Journal Update

Periodically, the National Center for Health Promotion and Disease Prevention will post abstracts on relevant research and clinical topics in the health promotion and disease prevention arena.*

January 2009

Prevention Practice 

Gaziano, JM, Glynn, RJ, Christen, WG, et al.   Vitamins E and C in the prevention of prostate and total cancer in men:  the Physicians' Health Study II randomized controlled trial.  JAMA doi:10.1001/jama.2008.862.
http://www.ncbi.nlm.nih.gov/pubmed/19095166?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The Physicians’ Health Study II Randomized Controlled Trial is a randomized, double-blind, placebo-controlled factorial trial of vitamins E and C that began in 1997 and continued through completion in August 2007.  A total of 14,641 male physicians in the US initially aged 50 years and older were enrolled.  Neither vitamin E nor C supplementation reduced the risk of prostate or total cancer.  These data provide no support for the use of these supplements for the prevention of cancer in middle-aged and older men.

Lippman, SNM, Klein EA, Goodman PJ, et al.  Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. doi:10.1001/jama.2008.864.

http://jama.ama-assn.org/cgi/content/abstract/2008.864v1?etoc 

A randomized, placebo-controlled trial (SELECT) of 35,533 men from the US, Canada, and Puerto Rico randomly assigned to 4 groups (selenium, vitamin E, selenium + vitamin E, and placebo) in a double-blind fashion.  Eligibility included age 50 years or older (African American men) or 55 years or older (all other men), a prostate-specific antigen level of 4ng/mL or less, and a digital rectal examination not suspicious for prostate cancer.  Selenium or vitamin E, alone or in combination at the doses and formulations used, did not prevent prostate cancer in this population of relatively healthy men.  Study supplements were discontinued in October 2008 because of an absence of evidence of benefit from either supplement was demonstrated and there was no possibility of a benefit to the planned degree with additional follow-up.

Gann, Peter H.  Randomized trials of antioxidant supplementation for cancer prevention. Editorial. JAMA. doi:10.1001/jama.2008.863.

http://jama.ama-assn.org/cgi/content/full/2008.863v1?etoc

In the 1990’s, the Nutritional Prevention of Cancer trial reported a 65% reduction in prostate cancer incidence in men receiving selenium supplementation and the ATBC (alpha-Tocopherol, Beta Carotene) Cancer Prevention Trial had reported a 35% reduction in prostate cancer occurrence among men taking vitamin E supplements.  One decade later, results of two major randomized, double-blind trials designed after the previous trials’ positive findings, concluded that neither selenium nor vitamin E supplementation, alone or in combination, produced any reductions in prostate cancer or cancer of any type.

Kottke, TE, Faith, DA, Jordan, CO, Pronk, NP, Thomas, RJ, Capewell, S.  The Comparative Effectiveness of Heart Disease Prevention and Treatment Strategies. Am J Prev Med 2009;36(1): 82-8.  
http://www.ncbi.nlm.nih.gov/pubmed/19095166?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

This study uses modeling to predict the expected number of deaths (from any cause) that could be prevented or postponed if “perfect care” were delivered before (primary prevention) , between (secondary prevention), and at the time of acute heart disease events.  The study findings suggest that nearly one-third of all deaths (not just cardiovascular deaths) could be prevented or postponed by increasing population levels of physical activity.   In contrast, only 8% of all deaths can be prevented or postponed by ensuring that perfect care is delivered during the time of an acute cardiac event.  Policy makers can use this information to prioritize programs and resources to maximize impact at the population level.

Community Health

Etz, RS, Cohen, DJ, Woolf, SH, et al.  Bridging Primary Care Practices and Communities to Promote Healthy Behaviors. Am J Prev Med 2008;35(5S):S390-S397.

http://www.ajpm-online.net/article/S0749-3797(08)00673-9/abstract

This article is an analysis of eight projects that were designed to identify patients at risk for poor health behaviors, provide them with some form of counseling and refer them to community resources.  The paper addresses the emergent theme of "linking", or the work the teams did to forge connections between primary care practices and community resources.  The projects analyzed in the study demonstrate that primary care practices have the ability to develop linkages that would connect the patients with the community resources able to assist them with health behavior changes.  They discuss numerous roadblocks to successful "linking" and offer creative solutions for overcoming the roadblocks. An important take home message from the project related to the HealthierUS Veterans Initiative is that partnerships do not come naturally; they take strategy, effort and knowledge of the work of each group to collaborate successfully.

Veterans’ Health Education and Information

Carpenter, KM, Cohn, LG, Glynn, LH, Stoner, SA.  Brief Interventions for Tobacco Users: Using the Internet to Train Healthcare Providers. International Electronic Journal of Health Education, 2008; 11: 1-12. 
 http://www.aahperd.org/iejhe/2008/08_K_Carpenter.pdf

Motivational Interviewing is a prescribed way to interact with patients around issues of behavioral change. This study focused on clinicians who provide care to smokers, at the pre-contemplative stage of change (not thinking about change).  One hundred and fifty-two health care providers were randomly assigned to one of two groups:  (1)  those given training reading materials or (2) those who participated in the on-line tutorials.  Two interactive sessions were developed for the tutorial group.  While both groups improved their scores from pre testing to post testing, the group receiving the tutorial sessions scored significantly higher on the post test than the reading materials only group. This study supports the growing body of knowledge that well designed- interactive e-learning can be a helpful tool in promoting improved communication skills among health care professionals.

Weight Management/ MOVE!

Wang, Y, Beydoun, MA, Liang, L, Caballero, B, & Kumanyika, SK. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic.  Obesity, 2008;13:2323-2330. 
http://www.nature.com/oby/journal/v16/n10/full/oby2008351a.html 

Public health and economic researchers from Johns Hopkins, the Agency for Healthcare Research and Quality, and the University of Pennsylvania utilized data collected between the 1970s and 2004 for the National Health and Nutrition Examination Study (NHANES) to project weight trends over the next several decades. Assuming that weight trends for the past three decades are similar in the future, they predict that by 2030, 86.3% of adults will be overweight or obese and that 51% will be obese.  They note that particular subgroups of the US population appear to be progressing more rapidly toward obesity including black women and Mexican-American men.  They predict that, by 2048, all American adults would become overweight or obese.  Total healthcare attributable to obesity/overweight would double every decade to 860.7-959.9 billion US dollars by 2030, accounting for 16-18% of total US healthcare costs.  The authors note that the Health People 2010 objectives are unlikely to be met and that broad, comprehensive approaches are required to address the obesity epidemic.  The authors reflect on the literature showing that the obesity epidemic results from “complex factors operating interactively at multiple levels (e.g., individual, community/school, society, and international)” that has been primarily addressed, to date, through a focus on changing individual behaviors.  They point out that creative initiatives are required to effect environmental changes and that this will require strong and sustained collaborations among “the public and private sectors, educators, food producers, urban planners, transportation experts, parents, and the general public.”  These relatively dire predictions suggest that we should look beyond individual patient care if we wish to alter this population trend.

Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G.  Financial incentive-based approached for weight loss:  a randomized trial.  JAMA.  2008 Dec 10;300(22):2631-7.
http://jama.ama-assn.org/cgi/content/abstract/300/22/2631 

This study was a controlled trial in which obese subjects were randomized to one of two types of financial incentives for weight loss (lottery or deposit contract) or a control group.  Both incentive groups lost significantly more weight at 16 weeks as compared to the control group.  However, differences in weight among the treatment and control groups at 7 months (after the incentive interventions ceased) were not statistically different.  Financial incentives are effective for promoting short-term weight loss, but more research is needed to understand how to best use incentives for long-term weight loss or weight loss maintenance.

Journal Update Archive

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