people a year – an average of one person every six seconds. The total number of death [...] Read more.
According to the World Health Organization (WHO), tobacco-related disease is the single largest preventable cause of death in the world today, killing around 5.4 million people a year – an average of one person every six seconds. The total number of death caused by tobacco consumption is higher than that of tuberculosis, HIV/AIDS and malaria combined. Unlike other communicable diseases, however, tobacco-related disease has a man-made consensus vector – the tobacco companies that play an active role to promote tobacco consumption, which directly heightens the disease morbidity. Any public health policy designed to curb smoking behavior has to prepare for opposite lobbying actions from tobacco companies that undermine the effects of the health measures. Another unique nature of the tobacco epidemic is that it can be cured, not by medicines or vaccines, but on the concerted actions of government and civil society. Many countries with a history of tobacco control measures indeed experienced a reduction of tobacco consumption. As most of these governments launched a range of measures simultaneously, it is hard to quantify the relative merits of different control strategies that contributed to the drop in the number of smokers. These packages of strategies can come in different forms but with some common features. Political actions with government support, funding, and protection are crucial. Without these, antismoking efforts in any part of the world are unlikely to be successful. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessReview Overview of Dose Assessment Developments and the Health of Riverside Residents Close to the “Mayak” PA Facilities, Russia
Int. J. Environ. Res. Public Health 2009, 6(1), 174-199; doi:10.3390/ijerph6010174
Received: 3 December 2008 / Accepted: 7 January 2009 / Published: 9 January 2009
Cited by 2 | PDF Full-text (2277 KB) | HTML Full-text | XML Full-text
Abstract
The Norwegian Radiation Protection Authority (NRPA) has been involved in studies related to the Mayak PA and the consequences of activities undertaken at the site for a number of years. This paper strives to present an overview of past and present activities [...] Read more.
The Norwegian Radiation Protection Authority (NRPA) has been involved in studies related to the Mayak PA and the consequences of activities undertaken at the site for a number of years. This paper strives to present an overview of past and present activities at the Mayak PA and subsequent developments in the quantification of health effects on local populations caused by discharges of radioactive waste into the Techa River. Assessments of doses to affected populations have relied on the development of dose reconstruction techniques for both external and internal doses. Contamination levels are typically inhomogeneous and decrease with increasing distance from the discharge point. Citations made in this paper give a comprehensive, though not exhaustive, basis for further reading about this topic. Full article
(This article belongs to the Special Issue Public Health: Feature Papers)
Open AccessReview Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century
Int. J. Environ. Res. Public Health 2009, 6(1), 209-224; doi:10.3390/ijerph6010209
Received: 15 December 2008 / Accepted: 7 January 2009 / Published: 9 January 2009
Cited by 22 | PDF Full-text (247 KB) | HTML Full-text | XML Full-text
Abstract
One hundred million deaths were caused by tobacco in the 20th century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21st century. Chronic obstructive pulmonary disease (COPD) is rapidly [...] Read more.
One hundred million deaths were caused by tobacco in the 20th century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21st century. Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis with smoking being recognized as its most important causative factor. The most effective available treatment for COPD is smoking cessation. There is mounting evidence that the rate of progression of COPD can be reduced when patients at risk of developing the disease stop smoking, while lifelong smokers have a 50% probability of developing COPD during their lifetime. More significantly, there is also evidence that the risk of developing COPD falls by about half with smoking cessation. Several pharmacological interventions now exist to aid smokers in cessation; these include nicotine replacement therapy, bupropion, and varenicline. All pharmacotherapies for smoking cessation are more efficacious than placebo, with odds ratios of about 2. Pharmacologic therapy should be combined with nonpharmacologic (behavioral) therapy. Unfortunately, despite the documented efficacy of these agents, the absolute number of patients who are abstinent from smoking at 12 months of follow-up is low. Full article
(This article belongs to the Special Issue Smoking and Tobacco Control)
Open AccessReview A Multivariate Approach to a Meta-Analytic Review of the Effectiveness of the D.A.R.E. Program
Int. J. Environ. Res. Public Health 2009, 6(1), 267-277; doi:10.3390/ijerph6010267
Received: 8 December 2008 / Accepted: 8 January 2009 / Published: 13 January 2009
Cited by 16 | PDF Full-text (219 KB) | HTML Full-text | XML Full-text
Abstract
The Drug Abuse Resistance Education (D.A.R.E.) program is a widespread but controversial school-based drug prevention program in the United States as well as in many other countries. The present multivariate meta-analysis reviewed 20 studies that assessed the effectiveness of the D.A.R.E. program [...] Read more.
The Drug Abuse Resistance Education (D.A.R.E.) program is a widespread but controversial school-based drug prevention program in the United States as well as in many other countries. The present multivariate meta-analysis reviewed 20 studies that assessed the effectiveness of the D.A.R.E. program in the United States. The results showed that the effects of the D.A.R.E. program on drug use did not vary across the studies with a less than small overall effect while the effects on psychosocial behavior varied with still a less than small overall effect. In addition, the characteristics of the studies significantly explained the variation of the heterogeneous effects on psychosocial behavior, which provides empirical evidence for improving the school-based drug prevention program. Full article
(This article belongs to the Special Issue Drug Abuse and Addiction)
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Open AccessReview Bacterial Degradation of Aromatic Compounds
Int. J. Environ. Res. Public Health 2009, 6(1), 278-309; doi:10.3390/ijerph6010278
Received: 6 November 2008 / Accepted: 6 January 2009 / Published: 13 January 2009
Cited by 174 | PDF Full-text (320 KB) | HTML Full-text | XML Full-text
Abstract
Aromatic compounds are among the most prevalent and persistent pollutants in the environment. Petroleum-contaminated soil and sediment commonly contain a mixture of polycyclic aromatic hydrocarbons (PAHs) and heterocyclic aromatics. Aromatics derived from industrial activities often have functional groups such as alkyls, halogens [...] Read more.
Aromatic compounds are among the most prevalent and persistent pollutants in the environment. Petroleum-contaminated soil and sediment commonly contain a mixture of polycyclic aromatic hydrocarbons (PAHs) and heterocyclic aromatics. Aromatics derived from industrial activities often have functional groups such as alkyls, halogens and nitro groups. Biodegradation is a major mechanism of removal of organic pollutants from a contaminated site. This review focuses on bacterial degradation pathways of selected aromatic compounds. Catabolic pathways of naphthalene, fluorene, phenanthrene, fluoranthene, pyrene, and benzo[a]pyrene are described in detail. Bacterial catabolism of the heterocycles dibenzofuran, carbazole, dibenzothiophene, and dibenzodioxin is discussed. Bacterial catabolism of alkylated PAHs is summarized, followed by a brief discussion of proteomics and metabolomics as powerful tools for elucidation of biodegradation mechanisms. Full article
(This article belongs to the Special Issue Biodegradability and Environmental Sciences)
Open AccessReview Bloodborne Viral Hepatitis Infections among Drug Users: The Role of Vaccination
Int. J. Environ. Res. Public Health 2009, 6(1), 400-413; doi:10.3390/ijerph6010400
Received: 26 December 2008 / Accepted: 20 January 2009 / Published: 22 January 2009
Cited by 9 | PDF Full-text (184 KB) | HTML Full-text | XML Full-text
Abstract
Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral [...] Read more.
Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral hepatitis is not inevitable for DUs. Licensed vaccines are available for hepatitis A and hepatitis B. The purpose of this overview is to show some epidemiological data about HBV and the other blood-borne viral hepatitis among DUs and to summarize and discuss use of hepatitis vaccinations in this population. Successful vaccination campaigns among DUs are feasible and well described. We try to focus on the most significant results achieved in successful vaccination programs as reported in scientific literature. Vaccination campaigns among DUs represent a highly effective form of health education and they are cost-saving. Full article
(This article belongs to the Special Issue Drug Abuse and Addiction)

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