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Nicotine replacement therapies (NRT) have been available without a prescription in the United States since 1996. Given that nicotine, at least as it is delivered through tobacco products, is addictive, we examined whether NRT was being used by individuals who have never smoked cigarettes. Adults (n=18,986) and adolescents (n=9187) who participated in the in-home survey and physical examination components of the 1999-2006 National Health and Nutrition Examination Surveys were assessed for cigarette smoking status, other tobacco use or exposure, and use of NRT. Among the 8415 adults (ages 20 and older) who reported never having smoked 100 cigarettes and who provided a blood sample during their physical exam, 3 (0.08%; 95% CI=0.02-0.28%) reported using NRT within the 5 days prior to being examined. Among the 5510 adolescents (aged 12-19 years) who reported never smoking and who provided a blood sample, 5 (0.12%; 95% CI=0.04%-0.36%) reported using NRT. Analyses of cotinine (a metabolite of nicotine) from their blood samples, along with analysis of their other survey responses regarding additional nicotine exposures suggest that it is unlikely that any of the adults were never smokers using NRT and perhaps 2 adolescents may have been never smokers who used NRT. Based on these assessments, the re-estimated prevalence of NRT use by never smokers would be 0% among adults and 0.05% (95% CI=0.01-0.27%) among adolescents. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the difference in tobacco use between adolescents who participate in organized sports and those who do not. METHODS: Using a cross-sectional study design, this study uses data from a nationally representative sample of adolescents enrolled in public high schools in the United States. RESULTS: Those participating in organized sports were 25% less likely to be current cigarette smokers. However, smokeless tobacco use was found to be associated with participation in organized sports. CONCLUSIONS: Given the large proportion of students involved in organized sports, intervening through this venue to address tobacco use has the potential to reach significant numbers of adolescents. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand changes in cigarette-brand choice by adolescents in the context of demographic differences and advertising. METHODS: Data from 3 nationally representative cross-sectional surveys of adolescents were analyzed. RESULTS: Marlboro, Camel, and Newport brand cigarettes accounted for over 80% of the cigarettes usually bought by adolescents in 1989, 1993, and 1996. Between 1989 and 1996, Marlboro and Camel market shares changed little, whereas preference for Newport doubled among white and Hispanic adolescents. CONCLUSIONS: Brand preference among adolescents has been steadily concentrated among 3 brands. More attention may need to be focused on mentholated brands given the increase in Newport's market share. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine the association between demographic and smoking behavior variables and the likelihood of acquiring cigarettes through noncommercial sources. The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes among Teenagers and Young Adults was the data source in this analysis. Respondents were high school students (grades 9 through 12) ages 13 to 19 years. The sample sizes, respondent selection procedures, and weighting procedures were designed to develop national estimates of adolescent smoking behaviors and attitudes. The questionnaire, modeled on previous surveys and input from leading tobacco control experts, was self-administered. Logistic regression was used to model the independent effects of each variable on the outcome while controlling for the influence of all other variables in the model. An inverse relationship was found between age and the likelihood of acquiring cigarettes through noncommercial sources. Females were 58% more likely to acquire cigarettes through noncommercial sources than were males. There were no differences among adolescents of different racial/ethnic groups in acquisition through noncommercial sources. Those who believed that cigarettes were difficult to acquire were more likely to obtain cigarettes by noncommercial means. Although point-of-sale restrictions have been a focal point of tobacco control legislation, these data suggest that younger smokers and those who view commercial purchase to be difficult are not using commercial sources. Therefore, more comprehensive approaches to limiting access may be required to address all sources of adolescents' acquisition. The proliferation of point-of-sale restrictions may have contributed to increases in noncommercial acquisition by creating the impression that cigarettes were more difficult to purchase. This reinforces the need for educational programs, interventions, and policies that more effectively target noncommercial sources of cigarettes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine adolescents' attitudes toward smoking, the presence of a false consensus effect, and the influence of peer and parental attitudes about smoking choices on being a susceptible, never smoker; an experimenter; and a current smoker. METHODS: Data from The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults (RWJF survey) were used to produce national estimates of the tobacco use behaviors and attitudes of adolescents enrolled in high school. Three logistic regression models were estimated to examine which psychosocial variables were associated with three different stages of smoking uptake. RESULTS: Positive attitudes toward tobacco use were associated with a greater likelihood of being a susceptible, never smoker (OR = 1.50), an experimenter (OR = 1.27), and a current smoker (OR = 2.96). Those respondents who believed that 50% or more of all adolescents smoked were more likely to be current smokers (OR = 1.45). The importance of the opinions of one's friends and parents about his/her choice to smoke was also found to be associated with smoking behavior. CONCLUSIONS: Preventing the initiation and continuation of smoking among adolescents will require interventions that address individual attitudes with respect to tobacco and will also need to present a clear picture of adolescent smoking. In addition, prevention and intervention messages should emphasize the importance of parental opinions on youth tobacco use regardless of parental tobacco use behavior. [ABSTRACT FROM AUTHOR]

Mass circulating magazines offer an opportunity to inform large segments of the population about preventive health behaviors relevant for cancer control. We collected information about the number and type of cancer articles from January 1987 through December 1994 in Jet, Ebony and Essence magazines. These magazines each have a principal readership of African-American women and a paid circulation of 1,000,000 or more annually. Cancer articles were counted if the content was gender neutral or specifically targeted for women. There were 84 articles on cancer including 6 on lung cancer and 3 on other tobacco-related cancers. Nine additional references to lung cancer were mentioned under the general cancer category, but lung cancer was not the primary focus of the articles. There were 24 articles on breast cancer and 9 on cervical cancer over the 8 year period. Most of the articles (> 70%) were short fillers of less than one page in length. A prevention focus was included in 42.2%, 75.0%, and 71.0% of the cancer articles in Jet, Ebony, and Essence respectively. Of the 649 health articles, 116 were on cardiovascular disease. In contrast, there were 1,477 tobacco advertisements over the 8 years. The number of cancer articles was not significantly associated with the number of tobacco advertisements. Because tobacco-related cancers are entirely preventable and contribute to the significant cancer burden, the lack of coverage of tobacco-related cancers is a missed opportunity for health promotion among African-American females. [ABSTRACT FROM AUTHOR]

Women's magazines are an important source of health information. To evaluate the relevancy of articles in these publications to known disease risks, seven women's magazines were reviewed to assess their coverage of colon cancer, the third leading cause of cancer mortality in U.S. women. Specifically, the amount of coverage devoted to colon cancer as well as the presentation of issues in the prevention, risks, treatment, diagnosis and genetics of colon cancer were recorded. Twenty articles were published on colon cancer in these magazines during the years 1987-1995. Compared to five other cancers that also affect women, colon cancer was the focus of the fewest articles in the seven magazines analyzed. [ABSTRACT FROM AUTHOR]

Pain and addiction are complex disorders with many commonalities. Beneficial outcomes for both disorders can be achieved through similar principles such as individualized medication selection and dosing, comprehensive multi-modal therapies, and judicious modification of treatment as indicated by the patient's status. This is implicit in the term "medication assisted treatment" (MAT) for opioid use disorders (OUD), and is equally important in pain management; however, for many OUD and pain patients, medication is central to the treatment plan and should neither be denied nor withdrawn if critical to patient well-being. Most patients prescribed opioids for pain do not develop OUD, and most people with OUD do not develop it as a result of appropriately prescribed opioids. Nonetheless, concerns about undertreatment of pain in the late 20th century likely contributed to inappropriate prescribing of opioids. This, coupled with a shortfall in OUD treatment capacity and the unfettered flood of inexpensive heroin and fentanyl, behavioral economics and other factors facilitated the 21st century opioid epidemic. Presently, injudicious reductions in opioid prescriptions for pain are contributing to increased suffering and suicides by pain patients as well as worsening disparities in pain management for ethnic minority and low-income people. Many of these people are turning to illicit opioids, and no evidence shows that the reduction in opioid prescriptions is reducing OUD or overdose deaths. Comprehensive, science-based policies that increase access to addiction treatment for all in need and better serve people with pain are vital to addressing both pain and addiction., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Kratom is a South Eastern Asian tree whose leaves are used to make tea-like brews or swallowed in powdered form for various health and well-being reasons including to relieve pain and opioid withdrawal. It is important to learn more about the potential public health impact of kratom in the context of the opioid epidemic., Methods: An anonymous online survey of kratom users (2867 current users and 157 former users) was conducted in September 2017 through the American Kratom Association and associated social media sites., Results: Kratom was used primarily to relieve pain (endorsed by 48% of respondents), for anxiety, PTSD, or depression (22%), to increase energy or focus (10%) and to help cut down on opioid use and/or relieve withdrawal (10%). Over 90% of respondents who used it in place of opioids indicated that it was helpful to relieve pain, reduce opioid use, and relieve withdrawal. The reported incidence of bad adverse reactions was 13%, and reactions were overwhelmingly mild and self-managed., Conclusions: Respondents reported using kratom for conditions which often require use of opioids, including pain and reduction of opioid use. The high self-reported efficacy and low incidence of adverse reactions associated with kratom use suggest that it may provide a potential alternative to opioids for some persons even though it has not been evaluated in multi-center clinical trials or approved for any therapeutic purpose. Further study of kratom, including systematic characterization of its safety and efficacy for various conditions is warranted., (Copyright © 2019. Published by Elsevier B.V.)

Introduction: Smokers switching completely from combustible cigarettes to electronic cigarettes (e-cigarettes) are likely to reduce health risk, suggesting that e-cigarettes should be made appealing to adult smokers. However, uptake of e-cigarettes by nonsmoking teens would add risk without benefit and should be avoided. Although e-cigarette flavors may appeal to adult smokers, the concern is that flavors might attract nonsmoking teens., Methods: Nonsmoking teens (n = 216, ages 13-17, no tobacco in past 6 months) and adult smokers (n = 432, ages 19-80, smoking 3+ years; could have used e-cigarettes) were recruited from an Internet research panel. In assessments completed online (May 22, 2014 to June 13, 2014), participants indicated their interest (0-10 scale) in e-cigarettes paired with various flavor descriptors. These were mixed (order balanced) with similar flavor offerings for ice cream and bottled water to mask the focus on e-cigarettes and validate the assessment. Mixed models contrasted interest between teens and adults and among adults by e-cigarette history., Results: Nonsmoking teens' interest in e-cigarettes was very low (mean = 0.41 ± 0.14 [SE] on 0-10 scale). Adult smokers' interest (1.73 ± 0.10), while modest, was significantly higher overall (p < .0001) and for each flavor (most p values < .0001). Teen interest did not vary by flavor (p = .75), but adult interest did (p < .0001). Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor. Adults who never tried e-cigarettes had the lowest interest, yet still higher than nonsmoking teens' interest (p < .0001)., Conclusion: The e-cigarette flavors tested appealed more to adult smokers than to nonsmoking teens, but interest in flavors was low for both groups., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Stimulants are a diverse array of drugs that range from everyday caffeine to prescription medications and illicitly manufactured street drugs. The surveillance of misuse and abuse of stimulants many times confounds prescription and illicit street drugs such that the data are not specific enough to guide mitigation efforts or assess their impact. This review highlights the surveillance efforts that are conducted in the United States (US) for stimulant misuse and abuse. These surveillance efforts include national level surveys as well as reporting systems such as Poison Centers and emergency departments. This epidemiologic analysis has implications for interpreting the current known neuropharmacology of stimulants and possibly informing future neuropharmacology research that may contribute to a better understanding of potential neuropharmacologic factors influencing differing patterns of use, abuse, and adverse consequences associated with various stimulants. This article is part of the Special Issue entitled 'CNS Stimulants'., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Patient education and warnings have emerged as prominent interventions for improving drug safety. As part of the provision of information and guidance on safe use of drugs, patients often receive multiple pieces of written information when they obtain a prescription medication, including a Food and Drug Administration (FDA)-mandated medication guide (MG), consumer medication information (CMI), and patient package insert (PPI)., Objective: To determine whether patients understand the materials providing drug information and whether the materials convey the intended information., Methods: Fifty-two adults with a high school education or less were shown an actual (blinded) MG, CMI, and PPI for a marketed antidepressant medication. Comprehension was tested with methods used by the FDA to assess label comprehension for nonprescription products., Results: The majority of participants (88.2%) looked at all 3 pieces of information provided. The mean (SD) time spent reviewing the CMI was 5.2 (4.8) minutes (range 0-21.9), 16.5 (13.3) minutes for the PPI (range 0-43.0), and 2.5 (1.6) minutes for the MG (range 0-7.6). Less than 20% of participants were able to identify the symptoms of a rare but potentially life-threatening situation that can occur with this medication and only 61.5% recalled the risk of teen suicide, which is the sole focus of the MG. Respondents with lower literacy scores performed more poorly than those with higher literacy scores., Conclusions: Information provided with at least some prescription drugs is not adequately understood by less-educated consumers and does not effectively communicate critical safety messages or directions.

Background: Prior research suggests that ethnic minorities and individuals of low socioeconomic status (SES) may be more likely to attempt weight loss using unproven methods., Methods: Data were from a national, random-digit-dial telephone survey of weight loss practices. Seven modalities of weight loss were examined. Multivariable analysis controlled for clinical and sociodemographic variables (including race/ethnicity, SES, and body mass index), as well as self-perception of weight and weight loss attitudes., Results: In multivariable analysis, African Americans (OR, 1.71; 95% CI, 1.05-2.78; p =.03) and Latinos (OR, 1.69; 95% CI, 1.11-2.60; p = .016) were more likely than Caucasians to report use of over-the-counter (OTC) weight loss supplements. African Americans (OR, 0.39; 95% CI, 0.21-0.71; p = .002) and Latinos (OR, 0.56; CI, 0.33-0.97; p = .038) also were less likely than Caucasians to report use of commercial weight loss programs. Higher-SES individuals were more likely than low-SES persons to report self-directed attempts at weight loss (OR, 1.39; CI, 1.00-1.93; p = .05) and commercial programs (OR, 2.12; CI, 1.51-2.97; p < .001) and less likely to report use of OTC supplements (OR, 0.64; CI, 0.47-0.88]; p = .006). African Americans were more likely than Caucasians to report use of medically supervised programs (OR, 1.74; CI, 1.06-2.86; p = .028)., Conclusions: With the exception of medically supervised programs, ethnic minorities and low-SES individuals are generally more likely to report use of unproven methods for weight loss and less likely to report use of potentially beneficial treatments. These findings should be explored in more detail. Use of proven treatments for weight management should be encouraged.

Background: Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent-child relationship, such as parenting style., Methods: The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style--authoritative, permissive, autocratic, and unengaged--experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking., Results: Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents' opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents' opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents' opinions about smoking are important., Discussion: Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.

Objective: To explore whether an association exists between adolescent smokers' attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents' expressed disapproval of smoking, and the importance they place on their parents' opinions., Methods: This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. "Have you ever seriously thought about quitting smoking?" was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit., Results: Regardless of whether their parents smoked, adolescents who placed value on their parents' opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents' expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, "When I'm older, my parents won't mind that I smoke" was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit., Conclusions: Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers' desire to quit smoking.

Cigarette smoking is the largest preventable cause of death and morbidity in the United States. Heightened recognition of this public health concern has led researchers from multiple and varied disciplines to address this complex and multidimensional behavior. The need for an alternative research paradigm, focusing on a transdisciplinary approach that integrates work across disciplines in order to advance the field most quickly, has been identified. This recognized need led to the development of the Transdisciplinary Tobacco Use Research Centers (TTURC) initiative, funded jointly by the National Cancer Institute, the National Institute on Drug Abuse, and The Robert Wood Johnson Foundation. This paper discusses the formation and early implementation stages of the initiative, including meetings that led to the development of the TTURCs, funders' and research centers' perspectives on implementation, and early observations about the products of the initiative.

Context: Understanding how advertising and other risk and demographic factors affect adolescent susceptibility to smoking would allow for the development of more effective youth-targeted tobacco prevention and cessation programs and policies., Objective: To examine the effect of various demographic and risk factors on different stages of smoking among adolescents., Design: A nationally representative cross-sectional survey, The Robert Wood Johnson Foundation's Survey of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults., Subjects: The Robert Wood Johnson Foundation's Survey of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults included 17,287 adolescent respondents (aged, 13-19 years) in 1996., Main Outcome Measures: Stage of susceptibility and correlates of progression toward regular smoking., Results: Of all never [corrected] smoking adolescents, 32% were susceptible smokers (have never smoked, but might) with younger adolescents almost 3 times more likely than older adolescents to be susceptible. Female subjects were 50% [corrected] more likely than male subjects to be susceptible. In addition to exposure to others' smoking, owning or willingness to own tobacco promotional items, having a favorite cigarette advertisement, skipping school, poor school performance, and lack of attendance in religious activities were associated with progression along the uptake continuum., Conclusions: Improved understanding of the tobacco use trajectories of adolescents and the risk factors associated with progression will help clinicians and tobacco control advocates create effective youth-targeted interventions and policies. Findings suggest that physicians and other health care providers should redouble their efforts to ask preadolescents and young adults about smoking or the likelihood of their smoking. Nonsmokers should also be advised about the addictive nature of tobacco products and the resulting loss of control that accompanies addiction.

We examined trends in smoke-free workplace policies among all indoor workers in the United States using the National Cancer Institute's Tobacco Use Supplement to the Census Bureau's Current Population Survey (total n = 270,063). Smoke-free was defined as smoking not permitted in public or common areas or in work areas of a worksite. Nationally, we found that nearly 70% of the US workforce worked under a smoke-free policy in 1999. At the state level, a greater than 30-percentage-point differential existed in the proportion of workers with such policies. Although significant progress has been made to reduce worker exposure to environmental tobacco smoke on the job, we predict further progress may be difficult unless comprehensive regulations to protect all workers are implemented at the national, state, or local level.

Purpose: Women's magazines are a significant source of health information for many women, but there is some concern that the media may misrepresent a woman's risk of breast cancer. This review analyzes breast cancer articles in selected women's magazines to determine if the information presented is accurate and balanced., Search Methods: For the years 1987 to 1995, the quantity and content of breast cancer articles were examined in four popular women's magazines and three magazines with a large African-American audience. Fifty-nine lead factual breast cancer articles were analyzed for the information presented on prevention measures, risk factors, incidence/mortality statistics, and lifetime risk. The age at diagnosis for women featured in these articles was also determined., Summary of Important Findings: Breast cancer was the topic of 34.9% of the 585 cancer articles published in these seven magazines. Mammography screening guidelines were recommended in 68% of articles that discussed prevention; 66% presented the American Cancer Society guidelines. Risk factors for breast cancer were reported as age greater than 50 in 41% and family history in 78% of the articles that discussed risk factors. Twenty articles used the lifetime risk statistic of developing breast cancer; six explained what this statistic means. The average age of diagnosis for women featured in the articles was 40.5., Major Conclusions: The proportion of breast cancer articles to all cancer articles in these magazines (34.9%) was similar to breast cancer incidence (32.2%) but was higher than its contribution to either female cancer mortality (17.2%) or overall female mortality (4.0%). Magazines that targeted the African-American audience had fewer breast cancer articles than the other four magazines. Risk factors for breast cancer were not discussed in proportion to their impact on risk. The popular lifetime risk statistic was not explained in the majority of cases where it was presented. The average age of diagnosis for the women featured in these articles was far below the median age of diagnosis of 65. Thus, magazine reports may be contributing to women's misunderstanding of their true breast cancer risk.

Background: Women use magazines as sources of health-related information, including information about cancer. Given this reliance on magazines for cancer-related information, it may interest cancer educators to know which cancers are reported on in women's magazines and what types of information are being presented., Methods: Four widely circulated monthly women's magazines were analyzed for their coverage of cancers during the years 1987-1995. The types of cancers discussed and the frequencies of coverage were noted for each issue of every magazine. Additionally, the content of every cancer-related article was assessed for issues in cancer prevention (primary and secondary), risks, treatment, and genetics., Results: All four magazines in this study reported on breast cancer more often than any other cancer. Lung and colon cancers received very little coverage. The percentages of articles devoted to the six most-discussed cancers (breast, cervical, colon, lung, ovarian, and skin) did not reflect either the mortality rates or the incidence rates of these cancers., Conclusions: The discussions of cancers in these four women's magazines focused mostly on breast and skin cancers and neglected two very important cancers--lung and colon. If women are indeed receiving much of their cancer information from such media coverage, these findings should alert cancer educators to the possible need to work with these media to help in the dissemination of additional information about cancers to women.

Objective: To determine the prevalence of smoking policies in indoor work environments as reported by a nationally representative sample of workers in the United States., Design: Cross-sectional survey of households within the United States., Setting: All 50 state and the District of Columbia, 1992-93., Participants: Currently employed indoor workers 15 years of age and older who responded to the National Cancer Institute's Tobacco Use Supplement to the Current Population Survey (n = 100,561)., Main Outcome Measures: The prevalence and restrictiveness of workplace smoking policies as reported by workers currently employed in indoor workplaces in the United States., Results: Most of the indoor workers surveyed (81.6%) reported that their place of work had an official policy that addressed smoking in the workplace; 46.0% reported that their workplace policy did not permit smoking in either the public/common areas--for example, restrooms and cafeterias--or the work areas of the workplace. The reporting of these "smoke-free" policies varied significantly by gender, age, race/ethnicity, smoking status, and occupation of the worker., Conclusions: Although nearly half of all indoor workers in this survey reported that they had a smoke-free policy in their workplace, significant numbers of workers, especially those in blue-collar and service occupations, reported smoke-free rates well below the national average. If implemented, the US Occupational Safety and Health Administration's proposed regulation to require worksites to be smoke-free has the potential to increase significantly the percentage of American workers covered by these policies and to eliminate most of the disparity currently found across occupational groups.

Tobacco has a long history of use in the U.S., and its serious health effects have been well-documented during the past half century, U.S. efforts to control tobacco use and tobacco-related morbidity and mortality have been reasonably successful over the past 25 years, during which time there has been a 34 percent reduction in adult smoking. Nevertheless, tobacco use remains a significant public health problem in the U.S., with more than 430,000 tobacco-related deaths per year and over one-fourth of the population continuing to smoke. Many organizations are involved in tobacco use control activities, the most broadly focused of which is the National Cancer Institute (NCI). As an example of the type of program needed to address the problem of tobacco use on a national scale, the NCI's public health research plan and activities are described and its emphasis on a data-based decision matrix in its approach to tobacco and cancer control research and applications of research is discussed. Finally, future approaches to tobacco use control in the U.S. are suggested.

The regulation of the core promoter of Hepatitis B virus (HBV) was investigated using the chloramphenicol acetyltransferase (CAT) reporter system. Deletional analysis of sequences 5' to the HBV core promoter indicated the presence of a negative regulatory element (NRE) located within a 282-bp BamHI-HincII DNA fragment. The NRE was functional in hepatic as well as nonhepatic cells. Results of in vivo competition experiments suggest a role for cellular transacting repressor protein(s) in the functioning of the NRE. The HBV NRE, positioned 5' to the SV40 early promoter, inhibited the activity of the heterologous promoter in an orientation-independent, but position-dependent manner. These data indicate that the HBV NRE is a silencer element, which functions to downregulate the activity of the core promoter.