Considerable evidence from preclinical studies indicates that plant-derived foods contain anticarcinogens.¹ A comprehensive review of the literature found that a diet high in vegetables and fruit probably decreases breast cancer risk and that a diet high in total fat possibly increases risk.² However, evidence of an association between a diet high in vegetables and fruit and low in total fat and prevention of cancer progression has been mixed in epidemiological studies.^3-17 An interim analysis of data from the Women's Intervention Nutrition Study (WINS), which assessed the effect of a dietary intervention designed to reduce fat intake on relapse-free survival in breast cancer patients,¹⁸ found that the intervention was associated with a marginally statistically significant improvement in relapse-free survival. To our knowledge, no other clinical trials investigating dietary change and breast cancer survival have been reported.

A NUMBER of studies have implicated tobacco industry advertising and promotional activities as possible causal agents in the stimulation of demand for cigarettes among adolescents.^1-3 The effectiveness of promotional activities over the past 10 years has been postulated as a major reason for the recent increases in adolescent smoking behavior.^4-6 There is abundant evidence that adolescents are exposed to and have high recall of tobacco industry promotional messages.^2,7,8 Studies of smoking initiation rates in population samples demonstrate that sharp increases in adolescent smoking coincide with the conduct of effective tobacco promotional campaigns.^9,10 Since the first Surgeon General's report on smoking and health in 1964,¹¹ these increases appear to be specific to adolescents aged 14 to 17 years; there were no similar increases among adults.^6,9,10

Purpose: Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables. Patients and Methods: A prospective study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000. Enrollment was an average of 2 years postdiagnosis. Only seven women were lost to follow-up through December 2005. Results: In univariate analysis, reduced mortality was weakly associated with higher vegetable-fruit consumption, increased physical activity, and a body mass index that was neither low weight nor obese. In a multivariate Cox model, only the combination of consuming five or more daily servings of vegetables-fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk), was associated with a significant survival advantage (hazard ratio, 0.56; 95% CI, 0.31 to 0.98). The approximate 50% reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women, although fewer obese women were physically active with a healthy dietary pattern (16% v 30%). Among those who adhered to this healthy lifestyle, there was no apparent effect of obesity on survival. The effect was stronger in women who had hormone receptor–positive cancers. Conclusion: A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity. The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival.

Objectives. We compared smoking quit rates by age in a nationally representative sample to determine differences in cessation rates among younger and older adults. Methods. We used data on recent dependent smokers aged 18 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey (n=31625). Results. Young adults (aged 18–24 years) were more likely than were older adults (aged 35–64 years) to report having seriously tried to quit (84% vs 66%, P<.01) and to have quit for 6 months or longer (8.5% vs 5.0%, P<.01). Among those who seriously tried to quit, a smoke-free home was associated with quitting for 6 months or longer (odds ratio [OR]=4.13; 95% confidence interval [CI]=3.25, 5.26). Compared with older smokers, young adults were more likely to have smoke-free homes (43% vs 30%, P<.01), were less likely to use pharmaceutical aids (9.8% vs 23.7%, P<.01), and smoked fewer cigarettes per day (13.2% vs 17.4%, P<.01). Conclusions. Young adults were more likely than were older adults to quit smoking successfully. This could be explained partly by young adults, more widespread interest in quitting, higher prevalence of smoke-free homes, and lower levels of dependence. High cessation rates among young adults may also reflect changing social norms.

EARLY PUBLIC HEALTH approaches to reducing population smoking prevalence emphasized interventions aimed at individual smokers.¹ However, the results of numerous studies indicated that too few individuals were reached for such a strategy to effect a measurable reduction in population smoking prevalence.² The varied successes of several comprehensive, community and statewide tobacco control programs^3-7 led to this approach being widely recommended as the most appropriate way to reduce tobacco use in the United States.^2,8 Starting in 1989, the California Tobacco Control Program introduced the use of increased tobacco excise taxes to continuously fund a large, coordinated statewide effort to reduce the health costs associated with smoking.⁹