[Show abstract][Hide abstract] ABSTRACT: Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. The authors used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them.
Participants were 2562 breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study, aged 28 to 74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. This study examined CAM use in relation to demographics, health behaviors, and quality of life.
Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit and vegetable intake, and lower body mass index (P < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users (P < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up.
This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.
Integrative Cancer Therapies 03/2011; 10(2):138-47. DOI:10.1177/1534735410392578 · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Declining lung cancer rates in California have been attributed to the California Tobacco Control Program, but may reflect earlier declines in smoking.
Using state-taxed sales and three survey series, we assessed trends in smoking behavior for California and the rest of the nation from 1960 to 2008 and compared these with lung cancer mortality rates. We tested the validity of recent trends in state-taxed sales by projecting results from a model of the 1960 to 2002 data.
From 1960 to 2002, the state-taxed sales and survey data are consistent. Californians initially smoked more than the rest of the nation, but cigarette consumption declined earlier, dropping lower in 1971 with an ever widening gap over time. Lung cancer mortality follows a similar pattern, after a lag of 16 years. Introduction of the California Tobacco Control Program doubled the rate of decline in cigarette consumption. From 2002 to 2008, differences in enforcement and tax evasion may compromise the validity of the taxed sales data. In 2010, smoking prevalence is estimated to be 9.3% in California and 17.8% in the rest of the nation. However, in 2008, for the first time, both cigarette price and tobacco control expenditures were lower in California than the rest of the nation, suggesting that the gap in smoking behavior will start to narrow.
An effective Tobacco Control Program means that California will have faster declines in lung cancer than the rest of the nation for the next 2 decades, but possibly not beyond.
Tobacco control interventions need further dissemination.
[Show abstract][Hide abstract] ABSTRACT: The 1998 Master Settlement Agreement (MSA) restricted tobacco industry advertising practices that targeted teens.
To assess whether cigarette-advertising campaigns conducted after the MSA continue to influence smoking among adolescents.
Participants were a national longitudinal cohort of 1036 adolescents (baseline age: 10-13 years) enrolled in a parenting study. Between 2003 and 2008, 5 sequential telephone interviews were conducted, including the participant's report of brand of "favorite" cigarette advertisement. The fifth interview was conducted after the start of RJ Reynolds' innovative "Camel No. 9" advertising campaign in 2007. Smoking outcome reported from the fifth survey.
The response rate through the fifth survey was 71.8%. Teenagers who reported any favorite cigarette ad at baseline (mean age: 11.7 years) were 50% more likely to have smoked by the fifth interview (adjusted odds ratio: 1.5 [95% confidence interval: 1.0-2.3]). For boys, the proportion with a favorite ad was stable across all 5 surveys, as it was for girls across the first 4 surveys. However, after the start of the Camel No. 9 advertising campaign, the proportion of girls who reported a favorite ad increased by 10 percentage points, to 44%. The Camel brand accounted almost entirely for this increase, and the proportion of each gender that nominated the Marlboro brand remained relatively stable.
After the MSA, adolescents continued to be responsive to cigarette advertising, and those who were responsive were more likely to start smoking. Recent RJ Reynolds advertising may be effectively targeting adolescent girls.
[Show abstract][Hide abstract] ABSTRACT: Objective: To assess the cost of adopting a plant-based diet.Methods: Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n1145) group; baseline and 12-month data on diet and grocery costs.Results: At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3 of E). The intervention change was associated with a significant increase of 1.22/ person/week (multivariate model, P0.027).Conclusions: A major change to a plant-based diet was associated with a minimal increase in grocery costs.
American journal of health behavior 08/2009; 33(5):530-539. DOI:10.5993/AJHB.33.5.6 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A diet high in vegetables, fruit, and fiber and low in fat decreased additional risk of secondary breast cancer events in women without hot flashes (HF-) compared with that in women with hot flashes (HF+), possibly through lowered concentrations of circulating estrogens.
The objective was to investigate the intervention effect by baseline quartiles of dietary pattern among breast cancer survivors in the HF- subgroup of the Women's Healthy Eating and Living Study. Design: A randomized controlled trial compared a putative cancer prevention diet with a diet of 5 servings of vegetables and fruit daily in early-stage breast cancer survivors. Participants did not experience hot flashes at baseline (n = 896). We confirmed cancer status for 96% of participants approximately 7.3 y after enrollment.
The study intervention achieved a large between-group difference in dietary pattern that, at 4 y, was not significantly different across baseline quartiles of dietary pattern. The intervention group experienced fewer breast cancer events than did the comparison group for all of the baseline quartiles. This difference was significant only in upper baseline quartiles of intake of vegetables, fruit, and fiber and in the lowest quartile of fat. A significant trend for fewer breast cancer events was observed across quartiles of vegetable-fruit and fiber consumption.
The secondary analysis showing the decreased risk in the HF- subgroup was not explained by amount of change in dietary pattern achieved. The difference was strongest in the quartile with the most putatively cancer-preventive dietary pattern at baseline.
American Journal of Clinical Nutrition 05/2009; 89(5):1565S-1571S. DOI:10.3945/ajcn.2009.26736F · 6.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether a low-fat diet high in vegetables, fruit, and fiber differentially affects prognosis in breast cancer survivors with hot flashes (HF) or without HF after treatment.
A secondary analysis was conducted on 2,967 breast cancer survivors, age 18 to 70 years, who were randomly assigned between 1995 and 2000 in a multicenter, controlled trial of a dietary intervention to prevent additional breast cancer events and observed through June 1, 2006. We compared the dietary intervention group with a group who received five-a-day dietary guidelines.
Independent of HF status, a substantial between-group difference among those who did and did not receive dietary guidelines was achieved and maintained at 4 years in intake of vegetable/fruit servings per day (54% higher; 10 v 6.5 servings/d, respectively), fiber (31% higher; 25.5 v 19.4 g/d, respectively), and percent energy from fat (14% lower; 26.9% v 31.3%, respectively). Adjusting for tumor characteristics and antiestrogen treatment, HF-negative women assigned to the intervention had 31% fewer events than HF-negative women assigned to the comparison group (hazard ratio [HR] = 0.69; 95% CI, 0.51 to 0.93; P = .02). The intervention did not affect prognosis in the women with baseline HFs. Furthermore, compared with HF-negative women assigned to the comparison group, HF-positive women had significantly fewer events in both the intervention (HR = 0.77; 95% CI, 0.59 to 1.00; P = .05) and comparison groups (HR = 0.65; 95% CI, 0.49 to 0.85; P = .002).
A diet with higher vegetable, fruit, and fiber and lower fat intakes than the five-a-day diet may reduce risk of additional events in HF-negative breast cancer survivors. This suggestive finding needs confirmation in a trial in which it is the primary hypothesis.
[Show abstract][Hide abstract] ABSTRACT: To assess the cost of adopting a plant-based diet.
Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs.
At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027).
A major change to a plant-based diet was associated with a minimal increase in grocery costs.
American journal of health behavior 01/2009; 33(5):530-9. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Physician awareness of their patients' use of complementary and alternative medicine (CAM) is crucial, particularly in the setting of a potentially life-threatening disease such as cancer. The potential for harmful treatment interactions may be greatest when a patient sees a CAM practitioner--perceived as a physician-like authority figure--but does not disclose this to their physician. Therefore, this study investigated the extent of nondisclosure in a large cohort of cancer patients.
CAM use in participants of the UCSD Women's Healthy Eating and Living (WHEL) Study, a multicenter study of the effect of diet and lifestyle on disease-free and overall survival in women aged 18-70 years who had completed treatment for invasive breast cancer between 1995 and 2000, is investigated. Data regarding CAM use and disclosure were collected via a telephone-administered questionnaire in 2003-2004. This questionnaire asked about different CAM modalities, including those requiring a "skilled CAM practitioner" (acupuncturist, chiropractor, homeopath, or naturopath) for administration. Demographic data were obtained at the WHEL baseline clinic interview. Modality-specific disclosure rates were determined and a comparison of demographic variables of disclosers versus nondisclosers was conducted using 2 tests for categorical variables, and t tests for continuous variables.
Of 3088 total WHEL participants, 2527 completed the CAM questionnaire. Of these, 2017 reported using some form of CAM. Of these, 300 received treatment from an acupuncturist, chiropractor, homeopath, or naturopath and also provided information on whether or not they disclosed this care to their conventional physician. The highest disclosure rate was for naturopathy (85%), followed by homeopathy (74%), acupuncture (71%), and chiropractic (47%). Among demographic characteristics, only education (P=.047) and study site (P=.039) were associated with disclosure. College graduates and postgraduates, in particular, were more likely to disclose CAM use to their physicians than those with lesser education.
Overall, moderately high rates of physician disclosure of CAM use for all modalities except chiropractic were observed. Education and study site associations suggest that disclosure may be greater when CAM use is more prevalent and possibly more socially accepted. These findings underscore the importance of open, destigmatized patient--physician communication regarding CAM use.
Integrative Cancer Therapies 10/2008; 7(3):122-9. DOI:10.1177/1534735408323081 · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the effect of dietary energy density change on body weight in participants of a randomized trial. Intervention participants markedly increased fruit and vegetable intake while reducing energy intake from fat. Participants were 2,718 breast cancer survivors, aged 26-74 yr, with baseline mean body mass index of 27.3 kg/m(2) (SD = 6.3). We assessed dietary intake by sets of four 24-h dietary recalls and validated with plasma carotenoid concentrations. Weight and height were measured at baseline, 1 yr, and 4 yr. Dietary energy density was calculated using food but excluding beverages. Intervention participants significantly reduced dietary energy density compared to controls and maintained it over 4 yr -- both in cross-sectional (P < 0.0001) and longitudinal (Group x Time interaction, P < 0.0001) analyses. Total energy intake or physical activity did not vary between groups. The intervention group had a small but significant weight loss at 1 yr (Group x Time interaction, P < 0.0001), but no between-group weight difference was observed at 4 yr. Our study showed that reducing dietary energy density did not result in a reduction in total energy intake and suggests that this strategy alone is not sufficient to promote long-term weight loss in a free-living population.
Nutrition and Cancer 12/2007; 60(1):31-8. DOI:10.1080/01635580701621320 · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.
Journal of Nutrition 11/2007; 137(10):2291-6. · 3.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival.
To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer.
Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006.
The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines.
Invasive breast cancer event (recurrence or new primary) or death from any cause.
From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, -13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment.
Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.
clinicaltrials.gov Identifier: NCT00003787.
JAMA The Journal of the American Medical Association 08/2007; 298(3):289-98. DOI:10.1001/jama.298.3.289 · 35.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables.
A prospective study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000. Enrollment was an average of 2 years postdiagnosis. Only seven women were lost to follow-up through December 2005.
In univariate analysis, reduced mortality was weakly associated with higher vegetable-fruit consumption, increased physical activity, and a body mass index that was neither low weight nor obese. In a multivariate Cox model, only the combination of consuming five or more daily servings of vegetables-fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk), was associated with a significant survival advantage (hazard ratio, 0.56; 95% CI, 0.31 to 0.98). The approximate 50% reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women, although fewer obese women were physically active with a healthy dietary pattern (16% v 30%). Among those who adhered to this healthy lifestyle, there was no apparent effect of obesity on survival. The effect was stronger in women who had hormone receptor-positive cancers.
A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity. The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival.
[Show abstract][Hide abstract] ABSTRACT: Cohort studies suggest that higher circulating carotenoid concentrations through food sources may reduce breast cancer events. Other intervention studies have not achieved the level of change in circulating carotenoids required to properly test this hypothesis.
In a randomized trial of 2,922 breast cancer survivors, we examined blood and self-reported diet at baseline and 1 year. Intensive telephone counseling encouraged a plant-based diet in the intervention group. Diet was measured via 24-hour recalls, and a panel of plasma carotenoid concentrations was assessed at both time points.
The study intervention was associated with a 51% increase in total carotenoid concentration, from 2.272 +/- 1.294 to 3.440 +/- 2.320 micromol/L, achieved mainly by marked increases in targeted carotenoids: alpha-carotene, beta-carotene, and lutein. For each of these targeted carotenoids, the proportion of the intervention sample remaining below the cutpoint for the lowest baseline quartile decreased by one third to one half. After 1 year of study, half of the intervention group was in the highest baseline quartile. No change in distribution was observed in comparison group. Intervention participants achieved this change by both dietary pattern and vegetable juice consumption. Participants who chose to change dietary pattern without consuming significant quantities of vegetable juice achieved 75% of the level of change observed in other intervention participants.
Innovative telephone counseling intervention and dietary targets in the Women's Healthy Eating and Living study were associated with the level of change in circulating carotenoid concentration necessary to test the diet and breast cancer hypothesis suggested by cohort studies.
[Show abstract][Hide abstract] ABSTRACT: To describe the intervention in a clinical trial examining the effect of a plant-based diet on breast cancer recurrence. To report baseline to 12-month dietary change and investigate whether cooking-class attendance influenced adherence to the study's dietary targets.
A descriptive analysis of baseline and 12-month dietary intake data and other variables from a subcohort of participants in the Women's Healthy Eating and Living Study.
Seven hundred thirty-nine women (primarily non-Hispanic white and well educated) who had been treated for early stage breast cancer. All were intervention group participants and had adhered to the Women's Healthy Eating and Living Study counseling and dietary assessment protocols. Mean age at study entry was 54 years, and mean body mass index was 26.7.
Telephone counseling, complemented by an orientation meeting, cooking classes, and newsletters.
The change in intake of vegetables, vegetable juice, fruit, fiber, and fat between baseline and 12 months is reported, and the association between cooking classes attended and overall dietary adherence is examined.
Mean intake for vegetables, vegetable juice, fruit, fiber, and fat were calculated. Percentage of women meeting select Healthy People 2010 objectives were tabulated.
Total daily vegetable, vegetable juice, fruit, and fiber intake increased significantly (P <.01), while fat decreased significantly (P <.01). The percentage of women meeting the Healthy People 2010 fruit and vegetable objectives increased substantially. Overall dietary adherence was associated with increased cooking-class attendance (P for trend <.01).
A multimodal approach to dietary modification, based largely on individualized telephone counseling, can substantially change the overall dietary pattern of women previously treated for breast cancer.
Journal of the American Dietetic Association 04/2005; 105(3):382-91; quiz 488. DOI:10.1016/j.jada.2004.12.008 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although a large body of evidence suggests that diet may play an important role in cancer prevention, randomized controlled trials reported to date have not achieved sufficient increases in protective micronutrients and phytochemicals to adequately test the hypothesis that diet can reduce cancer risk. The Women's Healthy Eating and Living (WHEL) Study, a randomized controlled trial of the role diet modification may play in future breast cancer events, introduced an innovative theory-based telephone counseling intervention to teach participants to consume a high fiber, low fat diet emphasizing vegetables and fruits rich in carotenoids and other potentially protective phytochemicals. This report examines the baseline to 12-mo changes in dietary intakes of 2970 participants, assessed through 24-h recalls and validated with plasma carotenoid concentrations. At 12 mo, the intervention group reported a significantly increased daily vegetable intake (+vegetable juice) of 7.1 servings (+82%) and fruit intake of 3.9 servings (+18%). Fiber intake increased from 3.04 to 4.16 g/(MJ. d), whereas energy from fat decreased significantly from 28.6 to 23.7%. Plasma carotenoid concentrations increased significantly, i.e., alpha-carotene (+223%); beta-carotene (+87%); lutein (+29%); and lycopene (+17%). In the comparison group, dietary intake and plasma carotenoid concentrations were essentially identical to those of the intervention group at baseline and were unchanged at 12 mo. The WHEL Study showed that a telephone counseling intervention can achieve major increases in micronutrient- and phytochemical-rich vegetables, fruit and fiber intakes, enabling an investigation of the potential cancer preventive effects of these food components.
Journal of Nutrition 03/2004; 134(2):452-8. · 3.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Women's Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.
[Show abstract][Hide abstract] ABSTRACT: Epidemiological studies suggest that a high vegetable diet may reduce risk for breast cancer and may also improve prognosis after the diagnosis of breast cancer. Circulating carotenoids may serve as a biomarker of vegetable and fruit intake, although several factors affect their bioavailability from food sources and may influence concentrations. One purpose of this study was to identify factors predictive of serum carotenoid, retinol, and alpha-tocopherol concentrations in 79 postsurgically resected breast cancer patients at enrollment and at 12 months in a feasibility study of a high vegetable, low fat diet intervention to reduce risk for cancer recurrence. Another purpose was to identify variables associated with change in these serum concentrations 12 months after randomization into control and intervention groups. The diet intervention (versus control) group had significantly greater increases in carotenoid intakes (P < 0.03) and significantly greater increases in serum concentrations of lutein, alpha- and beta-carotene, lycopene, and retinol (P < 0.04). Stepwise multiple regression revealed the level of dietary intake to be predictive of most serum carotenoid concentrations at baseline and 12 months, with additional associations between selected micronutrient concentrations and serum cholesterol, body mass index, age, percentage of energy intake from fat, and alcohol intake also observed at these time points. Intervention group change in serum carotenoid concentrations was inversely associated with baseline level, age, and change in serum cholesterol concentration and positively associated with change in carotenoid and alcohol intake. Circulating carotenoid concentrations are responsive to a high vegetable diet intervention, which also included reduced dietary fat and increased fiber intakes, to reduce risk for breast cancer recurrence.
[Show abstract][Hide abstract] ABSTRACT: Epidemiologic evidence supports the concept that diet influences risk for breast cancer and suggests that prognosis after the diagnosis of breast cancer may also be related to modifiable nutritional factors. The purpose of this study was to investigate the feasibility of a randomized trial of a high-vegetable, reduced-fat, and increased-fiber diet intervention to reduce risk for recurrence among breast cancer survivors. This major change in dietary pattern was promoted through intensive telephone counseling. Participants were 93 women who had been diagnosed with breast cancer (stages I, II, and IIIA) within the previous four years and who had completed their initial treatment. We assessed adherence to the study diet using repeated 24-hour dietary recalls at 6 and 12 months and measurement of circulating carotenoid concentrations. Six months after randomization, the intervention group had significantly increased their mean intake of vegetables (+4.6 servings/day), fruit (+0.7 servings/day), and fiber (+6.4 g/1,000 kcal) and significantly reduced their intake of dietary fat (-9.9% of energy) compared with the control group. Circulating concentrations of carotenoids also increased in the intervention group. These changes persisted at the 12-month visit. Results of this study demonstrate that telephone counseling can be a useful approach in diet intervention and that breast cancer survivors can adopt and maintain a high-vegetable, reduced-fat dietary pattern.
Nutrition and Cancer 02/1997; 28(3):282-8. DOI:10.1080/01635589709514589 · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: TOBACCO USE IN CALIFORNIA DETAILED FINDINGS SUMMARIZED BY CHAPTER Chapter 4. ASSESSING PROGRESS TOWARD PROGRAM GOALS 1. Between 1990 and 1993, the proportion of California children and nonsmoking workers who were protected from ETS exposure increased substantially. 2. Cigarette consumption in California declined by an estimated 13.7% following the passage of Proposition 99 and the mandated increase in excise tax on cigarette products. This accelerated decline in consumption lasted approximately 5 months after the imposition of the 25-cent tax. 3. The introduction of Tobacco Control Program interventions was associated with an increase in the rate of decline in cigarette consumption. 4. Between 1988 and 1993, we observed a 27% decrease in per capita tobacco consumption and a 28% decline in smoking prevalence. Based on mUltiple surveys, the best estimate of smoking prevalence in 1993 among California adults is 19.1 %. 5. Following the passage of Proposition 99, smoking prevalence declined at twice the rate observed before Proposition 99. However, this new rate of decline must be increased by a further 50% in order to achieve the Program goal of a 75% reduction in prevalence by 1999. 6. Smoking prevalence among 16- to 18-year-old Californians appeared to be increasing sharply following the introduction of the "Joe Camel" tobacco advertising campaign. We were unable to identify a decline in prevalence associated with the imposition of the excise tax. No further increases in adolescent smoking prevalence were observed following the introduction of the Tobacco Control Program. 7. The decline in tobacco consumption and smoking prevalence in California appears to result from increases in successful smoking cessation among adults. 8. Popular support for a further increase in the excise tax on tobacco has grown. In 1993, 60% of Californians indicated support for an additional increase in the excise tax of at least 50 cents, provided that the money would be used for
[Show abstract][Hide abstract] ABSTRACT: Evaluation of the California Tobacco Control Program Progress from 1988 through 1993 1. Protection of Nonsmokers form Environmental Tobacco Smoke (ETS) (a) Children at Home: 80% of children younger than 17 years protected by 1993 (b) Nonsmokers at Work: 23% decrease in the number of nonsmokers exposed to ETS during 1990-1993 2. Reduction in Smoking Prevalence (a) Tobacco consumption declined 27% between 1988 and 1993. (b) Smoking prevalence declined 28% from an estimated 26.5% in 1988 to a best estimate of 19.1% in 1993. (c) The observed decline in consumption and prevalence resulted from an increase in successful quitting among California adults. (d) No decline in adolescent smoking was observed after 1990. The Program appears to have halted the increases in adolescent smoking observed during 1988-1990. Forecast to Year 1999 1. As currently implemented, the Tobacco Control Program will not meet the legislatively set goal of a 75% reduction in smoking prevalence. 2. To achieve the set goal, the Program should emphasize effective interventions in order to increase its annual impact by 50% for the period 1994 through 1999.