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Front Matter -- Reviewers -- Preface -- Acknowledgments -- Contents -- Tables, Figures, and Boxes -- Acronyms and Abbreviations -- General Summary -- Summary -- 1 Introduction -- 2 A Brief History of Presumptive Disability Decisions for Veterans -- 3 The Presumptive Disability Decision-Making Process -- 4 Legislative Background on Presumptions -- 5 Case Studies Summary Chapter -- 6 Establishing an Evidence-Based Framework -- 7 Scientific Evidence for Causation in the Population -- 8 Synthesizing the Evidence for Causation -- 9 Applying Population-Based Results to Individuals: From Observational Studies to Personal Compensation -- 10 Health and Exposure Data Infrastructure to Improve the Scientific Basis of Presumptions -- 11 Governmental Classification and Secrecy -- 12 The Way Forward -- 13 Recommendations -- Appendixes -- Appendix A: Statement of the Veterans' Disability Benefits Commission to the Institute of Medicine's Committee on the Presumptive Disability Decision-Making Process, May 31, 2006 -- Appendix B: Committee on Evaluation of the Presumptive Disability Decision-Making Process for Veterans Open Session Meeting Agendas -- Appendix C: Glossary -- Appendixes D-M (originally on enclosed CD) -- Title Page -- Appendix D: Historical Background -- Appendix E: Arguments Favoring and Opposing Presumptions -- Appendix F: Tables: Summary of Presumptive Disability Decision-Making Legislative History -- Appendix G: VA's White Paper on the Presumptive Disability Decision-Making Process -- Appendix H: IOM's Statements of Task and Conclusions for Agent Orange and Gulf War Reports -- Appendix I: Case Studies -- Appendix J: Causation and Statistical Causal Methods -- Appendix K: Sources of Health and Exposure Data for Veterans -- Appendix L: Additional Classification and Secrecy Information.

Purpose.To estimate the independent effect of cigarette smoking on respiratory tract symptoms and health status indicators among high school seniors.Design.Consolidated data sets from one-time cross-sectional survey designs.Setting.High schools in the United States, 1982–1989.Sample.A total of 26,504 high school seniors, with an 83% response rate.Measures.Odds ratios for respiratory tract symptoms and health status indicators for cigarette smokers compared with nonsmokers, while controlling for sex, socioeconomic status, and use of other drugs.Results.High school seniors who were regular cigarette smokers and who began smoking by grade nine were significantly more likely than never smokers to report shortness of breath when not exercising (adjusted odds ratio [OR] = 2. 7), coughing spells (OR = 2.1), productive cough (OR = 2.4), and wheezing or gasping (OR = 2.6). These smokers were also more likely to have seen a doctor or other health professional for an emotional or psychologic complaint (OR = 3.0) and to rate their overall health as poorer than average (OR = 2.4). We found strong dose-response relationships for most outcome measures.Conclusions.Cigarette smoking among high school seniors is associated with respiratory tract symptoms and poorer overall physical health and may be a marker for underlying mental health problems. Smoking prevention activities directed at adolescents should include information on the early adverse health consequences of cigarette smoking.

We present a case study that utilizes community-based participatory research principles, community-organizing, and evaluation processes as an example of how to conduct community-based research to maximize compliance with policy implementation on tobacco sales in the retail environment. The study covers five different vulnerable communities in Los Angeles, California, including socioeconomically disadvantaged African American, American Indian, Hispanic Americans, Korean, and non-Hispanic Whites. We document barriers to compliance with the U.S. Food and Drug Administration, a government authority in charge of implementing tobacco policy. The case study presents a step-by-step community-based participatory research process with community-organizing principles to help guide the conduct of similar types of research. We discuss development and implementation of culturally tailored and language-specific research protocols. We provide examples of instrumentation development and make a case for community-based research on tobacco control in vulnerable populations. Our research design utilizes a mixed-methods approach, including qualitative (focus groups with key opinion leaders) and quantitative methods via retailer surveys and store audits/observations. We highlight lessons learned and benefits of community inclusion in conducting this type of research.

Background/nCharacterizing and comparing the determinant of cotinine concentrations in different populations should facilitate a better understanding of smoking patterns and addiction. This study describes and characterizes determinants of salivary cotinine concentration in a sample of Spanish adult daily smoker men and women. Methods: A cross-sectional study was carried out between March 2004 and December 2005 in a representative sample of 1245 people from the general population of Barcelona, Spain. A standard questionnaire was used to gather information on active tobacco smoking and passive exposure, and a saliva specimen was obtained to determine salivary cotinine concentration. Two hundred and eleven adult smokers (>16 years old) with complete data were included in the analysis. Determinants of cotinine concentrations were assessed using linear regression models. Results: Salivary cotinine concentration was associated with the reported number of cigarettes smoked in the previous 24 hours (R2 = 0.339; p < 0.05). The inclusion of a quadratic component for number of cigarettes smoked in the regression analyses resulted in an improvement of the fit (R2 = 0.386; p < 0.05). Cotinine concentration differed significantly by sex, with men having higher levels./nConclusion: This study shows that salivary cotinine concentration is significantly associated with the number of cigarettes smoked and sex, but not with other smoking-related variables. ; This project was funded by the Instituto de Salud Carlos III (grants FIS PI020261 & PI081436) and the Thematic Network of Cooperative Research on Cancer (grant RD06/0020/0089), Government of Spain, and the Ministry of Universities and Research (grant 2009SGR192), Government of Catalonia. We also thank Chupa Chups Spain for providing the Smint® candies.

OBJECTIVE: Blacks/African Americans have experienced direct public health harm from US governmental agencies (eg, police violence, Tuskegee syphilis experiment) that may influence perceptions of the trustworthiness of government messages regarding tobacco products. Consequently, we sought to explore Black Americans' awareness of and trust in the FDA's role as a tobacco regulator. METHODS: Data were from 2 focus groups conducted with a purposive sample of 23 Black stakeholders in Los Angeles, California. Discussions were audio-recorded and transcribed verbatim for analysis. RESULTS: Although most (N = 14; 61%) participants were aware of the FDA's role as a tobacco regulator, they all noted that the Black community in Los Angeles is not aware. Recurrent across the focus groups were discussions about distrust in the FDA with 4 main contributing factors: (1) that the FDA is influenced by the tobacco, agricultural, and pharmaceutical industries; (2) that the FDA is influenced by money and politics; (3) that the FDA is a bureaucracy exercising monopoly and power; and (4) that the FDA lacks technical capacity and competence to regulate tobacco products. CONCLUSIONS: Study findings highlight opportunities for the FDA to increase awareness and build trust in their tobacco regulatory role through communication campaigns targeted at Black Americans, and community engagement with Black stakeholders.

OBJECTIVES: Research is limited on tobacco retailers' perceptions of the Food and Drug Administration's (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA's tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California. METHODS: Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA. RESULTS: Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non-African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04). CONCLUSIONS: Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance.