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Aims and Background: Increasing smoke-free homes is an important public health goal, but only few interventions have yielded positive results. The aim of the "Don't smoke in our home" trial was to evaluate a counseling intervention focused on promoting totally smoke-free homes and cars (TSFHC) delivered to women with children resident in four Tuscan towns., Methods and Study Design: We used a two-group randomized controlled trial design. Participants were asked about their smoking habits and about restrictions on smoking in their homes and cars. All women received a self-help booklet promoting TSFHC, and 110 women randomized to the intervention also attended brief counseling on second-hand smoke exposure protection and received three gifts to remember the commitment to TSFHC. Follow-up was conducted by phone after four months., Results: We recruited 218 women, 64 of whom had a university degree and 131 of whom were smokers; 62% reported smoking indoors and 58% in cars. Before the intervention, nonsmokers were more likely to report totally smoke-free homes (TSFH, 52%) and cars (TSFC, 53%) than smokers (26% and 17% respectively; P <0.001). Participants of the experimental arm had similar odds as controls of having implemented TSFH after the intervention, and nonsignificantly increased odds of having introduced TSFC (odds ratio [OR] 1.47; 95% confidence interval [CI] 0.69-3.11), particularly among smokers (OR 2.24, 95%CI 0.69-7.26). All participants independently of the study arm recorded significant increases of 12 and 15 percentage points in TSFH and TSFC, respectively. Few smokers quit smoking (7%), stopped smoking indoors (5%), and stopped smoking in cars (7%), with no differences between the intervention and control groups., Conclusions: Adding brief counseling to written materials did not significantly increase TSFHC. However, delivering written materials only may produce modest but noteworthy TSFHC increases at the population level, even though the participants in the study did not represent a population-based sample, given the high proportion of highly educated women. Further studies are required to confirm these results.

Aims and Background: In the last decades in Italy, a smaller decrease in smoking among women than in men has been observed and a younger age at start in young women. Nevertheless, gender-specific strategies for smoking cessation have rarely been developed, except those for pregnant women. A study was conducted to evaluate the feasibility of carrying out an intervention of primary prevention by counseling for smoking cessation the female smokers attending cervical cancer screening programs in Florence, Italy., Methods: All female smokers attending the services for cervical cancer prevention at the Cancer Prevention and Research Institute in Florence, Italy, between March 2004 and January 2005, who volunteered to participate in the study, received a brief motivational stage-matched counseling for smoking cessation and a face to face interview at enrollment and after 6 and 12 months. The counseling was evaluated by comparing quit rates, changes in smoking intensity, and motivation to quit at the first and second follow-up periods to the same data collected at enrollment. Multivariate logistic regression analysis was performed to estimate the influence on smoking cessation of demographic characteristics, smoking habit and attitude to quit., Results: 177 women participated in the study. After 1 year, a quit rate of 12.4% (95% CI, 7.5-17.3) was observed. Among those who never quit, there was a 39.3% reduction in the average daily cigarette consumption and a 51.9% reduction in smoking the first cigarette of the day immediately on awaking or just after breakfast., Conclusions: The results and the opportunity to contact a large number of female smokers on the occasion of cervical cancer screening suggest the importance to evaluate the efficacy of the intervention of primary prevention in this health setting.

Aims and Background: For the first time in 2006, cancer became the main cause of death in men in Italy, exceeding cardiovascular disease. The aim of the study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany or in some of its 12 subregional areas and whether there was a geographical trend., Methods: Age-standardized mortality rates from the Tuscan Regional Mortality Registry, 1987-2008, were calculated for neoplasms, cardiovascular diseases, and respiratory diseases, considering the whole region and its 12 areas. Joinpoint analyses were carried out to study temporal trend., Results: Up to 2008, the number of male deaths for neoplasms (6786) in Tuscany did not exceed deaths from cardiovascular disease (7065). Instead, overtaking occurred in some subregional areas from 2004 onwards. When we compared age-standardized mortality rates, cancer became the first cause of death in Tuscany from 2004 onwards (age-standardized mortality rates for cancer 236.5 per 100,000; for cardiovascular disease 227.8 per 100,000). Age-standardized mortality rates for cardiovascular disease recorded an annual 2.4% decrease until 1998, then a 3.5% decrease. Age-standardized mortality rates for all cancers recorded an annual 1.6% decrease in the whole period., Conclusions: Our study confirmed a geographical trend in cancer overtaking as the main cause of death in males: from the more urbanized areas in northern Tuscany, where the phenomenon occurred earlier, to the southern part.

Aims and Background: Environmental pollution originating in sewage and industrial plants can be associated with lung cancer risk, as ecological and case-control studies have indicated. In the present study, the association between lung cancer occurrence and residence near a sewage plant in Prato (Italy) was investigated. A previous geographic study in the same area had shown an increasing trend of lung cancer mortality and incidence with propinquity to the plant., Methods: A case-control study was carried out in the male population of Prato. Incident cases in the period 1987-1997 were identified from the Tuscan Cancer Registry (no. 918). Controls were randomly extracted from the Registry Office of the Municipality of Prato (no. 1852). For all subjects, the residential history was reconstructed. A weighted average distance from the plant was computed and used as a proxy variable of exposure. Two analyses were performed: on the whole data set and on a subset of subjects for whom information on tobacco exposure and education was obtained through a postal questionnaire (response rate, 41.1%). Logistic regression models were applied to estimate odds ratios and 95% CI., Results: Both analyses showed a significantly elevated lung cancer risk for subjects living within 1.5 km (ORwhole= 1.56, 1.06-2.28; ORsubset= 2.28, 1.06-4.86) and suggested a risk increase with a decrease of weighted average distance from the plant., Conclusions: The findings highlight a possible role, in lung cancer occurrence, for environmental pollution spread from the plant. Due to drawbacks of the study, further analyses are needed to evidence a noncontroversial etiological conclusion. When environmental data are not available, results of epidemiological studies using residential histories may be useful in preventive policies regarding point source emissions.

Aims and Background: In Tuscany, lung cancer mortality in men has shown a decreasing geographical trend over the last 3 decades from the most industrialized north-western coastal areas (Massa-Carrara, Viareggio) to the south-eastern areas (Arezzo, Siena), following the path of the development of industrial activities. The aim of the study was to evaluate lung cancer mortality in males by birth cohort in order to verify whether there was also a decreasing birth cohort trend in male lung cancer mortality rates between north-western and south-eastern Tuscan areas., Methods: Lung cancer deaths that occurred in men resident in Tuscany, 1971-2006, were analyzed by birth cohort, age group and local health authority area., Results: Rates in men >65 years were significantly higher in Viareggio and Massa-Carrara than in the south-eastern areas for all generations, in particular for men born in 1896-1926. Rates for men aged 55-64 years were higher in Massa-Carrara and Viareggio than in south-eastern areas for men born before 1926, whereas for younger generations the rates leveled off. For men aged 45-54 years, rates were similar in all areas only for younger generations (men born around 1951 and 1956), whereas for men aged 35-44 years, rates were similar in all areas for all generations considered., Conclusions: The higher lung cancer mortality rates in men aged >65 years and born in 1896-1926 in the north-western areas than in those born in the south-eastern areas may indicate that the tobacco epidemic spread earlier in the north-western areas of Tuscany, following the path of industrialization. However, the higher mortality rates in north-western than in south-eastern areas are at least in part attributable to the high occupational risks for lung cancer experienced by workers in these areas during the first half of 20th century.

Unlabelled: AIMS, BACKGROUND, AND METHODS: In Tuscany, Italy, gastric cancer mortality has been decreasing since 1950, although with relevant geographical variability across the region. In Eastern Tuscan areas close to the mountains (high risk areas), gastric cancer mortality has been and is still significantly higher than that recorded in Western coastal areas and in the city of Florence (low risk areas). High-risk areas also showed higher Helicobacter pylori seroprevalence. Aim of this paper is to study gastric cancer mortality trends in high and low-risk areas, during the period 1971-2004, using age-period-cohort models., Results: In high-risk areas, gastric cancer mortality rates declined from 61.4 per 100,000 in 1971-74 to 19.8 in 2000-2004 and in low-risk areas from 34.9 to 9.8. Mortality decline in high-risk areas was mainly attributable to a birth cohort effect, whereas in low-risk areas it was due either to a birth cohort effect or a period effect. In low- and high-risk areas, birth-cohort risks of dying decreased over subsequent generations, except for the birth cohorts born around the second world war., Conclusions: Gastric cancer mortality in areas with higher H. pylori seroprevalence in Tuscany (high-risk areas) showed a predominant decline by birth cohort, in particular for younger generations, possibly due to the decrease of the infection for improvement of living conditions.

Aims and Background: The aim of the study was to evaluate mortality lung cancer trends, as an indicator of female smoking trends, in women resident in different urbanization areas., Methods and Study Design: Data on the 5782 female lung cancer deaths that occurred in Tuscany, Italy, during the period 1987-2002 were analyzed, using age-period-cohort models by areas at different urbanization levels. Trends were examined with a log-linear regression model, calculating the yearly estimated percent change. Empirical bayesian estimators of the ratios between observed and expected deaths by municipality were calculated for the most recent period and mapped., Results: The age-adjusted lung cancer mortality rates increased from 1987 to 2002: estimated percentage change values were equal to 24.5% in the urban areas (P < 0.001) and 17.2% in the rural areas (P = 0.023). The age-period-cohort model analyses showed a statistically significant drift and non-linear cohort effects. The higher risk was observed for the birth cohort of women born around 1955 (RR, 5.25; 95% CI, 2.83-9.72). In the rural areas, no significant effects were observed, and the age model showed the best fit. In recent years, the risk appeared concentrated in 9 Tuscan municipalities, accounting more than 35% of the female urban population., Conclusions: The observed significant cohort effect in the age-period-cohort analyses for the urban areas reflects the social impact of living in these areas to induce smoking-related disease like lung cancer in women. The risk appeared particularly relevant in more recent and urbanized generations (women born around 1955), thereby suggesting urgent effective campaigns against smoking, gender dedicated, especially in urban areas.

Aims and Background: General practitioners (GPs) are in a key position to intervene with patients who smoke. The cornerstone of a smoking cessation strategy should be the routine provision of brief advice and follow-up in primary care. However, it seems GPs do not often take action against smoking, at least in Italy as shown by previous reports. The survey was planned, in the context of the "GPs Empowerment Project", a collaborative project involving Denmark, France, Greece, Italy and Portugal, under the ENSP contract with the European Commission (Health & Consumer protection Directorate-General), to evaluate the general attitude, knowledge and behavior of GPs regarding smoking cessation methods., Methods: A total of 729 family doctors, 409 in Northern and 320 in Southern Italy, were interviewed by phone in the period July-October 2000 regarding their personal smoking habits and their approach with patients on the topic. Prevalence rates were computed using the Epi INFO 6.0 software and were presented as the unadjusted percentage prevalence., Results: The percentage of current smokers among GPs included in the survey was 28.3%, with a higher prevalence in the south (33.3%). Most of the GPs believe that it is their duty to give information about smoking cessation (96.8%) and consider giving information about smoking cessation to their patients an important intervention (98.5%), but only about 49% think their patients will accept their advice. Most GPs (87.3%) declared having discussed about tobacco use with their patients during the month preceding the interview, and 83.5% would like to be trained on smoking cessation strategies., Conclusions: The results show that, in order to implement primary prevention in clinical practice in Italy, it appears essential to reduce the number of GPs who smoke and to improve GP training on smoking cessation procedures.