Objective. To assess the effect of group exercise programs on smoking cessation. Data Sources. A MEDLINE search, a manual review of journal articles, and a search of previous reviews were used. Study Selection. Published studies which 1) employed an exercise program for an intervention group and, 2) reported numbers of smokers of both exercise and control groups at baseline and at 6 to 24 months later were selected. Data Extraction. Five randomized trials were selected. In three of these, smoking cessation was the main aim and exercise was employed for relapse prevention concurrently with or after a group smoking cessation program. The studies produced a moderate qualitative score of 7 to 9 out of a 13 total score of modified DerSimonian's quality checklist. Data Synthesis. The summary odds ratio of the three studies which primarily aimed at smoking cessation was 2.35 (95% C.I. 0.75-7.31). When the two other studies were added, it dropped to 1.85 (95% C.I. 0.65-5.24). Conclusions. Due to the small number of studies and the small sample size for each study, the effect remains unclear. Further analysis, both qualitative and quantitative, is necessary to clarify these issues. J Epidemiol, 1998 ; 8 : 79-84.
Objective To evaluate the prevalence of cigarette smoking in Cambodia and identify prevailing knowledge, attitudes and practices (KAP). Design Information on tobacco smoking and KAP was collected using the 30-cluster survey design wherein 10 - 15 males (age over 15 years) were interviewed from each of 30 randomly- selected population clusters in Phnom Penh (herein referred to as 'urban') and Siem Reap (herein referred to as 'rural') for a total of 601 interviews. Results and Discussion Findings show that 65% of urban respondents and 86% of rural respondents smoke. Rural men start smoking at an earlier age, but the average urban smoker spends more. 17% of an urban smoker's personal cash income is spent on tobacco, whereas his rural counterpart spends 8%. This discrepancy is partly due to extensive tobacco brand- name promotion in urban areas which has resulted in the average price of a pack of cigarettes being four times higher than that of rural. Other findings show an inverse correlation between incidence of smoking and levels of education/income. Concerning smoking cessation, 66% of urban smokers and 86% of rural smokers interviewed indicated they would attend a program in their area to stop smoking if such a program were available. Conclusion The high prevalence of smoking in Cambodia, and the health impact it has and will increasingly have on its people is significant. The high cash expenditure for tobacco, especially in urban, is an important factor contributing to Cambodia's impoverished economy. Education, regulatory policies, and smoking cessation are important measures to be considered for effective tobacco control planning and implementation. J Epidemiol, 1998 ; 8 : 85-89
The objective of this study is to clarify clinical characteristics which differentiate bacteriologically positive pulmonary tuberculosis patients from negative ones in Mongolia. The subjects include 338 patients aged 16 years and older who had undergone bacteriological examinations. Of them, 107 patients (31.7%) were confirmed bacteriologically. The proportion of bacteriological positive results increased significantly among patients who had cavities in the roentgenographic examination, cough at diagnosis and the family history of tuberculosis. Addressing these clinical characteristics will contribute to raising not only the sensitivity of the sputum examination, but also the specificity of the roentgenographic examination in the diagnostic process of tuberculosis. J Epidemiol, 1998; 8 : 90-93.
In recent years, an elevated serum α 1-antichimotrypsin (ACT) levels is associated with increased risk of Alzheimer-type dementia. The relationship between ACT and conventional various cardiovascular risk factors were studied using 589 noninstitutionalized individuals aged 65 and older living in the community in Japan. Serum ACT levels had no significantly differences between men and women, and had no significantly association with age in both sexes. Serum ACT levels had no statistically significant associated with body mass index, blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol in both sexes. There were no significant differences in mean of serum ACT levels between in subjects with prevalent and subclinical cardiovascular disease and in those who were free of disease. A prospective study design is needed to clarify the relation between ACT and the development of Alzheimer-type dementia. J Epidemiol, 1998 ; 8 : 94-98.
The purpose of this study was to call attention to a potential bias or misclassification resulting from disregarding sex and age of family members in assessing family history of hypertension. Family history of hypertension was obtained among 23, 803 family members through a questionnaire survey of 2, 316 high school students. From the obtained data sex- and age-specific proportion of a positive history of hypertension was calculated. The effects of sex and age on a positive history was assessed by the logistic regression analysis of the family history. Below age 70 the odds ratios for sex difference were at least 1.24 (p<0.05) and odds ratios for age difference were at least 1.05 (p<0.05). This indicated that below age 70 male members had a positive history at least 1.24 times more frequently than females of the same age, and that a positive history increased by at least (1.05)Y, where y was age difference by year. Above age 70 the odds ratios for sex and age differences were small. A potential bias or misclassification resulting from sex and age difference can be substantial below age 70. Some measures to control for sex and age of family members are required in assessing the family history. J Epidemiol, 1998 ; 8 : 99-105.
To investigate the relationship of food intake habits and dietary patterns to blood pressure, a cross-sectional study was conducted for 473 middle-aged Japanese males. After adjustment for age, residence, occupation, body mass index and alcohol consumption, mean systolic and diastolic blood pressure (SBP and DBP) were inversely associated with each intake frequency of dairy products, coffee, fruits, egg, beef, pork and chicken. The adjusted mean SBP and DBP of the individuals with 'all (=three)' of the following three dietary habits ; 'once and over/wk of dairy products', 'once and over/wk of fruits', and 'three times and over/wk of beef, pork or chicken', were 7.4mmHg and 6.9mmHg lower (p<0.001, for each) than those of 'zero or one' group. According to the analyses on 3-days weighed food records of 157 volunteers, the adjusted mean daily intake of total protein, animal protein and potassium were markedly higher in the 'two' or the 'three' group than in the 'zero or one' group (p<0.05, for each). These results suggest that habitual intake of dairy products, fruits, and meat or chicken may be associated with the reduction of blood pressure possibly through the intake of protein and potassium. J Epidemiol, 1998 ; 8 : 106-115.
A case-control study was conducted in Ibaraki, Japan. Cases were 148 women aged 26-69 diagnosed with breast cancer at Tsukuba University Hospital or Tsukuba Medical Center Hospital between January 1990 and March 1997. Two controls were individually matched to cases by age (within 1 year) and residence (municipalities). A self-administered questionnaire was used to obtain information on physical activity and the effects of potential confounding factors. Conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95 percent confidence intervals (95% CIs). After adjustment for potential confounding factors (height, body mass index (BMI), family history of breast cancer, education, age at menarche, age at first birth, parity, menopausal status), recreational physical activity was associated with a reduced risk of breast cancer (p for trend = 0.005). OR for breast cancer among women who played regular sport or exercise more than 15.3 METs per week was 0.35 (95% Cl = 0.17, 0.73), as compared to women with no sport or exercise. The risk of breast cancer was also reduced in women with higher occupational physical activity levels, but it was not significant (p for trend = 0.223). The adjusted OR among the highest quartile level was 0.55 (95% CI = 0.27, 1.12) with the lowest quartile level as reference. Our findings support a protective effect of recreational physical activity on breast cancer in Japanese women. J Epidemiol, 1998 ; 8 : 116-122.
Successful implementation of partner notification program (PNP) as a part of human immunodeficiency virus (HIV) prevention strategies in some developed countries motivated the execution of cost-effectiveness analysis of this program in Japan. Total number of HIV infected individuals and best estimated number of their partners in 1995 were used to elicit incremental cost-effectiveness ratio over no partner notification program. Index cases and their HIV positive partners world change their sex practice to safer one, thus preventing HIV transmission at a certain rate. This was translated to prevention of certain number of new HIV carriers and finally life years gained were calculated for it. The incremental cost-effectiveness ratio was US$ 4, 930 per life year gained. Sensitivity analysis indicated that partner notification program was cost- effective over a wide range of assumptions. These results compare favorably with other medical interventions in Japan. In conclusion, the results of this analysis strongly support the implementation of partner notification program as a part of HIV prevention strategies in Japan. J Epidemiol, 1998 ; 8 : 123-128.