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BackgroundCigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the development of structural lung disease, airflow obstruction and functional outcomes is not known.MethodsWe analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV1/FVC); secondary outcomes included five additional measures of disease: FEV1, CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George’s Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years.Results10 187 subjects were included. For FEV1/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years (P<0.001). After categorisation, there was a linear increase in adjusted means FEV1/FVC with increase in pack-years (regression coefficient β=−0.023±SE0.003; P=0.003) and duration over all ranges of smoking cigarettes/day (β=−0.041±0.004; P<0.001) but a relatively flat slope for cigarettes/day across all ranges of smoking duration (β=−0.009±0.0.009; P=0.34). Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV1, 6MWD and SGRQ.ConclusionSmoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years.Trial registration numberPost-results; NCT00608764.

BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant exposure as food environment indicator, and (2) not accounting for non-stationarity assumption. This study aimed to describe the spatial distribution of obesity and examine the association between community food environment and obesity, and the variation of magnitude and direction of this association across the USA.MethodsData from 20 897 adults who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment between January 2003 and October 2007 were eligible in analysis. Hot Spot analysis was used to assess the spatial distribution of obesity. The association between community food environment and obesity and the variation of this association across the USA were examined using global ordinary least squares regression and local geographically weighted regression.ResultsHigher body mass index (BMI) clusters were more likely to locate in socioeconomically disadvantaged, rural, minority neighbourhoods with a smaller population size, while lower BMI clusters were more likely to appear in more affluent, urban neighbourhoods with a higher percentage of non-Hispanic white residences. There was an overall significant, inverse association between community food environment and obesity (β=−0.0210; p<0.0001). Moreover, the magnitude and direction of this association varied significantly across the US regions.ConclusionsThe findings underscored the need for geographically tailored public health interventions and policies to address unique local food environment issues to achieve maximum effects on obesity prevention.

The current study aims to describe the Mediterranean diet (MD) adherence across the US regions, and explore the predictive factors of MD adherence among US adults. Cross-sectional secondary data analysis. MD adherence score (0-9) was calculated using the Block 98 FFQ. Hot spot analysis was conducted to describe the geospatial distribution of MD adherence across the US regions. Logistic regression explored predictors of MD adherence. Nationwide community-dwelling residency in the USA. Adults aged ≥45 years (n 20 897) who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. The mean of MD adherence score was 4·36 (sd 1·70), and 46·5 % of the sample had high MD adherence (score 5-9). Higher MD adherence clusters were primarily located in the western and northeastern coastal areas of the USA, whereas lower MD adherence clusters were majorly observed in south and east-north-central regions. Being older, black, not a current smoker, having a college degree or above, an annual household income ≥ $US 75K, exercising ≥4 times/week and watching TV/video <4 h/d were each associated with higher odds of high MD adherence. There were significant geospatial and population disparities in MD adherence across the US regions. Future studies are needed to explore the causes of MD adherence disparities and develop effective interventions for MD promotion in the USA.

Objectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

Crosby et al present a study determining the association between African American adolescent females' condom use and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. Sexually active African American adolescent females (aged 14-18) were recruited from multiple venues in low-income neighborhoods of Birmingham AL from Dec 1996 through Apr 1999. The findings suggested that using condoms consistently could result in substantial, but not complete, protection against STD acquisition.

Background Asthma is the most common chronic childhood disease and has significant impact on morbidity and mortality in children. Proper adherence to asthma medication has been shown to reduce morbidity among those with asthma; however, adherence to medications is known to be low, especially among low-income urban populations. We conducted a randomized clinical trial to examine the effectiveness of an intervention designed to increase adherence to asthma medication among children with asthma that required daily collection of data. Purpose and Methods A specifically designed web-based data collection system, the Asthma Agents System, was used to collect daily data from participant children at school. These data were utilized to examine the intervention's effectiveness in reducing the frequency of asthma exacerbations. This study examines the Asthma Agents System's effect on the frequency of missing data. Data collection methods are discussed in detail, as well as the processes for retrieving missing data. Results For the 290 children randomized, 97% of the daily data expected were available. Of the outcome data retrieved via the Asthma Agents System, 5% of those expected were missing during the period examined. Limitations Challenges encountered in this study include issues regarding the use of technology in urban school settings, transfer of data between study sites, and availability of data during school breaks. Conclusions Use of the Asthma Agents System resulted in lower rates of missing data than rates reported elsewhere in the literature. Clinical Trials 2008; 5: 31—37. http://ctj.sagepub.com

Objective: To describe the development of a consumer-oriented intervention for increasing intake of fruits and vegetables (FVs) in families (n=265). Method: A cognitive-mapping approach was used to specify intervention performance objectives and a tailoring strategy. Results: MDS and hierarchical cluster analysis indicated that FV perceptions are organized into 6 clusters arrayed along 3 dimensions. In combination with 3 general family-functioning measures, 11 perceptions explained approximately 18% of the variance in parent FVI. K-means cluster analysis revealed 4 types of families. Conclusion: Cognitive mapping provides a systematic approach for including qualitative data in the design of tailored interventions.

Diabetes is a chronic disease that affects over 25 million adults, many of whom are smokers. The negative health impact of diabetes and comorbid smoking is significant and requires comprehensive interdisciplinary management. The National Diabetes Education Program has identified specific providers, known as PPOD, who include pharmacists, podiatrists, optometrists, and dentists, as key individuals to improve diabetes-related clinical outcomes. These providers are encouraged to work together through interdisciplinary collaboration and to implement evidence-based strategies as outlined in the PPOD toolkit. The toolkit encourages healthcare providers to ask, advise, and assist patients in their efforts to engage in risk reduction and healthy behaviors, including smoking cessation as an important risk factor. While individual PPOD providers have demonstrated effective smoking cessation interventions in adults with other acute and chronic systemic diseases, they lack specific application and focus on adults with diabetes. This literature review examines the current role of PPOD providers in smoking cessation interventions delivered to adults with diabetes.

Introduction Excessive daytime sleepiness (EDS) is a common presenting symptom among sleep apnea (SA) patients. EDS is widely expected to improve with positive airway pressure (PAP) therapy, however, 12-29% of PAP-adherent patients report persistent sleepiness. Given the impact of EDS, we aim to understand the prevalence of EDS and associated quality-of-life (QOL) outcomes among a non-clinic-based sample of patients engaging in a SA online support, education, and research portal. Methods We conducted a cross-sectional survey among patients with SA through the Sleep Apnea Patient Centered Outcomes Network (MyApnea.Org). Survey measures included demographics, comorbidities, treatment, and QOL outcomes: work productivity and activity impairment (WPAI), physical and mental health (Short-Form Health Survey; SF-12v2), functional outcomes of sleep (FOSQ-10), insomnia (Women’s Health Initiative Insomnia Rating Scale; WHIIRS), depression (World Health Organization Well-being Index; WHO-5), and drowsiness-related driving events. QOL outcomes were examined with descriptive statistics by EDS status (Epworth Sleepiness Score, ESS>and≤10). We further examined differences by EDS using linear regression models adjusted for potential confounders. A sub-sample analysis was performed on those with self-reported PAP adherence averaging ≥6 hours/night. Results Of the respondents (n=292), 48.3% were female, 68.2% were ≥55 years, 91.4% were non-Hispanic/White, average body mass index was 32.8 kg/m2 (standard deviation: 8.1), and 47% reported sleeping ≤6 hours/night on average. Sleepiness was identified as a precipitating factor for seeking initial treatment for 31% of respondents. Compared to those without EDS, those with EDS reported poorer QOL outcomes (WPAI, SF-12v2, FOSQ-10, WHIIRS, WHO-5, drowsiness-related driving events; all nominal p<0.01). Associations persisted after adjusting for demographics and comorbidities. In sub-sample analyses among 181 (85%) PAP-adherent patients, 29.8% reported residual EDS, and similar associations between EDS and QOL were observed. Conclusion Patients seeking online SA support experienced a high prevalence of EDS, despite high self-reported PAP adherence. EDS was associated with poorer QOL, including functionality, work, mood, and driving. EDS burden among SA patients despite PAP treatment may drive these individuals to seek online support for problems with sleepiness-related QOL, suggesting potential gaps in clinical care. Support (If Any) Jazz Pharmaceuticals

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivaríate analyses showed no relationship between self-esteem and STD or pregnancy; multivaríate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.