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RESEARCH BRIEFSSmoke-free Dorms Dampen College Smoking HabitCollege students rooming in smoke-free dorms are 40 percent less likely to pick up the deadly habit than those living in dorms where smoking is permitted, according to HSPH researchers. The bad news is that only 27 percent of colleges prohibit smoking in college dormitories. Forty percent do not offer smoking cessation programs for those who want to quit. Henry Wechsler, Nancy Rigotti, and colleagues at the HSPH College Alcohol Study examined the smoking behavior of 4,495 students at 101 schools offering smoke-free housing. Students who had not smoked regularly before the age of 19 and who were currently living in nonsmoking dorms exhibited a significantly lower rate of smoking than those living in unregulated housing—10 percent compared to 16.9 percent. Living in a nonsmoking dorm did not appear to confer a protective benefit on students who smoked regularly before college. The results appear in the March American Journal of Preventive Medicine. "These findings suggest that smoke-free dorms may help incoming college students who have not yet taken up smoking to avoid tobacco addiction during college," said Wechsler, director of the College Alcohol Study and lecturer on social psychology at HSPH. In addition to limiting the opportunity for smoking, the smoke-free dorms may reduce the influence of smokers on their nonsmoking peers. "They also prevent nonsmokers from being exposed to the harmful effects of secondhand smoke and the risk of dormitory fires," Wechsler said. "All in all, smoke-free residences are a win–win situation." Yet in a separate study, the researchers surveyed health center directors at 604 four-year colleges and universities in the U.S. and found that fewer than a third of colleges offer such dorms, and only 60 percent offer smoking cessation programs. These findings appear in the March issue of the Journal of American College Health. Although previous research has shown that 50 percent of student smokers tried to quit smoking in the previous year, few of them drew upon college resources, such as smoking cessation programs, to do so. "These efforts are more likely to be successful if they are paired with environmental and policy changes, such as smoke-free dorms," said Rigotti, HMS associate professor of medicine. Cholesterol Buster May Also Cut Protein Tied to Heart AttackThe ability of the drug pravastatin to lower cholesterol and prevent heart disease is well established, but it may have another important action in the body. Retrospective analyses of studies, including the Cholesterol and Recurrent Events (CARE) trial, have suggested that pravastatin may also reduce levels of a key heart attack predictor, C-reactive protein (CRP). Levels of the protein are elevated in states of acute inflammation, including arterial inflammation, which is thought to play a central role in heart attacks. A new large-scale study has shown prospectively that prava-statin lowers CRP levels in healthy people and people with heart disease. The results of the trial, dubbed Pravastatin Inflammation CRP Evaluation (PRINCE), were presented last month at the 50th annual scientific sessions of the American College of Cardiology. Pravastatin reduced CRP levels to a similar extent in patients with and without a history of heart disease, said Paul Ridker, principal investigator and HMS associate professor of medicine at Brigham and Women's Hospital. The effects were seen within 12 weeks of treatment. Interestingly, the reductions in CRP were largely independent of changes in cholesterol. The investigators used a new high-sensitivity C-reactive protein test to measure CRP levels in the 2,400 PRINCE participants. One half of the patients enrolled in the trial, those with no clinical evidence of heart disease, were randomly assigned to pravastatin treatment or placebo. The other half, who had a history of heart attack, stroke, or coronary revas-cularization, were treated with pravastatin. The results of PRINCE underscore the utility of cholesterol-reduction therapy. "Cholesterol reduction is an effective form of preventative therapy, which remains underutilized in both the United States and Europe," said Ridker. Determining whether CRP is simply a marker of arterial inflammation or actually plays a role in the development of heart disease is a key question for the future. Economic Status May Affect Care for Colorectal Cancer PatientsOnly 43 percent of patients treated for stage III colon cancer are reported to receive the recommended combination of surgery and chemotherapy. David Hodgson of the University of Toronto, together with Charles Fuchs, HMS assistant professor of medicine at the Dana– Farber Cancer Institute, and John Ayanian, HMS associate professor of health care policy and of medicine at Brigham and Women's Hospital, have documented this imbalance in the April 4 Journal of the National Cancer Institute. Their review, which covers more than 50 studies spanning a 20-year period, examines both health care provider and patient characteristics that may contribute to variation in the management and treatment of colorectal cancers. Doctors and hospitals with large case loads tend to offer more advanced surgical procedures, such as sphincter-saving operations. These procedures are twice as likely to be performed by surgeons with specialty training. In contrast, though the number of studies addressing this criterion is small, surgeon expertise does not appear to influence mortality or long-term survival. Overall, patient ethnicity and socioeconomic status are far more significant in predicting the quality and success of treatment, the authors show. Black patients are just about half as likely to undergo a major therapeutic procedure and twice as likely to die of colorectal cancer as are white patients. In certain rural communities, the chances of receiving adjuvant chemotherapy are five times higher for whites. Among Hispanics and native Americans, survival rates compared to those of whites are 78 percent and 50 percent, respectively. Regardless of race, poor socioeconomic circumstances negatively affect both treatment quality and survival rates. In Florida, for example, noninsured patients are less likely to receive essential surgery, while those underinsured or enrolled in HMOs have higher mortality rates than those in fee-for-service plans. No Data Found Tying Breast Implants to Multiple MyelomaIn the '90s, initial studies linked silicone breast implants to a variety of connective tissue diseases, such as scleroderma, lupus, and rheumatoid arthritis. When closely examined, the associations did not hold up. Reports followed on other possible health risks incurred by using breast implants. A few cases suggested that women with implants develop early multiple myeloma. Yet women with breast implants do not appear to be at greater risk for developing an early indicator of the disease, according to a report in the March 26 Archives of Internal Medicine. Elizabeth Karlson, HMS assistant professor of medicine at Brigham and Women's Hospital, and her colleagues looked for evidence of monoclonal gammopathy of undetermined significance (MGUS)—an early sign of multiple myeloma—in 288 women with cosmetic breast implants and 288 without the implants. All were enrolled in the Nurses' Health Study. Five women with breast im-plants and 4 women without implants exhibited MGUS. "That was not a significant difference," said Karlson. Because of the small size of the sample she could not be absolutely sure there was no association between breast implants and MGUS, but the chances are slim. "We have very little evidence that the implants can lead to monoclonal gammopathy of undetermined significance," she said. |
