Lung Cuncer, 8 (1992) 229-243 0 1992 Elsevier Science Publishers B.V. All rights reserved 0169-5002/921$05.00 229

ABSTRACTS

Prevention State tobacco prevention, control activities: Results of 1989-1990

Association of State, Territorial Health OfEcials Survey - Final

Report.

Morbidity and Mortality Weekly Report,Aflan~a. GA. J Am Mcd Assoc

1991;226:310.5-x.

In October 19X9, the Assoc~atlon of State and Territorial Health

Officmls (ASTHO) conducted a survey of stale health department

personnel regarding programs, p&&s, and public health systems that

stress the prevention and control of the use of tobacco. Ttus survey

prowded detailed data assouated wth state tobacco-use control pro-

grams and their essential components (e.g., budgets, planning, coali-

tlons, surveillance systems, smokmg cessation programs, educational

actwties, legislatrvc actions, and health department policies). States

vary wdely m the strength and coverage of thclr programs for prevent-

ing and controllmg tobacco use. The ASTHO survey data may lx used

to help plan and evaluate state health department programs as par1 of an

effort to prevent chronic diseases r&ted to tobacco use. Outcomes of

state activmes may be evaluated through surveys such as CDC’s

BehavIoral Risk Factor Surveillance System (BRFSS) and the Current

Population Survey (CPS) of the Bureau ofthc Census. Future surveys of

state activities for controllmg the use of tobacco may bc included m the

evaluation of the upcommg (1993) American Stop Smoking Intcrven-

110” Study (ASSIST), which is cosponsored by the National Cancer

lnstltute and the American Cancer Society.

Transdermal nicotine for smoking cessation: Six-month results

from hvo multicenter controlled clinical trials

Christen A, Be&anger B, Mau M, Walker C, Hatsttkami D, Allen S et

al. Pulmonary and Crimal Care Medicine Secrion, Depariment of lnwrnal Medicine, University ofNebraska Medical Center, 600 S 42nd

Sr, Omaha, NE 68198.2465. J Am Med Assoc 1991;266:3133-8.

Objective. To evaluate the efficacy of a new transdermal nicotine

system for smoking cessation. Design. Two 6-week, randomized,

double-blind, placebo-controlled, parallel group trials were conducted.

Successful abstainers from both trials enrolled in a third trial for blinded

downtitration from medications (6 weeks) and subsequent off-drug

follow-up (12 weeks). Setting. Nine outpatient clinics specializing in

the treatment of smokmg cessation. Patients. - Healthy volunteers who

smoked one or more packs of cigarettes daily and wanted to participate

in a smoking cessation program. Intervention. - Patients were randomly

assigned to a uansdermal nicotine system delivering nicotine at rates of

21, 14. or 7 mg (m trial 1 only) over 24 hours or to placebo. Group

counsehng sessions were provided to all participants. Main Outcome

Measure. - Rates of continuous smoking absunence were determined

during 6 weeks of full-dose treatment, a 6-week weaning period

(through week 12). and a 3-month follow-up receiving no therapy

(through week 24). Abstinence was defined by patient diary reports of

no smokmg dttnng thedesignatedperiods, confirmed by expired-breath

carbon monoxide levels of 8 ppm or lower. Results. - The centers

enrolled 935 patients. Cessation rates during the last 4 weeks of the two

6-weektrials(pooleddata)were61%,48%,and27%for2l-and 14-mg

transdermal nicotine and placebo, respectively (p~.OOl for each active

treatment YS placebo). Six-month abstinence rates for 21-mg transder-

malnicotineandplacebowere26%and 12%,respectively~~.001). All

transdermal nicotine doses significantly decreased the severity of

nlcotine withdrawal symptoms and significantly reduced cigarette use

by patients who did not stop smoking. Compliance was excellent, and

no serious systemic adverse effects were reported. Conclusions. -

Transdermal mcotine systems show considerable promise as an aid 10

smokmg cessation.

Predictors of physicians’ smoking cessation advice

Frank E, WInkleby MA, Altman DG, Rockhill B, Fortmann SP.

Slanford Centerfor Research in Duease Prevemion, Smford Univer-

srry School ofMedicine, 1000 Welch Rd. Palo Alm, CA 94304-1885. J

Am Med Assoc 1991;266:3139-44.

Objectwes. - To determine the percentage of smokers reportmg that

a physician had ever advised them to smoke less or to stop smokmg, and

theeffectoftime,demographics,medical hlstory,andcigarettedepend-

ence on the likelihood thatrespondents would state that a physician had

ever advised them to stop smoking. Design and Setting. Data were

collected from the Stanford Five-City Project, acommunitywide health

educauon intervention program. The two treatment and three control

cities were located m northern and central California. As there was no

slgnlficant difference between treatment and control cmes regarding

cessation adwe, data were pooled for these analyses. PartxipanLs.

There were five cross-sectional, population- based Rve-Cny Project

surveys(conducted in 1979-1980,1981-1982,1983- 19X4,1985-1986,

and 1989-1990); these surveys randomly sampled households and

included all residents aged I2 to 74 years. Mam Outcome Measures. -

Improved smoking advice rates over time m all towns was an a prIori

hypothesis. Results. - Of the 2710 current smokers, 48.X% stated that

their phywlans had ever advised them to smoke less or stop smokmg.

Respondents were more likely to have been so advised if they smoked

more cigarettes per day, were surveyed later in the decade, had more

offze visits in the last year, or were older. In 1979-1980, 44. IF of

smokers stated that they had ever been adwsed to smoke less or to quit

by a physician. vs 49.X% of smokers in 1989-1990 (P<.O7). Only 3.6%

of 1672 ex-smokers stated thar their physwms had helped them quit.

Conclusion. - These findings suggest that physicians still need to

mcrease smoking cessation counselmg to all pauents, pamcularly

adolescents and other young smokers, minorities, and those without

cigarette-related disease.

RJR Nabisco’s cartoon camel promotes Camel cigarettes to chil-

dren

DiFranza JR, Richards JW Jr, Paulman PM, Wolf-Gillespie N, Fletcher

C, Jaffe RD et al. Department of Family Pracrrce. Unwerwy of

Massachusetrs Medical School, 47 Ashby Stare Rd. FmhburR. MA

01420. J Am Med Assoc 1991;266:3149-53.

Objectives. -To determine ,I RJR Nabisco’s cartoon-theme advertw

ing is more effective in promoting Camel ugarcttes to chddrcn or to

adults. To determme if children see, remember, and arc mfluenccd by

cigarette advertising. Desrgn. - Use of four standard marketing mea.-

ares to compare the effects of Camel’s Old Joe cartoon advertising on

children and adults. Subjects. High school students, grades 9 through

12, from five regions of the United States, and adults, aged 2 I years and

over, from Massachusetts. Outcome Measures. Recognmon of Camel’s

Old Joe cxtoon character, product and brand name recall, brand

preference, appeal ofadvertlsmg themes. Results. -Children were more

likely to report prior exposure to the Old Joe cartoon character (97.7%

vs 72.2%; P<.ooOl). Children were better able to ldentlfy the type of

product bung advertised (97.5% vs 67.0%; P<.OoOl) and the Camel

cigarette brand name (93.6% vs 57.7%; P<.OOOl). Children also found

theCamelclgarettcadvenisements moreappealing (P<.OoOl). Camel’?

share of the illegal children’s cigarette market segment has mcreaced

from 0.5% to 32.8%. representing sales estimated at $476 mdhon per

year. Conclusion.-Old Joe Camel carmon advertisements arc far more

successful at markeung Camel cigarettes to children than to adults. Ttus

findmg is consistent with tobacco industry documents that mdlcate that

a maJor function of tobacco advertising IS to promote and mamtam

tobacco addiction among children.