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Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project.

https://arctichealth.org/en/permalink/ahliterature127856
Source
Lancet Oncol. 2012 Mar;13(3):285-91
Publication Type
Article
Date
Mar-2012
Author
Lucy Gilbert
Olga Basso
John Sampalis
Igor Karp
Claudia Martins
Jing Feng
Sabrina Piedimonte
Louise Quintal
Agnihotram V Ramanakumar
Janet Takefman
Maria S Grigorie
Giovanni Artho
Srinivasan Krishnamurthy
Author Affiliation
Gynecologic Oncology Unit, McGill University Health Centre, Montreal, QC, Canada. lucy.gilbert@mcgill.ca
Source
Lancet Oncol. 2012 Mar;13(3):285-91
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Aged
Algorithms
CA-125 Antigen - blood
Chi-Square Distribution
Early Detection of Cancer
Feasibility Studies
Female
Humans
Logistic Models
Mass Screening - methods
Middle Aged
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Staging
Ovarian Neoplasms - diagnosis - epidemiology - immunology - ultrasonography
Pilot Projects
Predictive value of tests
Prevalence
Prognosis
Prospective Studies
Quebec - epidemiology
Tumor Burden
Abstract
Around 90% of deaths from ovarian cancer are due to high-grade serous cancer (HGSC), which is frequently diagnosed at an advanced stage. Several cancer organisations made a joint recommendation that all women with specified symptoms of ovarian cancer should be tested with the aim of making an early diagnosis. In the Diagnosing Ovarian Cancer Early (DOvE) study we investigated whether open-access assessment would increase the rate of early-stage diagnosis.
Between May 1, 2008, and April 30, 2011, we enrolled women who were aged 50 years or older and who had symptoms of ovarian cancer. They were offered diagnostic testing with cancer antigen (CA-125) blood test and transvaginal ultrasonography (TVUS) at a central and a satellite open-access centre in Montreal, QC, Canada. We compared demographic characteristics of DOvE patients with those of women in the same age-group in the general population of the area, and compared indicators of disease burden with those in patients with ovarian cancer referred through the usual route to our gynaecological oncology clinic (clinic patients).
Among 1455 women assessed, 402 (27·6%) were in the highest-risk age group (= 65 years). 239 (16·4%) of 1455 required additional investigations. 22 gynaecological cancers were diagnosed, 11 (50%) of which were invasive ovarian cancers, including nine HGSC. The prevalence of invasive ovarian cancer, therefore, was one per 132 women (0·76%), which is ten times higher than that reported in screening studies. DOvE patients were significantly younger, more educated, and more frequently English speakers than were women in the general population. They also presented with less tumour burden than did the 75 clinic patients (median CA-125 concentration 72 U/mL, 95% CI 12-1190 vs 888 U/mL, 440-1936; p=0·010); Eight (73%) tumours were completely resectable in DOvE patients, compared with 33 (44%) in clinic patients (p=0·075). Seven (78%) of the HGSC in the DOvE group originated outside the ovaries and five were associated with only slightly raised CA-125 concentrations and minimal or no ovarian abnormalities on TVUS.
The proportion of HGSC that originated outside the ovaries in this study suggests that early diagnosis programmes should aim to identify low-volume disease rather than early-stage disease, and that diagnostic approaches should be modified accordingly. Although testing symptomatic women may result in earlier diagnosis of invasive ovarian cancer, large-scale implementation of this approach is premature.
Canadian Institutes of Health Research, Montreal General Hospital Foundation, Royal Victoria Hospital Foundation, Cedar's Cancer Institute, and La Fondation du Cancer Monique Malenfant-Pinizzotto.
Notes
Comment In: Lancet Oncol. 2012 Apr;13(4):e138-9; author reply e139-4022469121
Comment In: Lancet Oncol. 2012 Apr;13(4):e137; author reply e139-4022469119
Comment In: Lancet Oncol. 2012 Mar;13(3):223-422257525
Comment In: Lancet Oncol. 2012 Apr;13(4):e137-8; author reply e139-4022469120
Comment In: Nat Rev Clin Oncol. 2012 Mar;9(3):12822310738
PubMed ID
22257524 View in PubMed
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Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents.

https://arctichealth.org/en/permalink/ahliterature158432
Source
Nicotine Tob Res. 2008 Mar;10(3):525-32
Publication Type
Article
Date
Mar-2008
Author
Jennifer O'Loughlin
Marie Lambert
Igor Karp
Jennifer McGrath
Katherine Gray-Donald
Tracie A Barnett
Edgard E Delvin
Emile Levy
Gilles Paradis
Author Affiliation
Department of Social and Preventive Medicine, University of Montréal, CRCHUM, Montréal. jennifer.oloughlin@umontreal.ca
Source
Nicotine Tob Res. 2008 Mar;10(3):525-32
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior
Attitude to Health
C-Reactive Protein - analysis
Confidence Intervals
Cross-Sectional Studies
Female
Humans
Logistic Models
Male
Odds Ratio
Quebec - epidemiology
Questionnaires
Self Concept
Smoking - blood
Abstract
Although related to inflammatory markers in adults, little is known about the association between cigarette smoking and C-reactive protein (CRP) in adolescent smokers. We examined the association between high-sensitivity CRP (hs-CRP) concentrations and smoking in youth. We used data from a cross-sectional, province-wide survey of a representative sample of youth conducted in Quebec, Canada, in 1999. Data were collected in self-report questionnaires completed by participants and their parents. Participants provided a fasting blood sample, and anthropometric measures were undertaken by trained technicians. The present analysis pertains to 1,501 adolescents aged 13 and 16 years who completed questionnaires and for whom blood samples were available. The independent association between a six-category indicator of smoking status and elevated hs-CRP, defined as a value at least in the 90th percentile of the age- and sex-specific CRP distribution, was assessed in multiple logistic regression analyses controlling for potential confounders. Relative to never-smokers, the odds ratios (95% confidence intervals) for puffers (i.e., never smoked a whole cigarette), those who smoked but not in the past month, light past-month smokers, moderate past-month smokers, and heavy past-month smokers were 1.04 (0.55-1.98), 1.76 (1.06-2.94), 1.39 (0.70-2.76), 2.07 (0.96-4.42), and 2.40 (1.18-4.88), respectively. Our data suggest a positive association between smoking status and elevated CRP in adolescents, and in particular among heavier past-month smokers. Damage related to cigarette smoking may begin soon after tobacco use initiation, reinforcing the preventive message that no level of smoking is safe in youth.
PubMed ID
18324572 View in PubMed
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Cardiac procedures after an acute myocardial infarction across nine Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature180468
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Publication Type
Article
Date
Apr-2004
Author
Louise Pilote
Patrick Merrett
Igor Karp
David Alter
Peter C Austin
Jafna Cox
Helen Johansen
William Ghali
Jack V Tu
Author Affiliation
McGill University Health Centre at the Montreal General Hospital, Montreal, Quebec, Canada. louise.pilote@mcgill.ca
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Angioplasty, Balloon, Coronary - utilization
Canada - epidemiology
Coronary Artery Bypass - utilization
Female
Health Services Needs and Demand - statistics & numerical data
Humans
Longitudinal Studies
Male
Medical Records
Middle Aged
Myocardial Infarction - epidemiology - etiology - therapy
Retrospective Studies
Sex Distribution
Waiting Lists
Abstract
Geographical variations in the use of invasive cardiac procedures have been documented. It remains unclear to what extent these variations exist across the Canadian provinces.
To describe variation in the use of invasive cardiac procedures and waiting times for these procedures across nine Canadian provinces.
Using longitudinal, de-identified patient data from the Canadian Institute for Health Information, records of patients who had suffered an acute myocardial infarction (AMI) in each of nine Canadian provinces between 1997/1998 and 1999/2000 were selected. Rates and median waiting times for percutaneous coronary intervention and coronary artery bypass graft surgery were calculated by age, sex and health region.
There was a large variation in the use of and waiting times for invasive cardiac procedures across the Canadian provinces studied. In general, cardiac procedure rates in Western provinces were higher than in Eastern provinces, most notably higher than in the Maritime provinces and Ontario. In addition to interprovincial variation, there was also significant regional variation in the rates of revascularization and waiting times. Rates of percutaneous coronary intervention increased over the study period, whereas rates of bypass surgery remained relatively stable.
Significant variation in the use of cardiac procedures after AMI exists across Canada and this April represent potential inequalities in the treatment of AMI across Canada.
PubMed ID
15100750 View in PubMed
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Comparing the validity of different sources of information on emergency department visits: a latent class analysis.

https://arctichealth.org/en/permalink/ahliterature176075
Source
Med Care. 2005 Mar;43(3):266-75
Publication Type
Article
Date
Mar-2005
Author
Nandini Dendukuri
Jane McCusker
François Bellavance
Sylvie Cardin
Josée Verdon
Igor Karp
Eric Belzile
Author Affiliation
Technology Assessment Unit, McGill University Health Center, Montreal, Canada. nandini.dendukuri@mcgill.ca
Source
Med Care. 2005 Mar;43(3):266-75
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Data Collection - methods
Emergency Service, Hospital - utilization
Female
Frail Elderly - statistics & numerical data
Hospitals, University - utilization
Humans
Insurance Claim Review
Male
Medical Records
Quebec - epidemiology
Research Design
Self Disclosure
Utilization Review - statistics & numerical data
Abstract
Emergency department (ED) use in Quebec may be measured from varied sources, eg, patient's self-reports, hospital medical charts, and provincial health insurance claims databases. Determining the relative validity of each source is complicated because none is a gold standard.
We sought to compare the validity of different measures of ED use without arbitrarily assuming one is perfect.
Data were obtained from a nursing liaison intervention study for frail seniors visiting EDs at 4 university-affiliated hospitals in Montreal.
The number of ED visits during 2 consecutive follow-up periods of 1 and 4 months after baseline was obtained from patient interviews, from medical charts of participating hospitals, and from the provincial health insurance claims database.
Latent class analysis was used to estimate the validity of each source. The impact of the following covariates on validity was evaluated: hospital visited, patient's demographic/clinical characteristics, risk of functional decline, nursing liaison intervention, duration of recall, previous ED use, and previous hospitalization.
The patient's self-report was found to be the least accurate (sensitivity: 70%, specificity: 88%). Claims databases had the greatest validity, especially after defining claims made on consecutive days as part of the same ED visit (sensitivity: 98%, specificity: 98%). The validity of the medical chart was intermediate. Lower sensitivity (or under-reporting) on the self-report appeared to be associated with higher age, low comorbidity and shorter length of recall.
The claims database is the most valid method of measuring ED use among seniors in Quebec compared with hospital medical charts and patient-reported use.
PubMed ID
15725983 View in PubMed
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Determinants of first puff and daily cigarette smoking in adolescents.

https://arctichealth.org/en/permalink/ahliterature149471
Source
Am J Epidemiol. 2009 Sep 1;170(5):585-97
Publication Type
Article
Date
Sep-1-2009
Author
Jennifer O'Loughlin
Igor Karp
Theodoro Koulis
Gilles Paradis
Joseph Difranza
Author Affiliation
Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, 3875 Saint-Urbain, Montreal, Quebec H2W1V1, Canada. jennifer.oloughlin@umontreal.ca
Source
Am J Epidemiol. 2009 Sep 1;170(5):585-97
Date
Sep-1-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior - psychology
Child
Cohort Studies
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Life Style
Male
Motivation
Quebec
Risk factors
Smoking - psychology
Social Environment
Socioeconomic Factors
Abstract
Few prospective studies of smoking initiation have investigated a wide range of time-varying and invariant predictor variables at the individual and contextual levels concurrently. In this study (1999-2005), 877 Canadian students (mean age = 12.7 years) who had never smoked at baseline completed self-report questionnaires on cigarette smoking and 32 predictor variables in 20 survey cycles during secondary school. Height and weight were measured in survey cycles 1, 12, and 19. School administrators completed questionnaires on school tobacco control policies/activities, and trained observers collected data on access to tobacco products in commercial establishments near schools. Younger age, single-parent family status, smoking by parents, siblings, friends, and school staff, stress, impulsivity, lower self-esteem, feeling a need to smoke, not doing well at school, susceptibility to tobacco advertising, alcohol use, use of other tobacco products, and attending a smoking-tolerant school were independent determinants of smoking initiation. Independent determinants of daily smoking onset among initiators of nondaily smoking included smoking by siblings and friends, feeling a need to smoke, susceptibility to tobacco advertising, use of other tobacco products, and self-perceived mental and physical addiction. Adolescent tobacco control programs should address multiple individual and contextual-level risk factors. Strategies that address nicotine dependence symptoms are also needed for adolescents who have already initiated smoking.
PubMed ID
19635735 View in PubMed
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Estimating the proportion of cases of lung cancer legally attributable to smoking: a novel approach for class actions against the tobacco industry.

https://arctichealth.org/en/permalink/ahliterature256733
Source
Am J Public Health. 2014 Aug;104(8):e60-6
Publication Type
Article
Date
Aug-2014
Author
Jack Siemiatycki
Igor Karp
Marie-Pierre Sylvestre
Javier Pintos
Author Affiliation
Jack Siemiatycki, Igor Karp, and Marie-Pierre Sylvestre are with the Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, and Health Risks Division, Centre de Recherche du CHUM, University of Montreal. Javier Pintos is with Health Risks Division, Centre de Recherche du CHUM, University of Montreal.
Source
Am J Public Health. 2014 Aug;104(8):e60-6
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Female
Humans
Liability, Legal
Linear Models
Lung Neoplasms - epidemiology - etiology
Male
Middle Aged
Models, Statistical
Quebec - epidemiology
Smoking - adverse effects - epidemiology
Tobacco Industry - legislation & jurisprudence
Abstract
The plaintiffs' lawyers for a class action suit, which was launched in Quebec on behalf of all patients with lung cancer whose disease was caused by cigarette smoking, asked us to estimate what proportion of lung cancer cases in Quebec, if they hypothetically could be individually evaluated, would satisfy the criterion that it is "more likely than not" that smoking caused the disease.
The novel methodology we developed is based on the dose-response relationship between smoking and lung cancer, for which we use the pack-years as a measure of smoking, and the distribution of pack-years of smoking among cases.
We estimated that the amount of smoking required to satisfy the "more likely than not" criterion is between 3 and 11 pack-years. More than 90% of the Quebec cases satisfied even the most conservative of these thresholds.
More than 90% of cases of lung cancer in Quebec are legally attributable to smoking. The methodology enhances the ability to conduct class action suits against the tobacco industry.
PubMed ID
24922168 View in PubMed
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Gender differences among general practitioners in smoking cessation counseling practices.

https://arctichealth.org/en/permalink/ahliterature162456
Source
Prev Med. 2007 Aug-Sep;45(2-3):208-14
Publication Type
Article
Author
Jennifer O'Loughlin
Héla Makni
Michèle Tremblay
Igor Karp
Author Affiliation
CR-CHUM and Department of Social and Preventive Medicine, University of Montreal, Montréal, Québec, Canada. jennifer.oloughlin@umontreal.ca
Source
Prev Med. 2007 Aug-Sep;45(2-3):208-14
Language
English
Publication Type
Article
Keywords
Adult
Counseling
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Physicians, Family
Quebec
Sex Factors
Smoking Cessation - methods
Abstract
To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender.
Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000.
Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p
PubMed ID
17631386 View in PubMed
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GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary SYndrome).

https://arctichealth.org/en/permalink/ahliterature124254
Source
Am Heart J. 2012 May;163(5):741-746.e2
Publication Type
Article
Date
May-2012
Author
Louise Pilote
Igor Karp
Author Affiliation
Division of General Internal Medicine, McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada. louise.pilote@mcgill.ca
Source
Am Heart J. 2012 May;163(5):741-746.e2
Date
May-2012
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - epidemiology - etiology - physiopathology
Adolescent
Adult
Age Distribution
Age of Onset
Cardiovascular Diseases - epidemiology - etiology - physiopathology
Cross-Sectional Studies
Environment
Evidence-Based Medicine
Female
Health Behavior
Hospitalization - statistics & numerical data
Humans
Incidence
Life Style
Logistic Models
Male
Middle Aged
Multivariate Analysis
Prognosis
Quebec - epidemiology
Questionnaires
Risk factors
Severity of Illness Index
Sex Distribution
Socioeconomic Factors
Young Adult
Abstract
Previous research has not adequately addressed the topic of sex and gender differences in occurrence of premature acute coronary syndrome (ACS). This study will investigate the clinical presentation, prognosis, and health care use in young men and women with ACS.
We have set up a prospective, multicenter study of 1,576 patients aged 18-55 years and admitted to hospital with ACS. At baseline, questionnaires will be administered, and anthropometric and biological measurements will be performed. The patients will be observed for at least 1 year, with additional questionnaires being administered at 1, 6, and 12 months post-discharge. A review of medical records will be performed both at baseline and during follow-up.
This study will provide important evidence on the roles that a wide range of behavioral, environmental, and biological factors play in premature ACS and will help determine to what extent these roles depend on the individual's sex and gender. Ultimately, the knowledge derived from this study may facilitate accurate diagnosis and effective prevention and management of ACS in young women and men.
PubMed ID
22607849 View in PubMed
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Impact of restrictive prescription plans on heart failure medication use.

https://arctichealth.org/en/permalink/ahliterature146515
Source
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):484-90
Publication Type
Article
Date
Sep-2009
Author
George Thanassoulis
Igor Karp
Karin Humphries
Jack V Tu
Mark J Eisenberg
Louise Pilote
Author Affiliation
Divisions of Clinical Epidemiology, Cardiology, and Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Source
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):484-90
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - economics - therapeutic use
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers - economics - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - economics - therapeutic use
Antihypertensive Agents - economics - therapeutic use
Canada - epidemiology
Cardiovascular Agents - economics - therapeutic use
Cohort Studies
Comorbidity
Diuretics - economics - therapeutic use
Drug Costs
Drug Prescriptions - economics - statistics & numerical data
Female
Health Policy
Heart Failure - drug therapy - economics - epidemiology
Humans
Insurance Coverage - economics
Male
Medication Adherence - statistics & numerical data
Multivariate Analysis
Abstract
Prescription plans frequently use restrictive strategies to control drug expenditures. Increased restrictions may reduce access to evidence-based therapy among patients with chronic disease. We sought to evaluate the impact of increased restrictions on medication use among heart failure (HF) patients.
We conducted a population-based cohort study of administrative data from 3 Canadian provinces. During 1998 to 2001, Quebec (QC) had a minimally restrictive plan, whereas Ontario (ON) and British Columbia (BC) had more restrictive prescription plans. We evaluated drug use at 30 days of discharge stratified by prescription plan. Provincial rates of filled prescriptions for HF drugs in QC, ON, and BC were 62%, 58%, and 47% for angiotensin-converting enzyme inhibitors; 34%, 22%, and 16% for beta-blockers; 9%, 5%, and 3% for angiotensin receptor blockers; and 79%, 76%, and 62% for loop diuretics, respectively. In multivariate analyses, patients residing in provinces with restrictive plans were less likely to be prescribed drugs that were restricted, such as beta-blockers (odds ratio, 0.53; 95% CI, 0.46 to 0.60; 0.36, 0.29 to 0.44, for ON and BC, respectively) and angiotensin receptor blockers (0.50, 0.45 to 0.56; 0.38, 0.32 to 0.46, for ON and BC, respectively), than drugs with no restrictions, such as loop diuretics (0.81, 0.74 to 0.88; 0.40, 0.36 to 0.45, for ON and BC, respectively) and angiotensin-converting enzyme inhibitors (0.80, 0.75 to 0.86; 0.47, 0.43 to 0.52, for ON and BC, respectively).
Among HF patients, residing in a province with a more restrictive prescription plan may be associated with lower use of restricted HF medications over and above the expected regional differences in HF drug use across provinces.
Notes
Comment In: Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):402-320031868
PubMed ID
20031881 View in PubMed
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Incidence and determinants of cigarette smoking initiation in young adults.

https://arctichealth.org/en/permalink/ahliterature107603
Source
J Adolesc Health. 2014 Jan;54(1):26-32.e4
Publication Type
Article
Date
Jan-2014
Author
Jennifer L O'Loughlin
Erika N Dugas
Erin K O'Loughlin
Igor Karp
Marie-Pierre Sylvestre
Author Affiliation
Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, University of Montréal, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montreal, Quebec, Canada. Electronic address: jennifer.oloughlin@umontreal.ca.
Source
J Adolesc Health. 2014 Jan;54(1):26-32.e4
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Child
Female
Humans
Incidence
Male
Prospective Studies
Quebec - epidemiology
Questionnaires
Risk factors
Smoking - epidemiology
Young Adult
Abstract
To describe the incidence and identify predictors of smoking initiation in young adults.
Data were collected in self-report questionnaires in 22 cycles over 13 years in a prospective cohort investigation of 1,293 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Participants were 12.7 years of age on average at cohort inception and 24.0 years of age in cycle 22. Independent predictors of smoking initiation in young adulthood (post-high school) were identified in multivariable logistic regression analysis using generalized estimating equations.
Of 1,293 participants, 75% initiated smoking by cycle 22. Of these, 44%, 43%, and 14% initiated before high school, during high school, and in the 6 years after high school, respectively. The incidence density rate of initiation was .33, .13, .14, .11, and .12 initiation events per person-year in grade 7, 8, 9, 10, and 11, respectively, and .05 post-high school. Independent predictors of smoking initiation in young adults included alcohol use, higher impulsivity, and poor academic performance.
A total of 14% of smokers who initiated smoking before age 24 years did so after high school. The predictors of initiation in young adults may provide direction for relevant preventive interventions.
PubMed ID
23992758 View in PubMed
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18 records – page 1 of 2.