Background A preliminary study using national cancer surveillance data from 1998–2002 suggested there were significant differences between non-Hispanic whites (“whites”) and Asian/Pacific Islanders (APIs) in the use of liver transplantation as a treatment for hepatocellular carcinoma (HCC). Methods We conducted a study to examine whether differences in liver transplantation between white and API HCC patients were changing over time. Using a population-based statewide cancer registry, we obtained data on all HCC cases diagnosed in California between 1998 and 2005, but limited the study to white and API patients with non-metastatic HCC, sized ≤ 5.0 cm (n = 1728). Results During 1998–2003 (n = 1051), the odds of receiving a liver transplant were 2.56 times higher for white patients than for API patients (95% confidence interval [CI], 1.72 to 3.80 times higher), even after adjusting for age, sex, marital status, year of diagnosis, TNM stage, and tumor grade. In contrast, during 2004–2005 (n = 677), there were no significant differences in the odds of receiving a transplant. Between 2002 and 2004, changes in liver transplantation policy assigned priority points to HCC patients (initially to stage I and II, then to stage II only). After the policy changes, API HCC patients experienced a significant increase in stage II diagnoses, while white patients did not. Conclusions In California, there was a large and significant disparity in liver transplantation among white and API patients with HCC during 1998–2003, but not during 2004–2005. Changes in liver transplantation policy during 2002–2004 may have played a role in decreasing this difference.

Literally, Public Law 99-252 (otherwise known as the Comprehensive Smokeless Tobacco Health Education Act of 1986) includes provisions that are informational in nature. Implicitly, however, this law is considered part of the federal effort in disease prevention and health promotion. This paper reviews the societal and legislative context of that act and presents a plan to evaluate the impact of this law on decreasing smokeless tobacco use. The uniqueness of this plan is its incorporation of nine disciplinary perspectives in the derivation of indicators to measure process, impact, and outcome measures for decreasing smokeless tobacco use. A basic prevention strategy is suggested by this interdisciplinary approach. In addition, specific lessons could be applied from the history of successes in public health to decreasing smokeless tobacco use.

In a previous paper, "Evaluating the Impact of P.L. 99-252 on Decreasing Smokeless Tobacco Use," the context of this law and the theoretical framework for an evaluation plan for measuring its impact were described. In this paper, the methodology and selected findings from this project as well as their implications are discussed. This discussion includes the identification of the six indicators considered to be the most relevant, valid, reliable, accessible, and practical for measuring the impact of this law on decreasing smokeless tobacco use, as well as a report on the feasibility analysis of three of these indicators. Pilot data on two indicators--pounds of smokeless tobacco sold and incidence rates of tobacco-induced leukoplakia--are presented and analyzed.

We analyzed 28 examples of smokeless tobacco educational print and audiovisual materials based on two criteria: (1) strength of the scientific bases for the selected materials, and (2) appropriateness of the materials for the known populations at risk to smokeless tobacco ever-use. We concluded that these materials in general are authoritative and provide the cancer educator with a solid scientific basis to initiate a primary prevention strategy. Nonetheless, some updating of materials to include the latest scientific findings (eg, cardiovascular and physiological/addictive effects) is needed. In terms of appropriateness of materials, we noted that the focus of materials was correctly targeted to young, white males; however, most materials tended to be aimed at seventh grade and beyond reading and social levels. Few, if any, materials were aimed at the other group at risk to smokeless tobacco adoption, namely youth in the early elementary grades. Consequently, while smokeless tobacco educational materials are generally authoritative, the cancer educator must still customize both the selection of materials and the educational approach to populations at risk.

Genealogical health histories were studied to determine the prevalence of family cancer in students taking an Ohio State University (OSU) cancer prevention/education class. One hundred twenty students enrolled in the spring 1987 Health Education class, "How to Avoid Dying from Cancer . . . Now and Later" reported a positive family cancer history. Survey forms indicating a cancer history were selected for use in this study. Cancer incidence and total cancer deaths were calculated for male and female populations. Male cancer incidence reported for fathers was 12%, paternal grandfathers 27%, and maternal grandfathers 25%. Female cancer incidence rates were lower than those reported in the male population. Cancer occurrences include 16%, 11%, and 21%, for mother, paternal grandmother, and maternal grandmother, respectively. In the study population, male (33%) and female (28%) cancer mortalities were reported as the leading cause of death. Frequent occurrences of skin and gastrointestinal cancer in males and breast cancer in females were noted. Family experiences with cancer are believed to stimulate student enrollment in OSU's cancer prevention program. Class promotion and design will be restructured to reflect the significance of a family cancer history. We believe this will provide a more effective means of generating the student's motivation to adopt cancer prevention activities.