NCI monographs : a publication of the National Cancer Institute最新文献

Fungal surveillance cultures have been studied as potential predictors of invasive or disseminated mycoses. Several studies have demonstrated that the presence of Candida tropicalis in mucosal surveillance cultures has a high predictive value for invasive fungal infection due to this pathogen in granulocytopenic patients. By comparison, surveillance cultures for Candida albicans have a poor positive predictive value for invasive fungal infection. The value of routine surveillance cultures of the nares for Aspergillus spp. has not been consistently confirmed. The use of surveillance cultures for less common fungal pathogens, such as Trichosporon beigelii, also remains unclear. Fungal surveillance cultures of the inanimate hospital environment have proven useful in identifying the source of conidia in well-defined clusters or outbreaks of nosocomial aspergillosis and other mycoses. As investigational tools, fungal surveillance cultures also may be useful for studying the effects of new antifungal agents on mucosal flora. Fungal surveillance cultures, especially for C. tropicalis and possibly Aspergillus spp. in high-risk populations, may be useful when a pathogen-directed approach to antifungal therapy is used. However, the time required, diagnostic limitations, and expense of routine mucosal fungal surveillance cultures must be balanced against the effect of this information on therapeutic decisions. Empirical antifungal therapy and early diagnostic approaches for high-risk patients may obviate the need for routine fungal surveillance cultures while decreasing the frequency of invasive mycoses.

Infection is the most common cause of morbidity and death in patients receiving chemotherapy for treatment of acute leukemia. Studies performed during the past decade suggest that over 30% of these infections originate from oral sources, particularly periodontal pockets and pericoronal flaps. Studies of large numbers of patients receiving a variety of myelosuppressive chemotherapy protocols are necessary to determine the risk-benefit ratio of dental treatment prior to chemotherapy.

Data from surveys of adolescents were analyzed so that we could determine the prevalence of smokeless tobacco use and identify and compare the concurrent correlates of its use and cigarette smoking. Panel data from seventh through eleventh and eighth through twelfth graders between 1980 and 1984 and cross-sectional data from seventh graders in 1980 and 1985 suggest that boys are more likely to use SLT than are girls and that the boys' use has increased with age and over time. Concurrent correlates of seventh-grade boys' and girls' SLT use and cigarette smoking were identified with discriminant analyses. Predictors of smokeless tobacco use were compared with those of weekly smoking for boys and girls separately. Predictors of use by boys were also compared with those by girls. Trying alcohol and the other form of tobacco were the only predictors that related to the use of either form by boys and girls. Differences among other predictors were noted and their implications for prevention are discussed.

This paper is focused on the approaches used to advertise and promote smokeless tobacco products during the early to mid-1980s. These included traditional motifs that featured rugged-looking masculine models in sporting and outdoor settings as well as an expanded white-collar appeal. Smokeless tobacco was not affected by the ban on broadcast advertising of cigarettes that went into effect in 1971, and, until 1986, both print and broadcast media were used to advertise it. Promotional activities ranged from sponsorship of sporting events to offers for clothing bearing smokeless tobacco product logos. Despite the claims of manufacturers that advertising and promotional efforts were not targeted to youth, smokeless tobacco companies sponsored tobacco-spitting contests with teenage participants, a college marketing program, and college scholarships. In efforts that appeared designed to bolster their public image in the face of growing concern over the consequences of smokeless tobacco use by young people, companies like U.S. Tobacco Company contributed to major social programs, including, ironically, alcohol- and drug-abuse prevention programs. Spurred by public health groups, federal legislation was passed in 1986 that banned television and radio advertising of smokeless tobacco products and required manufacturers to include warning labels on their products on the potential health hazards of smokeless tobacco use.

Future research needs in the area of adolescent smokeless tobacco use are addressed, based on the studies reported in this volume covering methodologic issues and substantive directions. In addition, we outline some implications for developing preventive interventions to deter smokeless tobacco use among adolescents.

A multicomponent, cognitive-behavioral intervention program, offered to 25 chronic, adolescent male users of smokeless tobacco, was divided into three sessions and involved self-monitoring of smokeless tobacco use, awareness of health risks, behavioral coping strategies, frequent phone contact, and relapse prevention training. Biochemical (carbon monoxide and cotinine) verification of self-reports was obtained, information about subject and environmental characteristics collected, and a 3-month follow-up conducted. Twenty-one of the 25 subjects completed treatment; 9 participants were abstinent at the conclusion of the program, and 4 remained successful in quitting at the 3-month follow-up. Participants who did not achieve complete abstinence reported substantial reductions in smokeless tobacco use, and no increase in cigarette consumption occurred as a result of reducing or quitting use of it. Subjects successful in achieving cessation had consumed a smaller amount of smokeless tobacco at baseline and were more likely to be involved in school athletics.

This is a report on smokeless tobacco use among Native American youth from Indian reservations in Washington State. Study findings indicate that snuff and chewing tobacco are used frequently, heavily, and at an early age by Native Americans. Nearly one-half of our subjects had used smokeless tobacco on 11 to 20 or more occasions; close to one-third of all the females had used smokeless tobacco on more than 20 occasions. Weekly users in this study were young. Of those Native subjects who used snuff or chewing tobacco weekly, 72% were under 12 years of age. Among youth who reported weekly smokeless tobacco use, about 74% of all females and 90% of all males had first used snuff or chewing tobacco before they were 10 years old. Study results have implications for efforts toward detection, treatment, and prevention of snuff and chewing tobacco use among Native American adolescents.

Prevalence data that are currently available indicate that smokeless tobacco use among youths in various parts of the United States is a significant and growing problem. Although relatively little is known about the factors that contribute to the initiation and maintenance of this behavior, previous research focusing on other substance use provides a valuable framework for both a study of smokeless tobacco use and the design of effective interventions for its prevention. The papers presented in this monograph address many of the gaps in our current knowledge and provide an accurate overview of research efforts in this area to date.

Questionnaire data obtained from 1,631 tenth grade students in 14 school districts in the State of Washington are used in this investigation of the relationship between the onset processes for smokeless tobacco use and smoking. Emphasized is the use of time-to-event data on the ages of occurrence of six events in these onset processes. Concepts and methods for the statistical analysis of time-to-event data are demonstrated. The occurrence of events in the smoking onset process are strongly related to increases in the subsequent onset rate for smokeless tobacco use. Compared with before initial smoking has occurred, the onset rates for weekly smokeless tobacco use after initial smoking has occurred are 2.03 (P less than .001) and 6.72 (P less than .001) times as large for males and females, respectively. Furthermore, both initial and weekly use of cigarettes contributes to the risk of subsequent weekly smokeless tobacco use. Conversely, the steps in the onset process of smokeless tobacco use are strongly related to increases in the subsequent smoking onset rate. Possible implications for intervention in prevention of smokeless tobacco use and for further research are discussed.

The concurrent and prospective correlates of the use of smokeless tobacco among 846 adolescent males were examined. There were 6- and 12-month follow-ups to the initial questionnaire. Substantial levels of tobacco, alcohol, and marijuana use were reported, with 21% reporting use of more than one drug in the last week. Daily smokeless tobacco users were more likely to initiate use of cigarettes, marijuana, and alcohol than were other males. In addition, the "having used" smokeless tobacco variable was related to increased use of cigarettes, marijuana, and alcohol at follow-up. Discriminant analysis of concurrent data identified peer use of smokeless tobacco and experience with cigarette smoking as the primary discriminating factors between males who had tried it and those who had not. Peer use of smokeless tobacco also discriminated between daily users and those who had tried it but had not gone on to become daily users. Thus peer influence seems to be an important factor not just in trial of smokeless tobacco but also in the development of a daily use pattern. Beginning use of smokeless tobacco was related to offers to use alcohol, cigarettes, and marijuana; peer use was the best predictor of continued daily use.