© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 1, 10-12,
January 2, 2002
© 2002 Oxford University Press
NEWS |
Whatever Happened to . . . ? Looking Back 10 Years
This is part of an occasional series that recalls some of the stories reported 10 years ago in the News section of the Journal.
In the Oct. 15, 1991, issue of the Journal of the National Cancer Institute, the News announced the launch of a 7-year, $165 million anti-smoking campaign called the American Stop Smoking Intervention Study, or ASSIST.
Under the program, 17 states received funding from the National Cancer Institute and the American Cancer Society to form community coalitions. The goal was to spread anti-smoking messages through public service announcements, work site programs, prevention classes, and other community activities.
The anti-smoking campaign was met with tough opposition from the tobacco industry, said Frances Stillman, Ed.D., director of the ASSIST evaluation. Moreover, smoking remained prevalent in tobacco-growing states such as North Carolina and Kentucky. "There were a lot of forces against tobacco control," said Stillman.
Preliminary information from the ASSIST evaluation suggested that ASSIST states were producing more policy changes, passing more tobacco-control laws, and raising tobacco taxes, said Stillman. ASSIST states were also reporting more anti-smoking news in the media, Stillman added.
Measuring the actual impact on smoking, however, was a much greater challenge. One reason, said Stillman, was that ASSIST states shared anti-smoking information with non-ASSIST states. In 1993, the Robert Wood Johnson Foundation began funding tobacco control efforts in non-ASSIST states. "By 1994, all states had something going on at some level," said Stillman.
The actual benefits of the ASSIST program may never be quantified, suggested Peter Greenwald, M.D., Dr.P.H., director of NCI’s Division of Cancer Prevention. "A lot of the benefit we’ve seen [in terms of] society change, we just couldn’t measure," he said.
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The ASSIST program ended in 1999, and a full-scale evaluation is ongoing. Results may be available as early as next year. Since 1999, the Centers for Disease Control and Prevention has been funding tobacco-control programs in all 50 states.
More Fruits and Vegetables
Another public health endeavor that went national in 1991 was the 5 A Day for Better Health initiative. The initiative urged Americans to increase their fruit and vegetable consumption to five or more servings a day, the News reported in the Nov. 6, 1991, issue.
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At the time, studies showed that Americans were eating only half that amount. Researchers believed that eating five or more serving of fruits and vegetables daily could help reduce the risk of cancer and other diseases.
"The evidence that vegetables and fruits decrease cancer risk is very strong," said Gloria Stables, Ph.D., former director of the 5 A Day program. Increasing fruit and vegetable intake to five or more servings a day decreases the risk of cancer by up to 20%, she noted.
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The 5 A Day program grew out of a cancer control program started in California in the late 1980s with support from NCI. In 1991, the National Cancer Institute and the Produce for Better Health Foundation launched the 5 A Day For Better Health initiative.
Like ASSIST, 5 A Day delivers its messages through the media, schools, work sites, and other community settings. Supermarkets and retail stores joined the effort by putting the 5 A Day logo on their products, displays, and advertising.
Between 1991 and 1997, a survey showed that awareness among adult Americans about the importance of eating five or more servings of fruits and vegetables a day nearly tripled—from 7% of the adult population to 20%. However, the increase in fruit and vegetable consumption was much more modest. From 1990 to 1995, Americans ate about half a serving more of fruits and vegetables a day.
"That’s not great progress," said Stables. But, she added, "With all the conflicting marketing done for non-healthy foods, it’s amazing we’ve seen any increase in fruit and vegetable consumption at all."
Lorelei DiSogra, Ed.D., the current director of the 5 A Day program, offered another perspective: "We’re talking about a massive social change. We are attempting to improve the eating habits of the entire U.S. population."
In November 2000, an external review board to the NCI evaluated the 5 A Day program and recommended that it continue past its original 10-year mark and that the National Cancer Institute continue to lead the effort.
Last year, a new partnership for 5 A Day formed that includes NCI, the Produce for Better Health Foundation, CDC, the American Cancer Society, the U.S. Department of Agriculture, the produce industry, state health departments, and the National Alliance for Nutrition and Activity.
"With more groups involved, we’re hoping that with their budgets and our budgets, there will be more available resources for the 5 A Day program," said Stables.
DiSogra pointed out that more than 30 countries have started programs modeled after 5 A Day. Some countries, like Canada and France, have 10 A Day programs. "Inadequate fruit and vegetable consumption is a problem worldwide," said DiSogra. "We’re all trying to address the problem."
Vitamins Don’t Prevent Cancer
Also in the Nov. 6, 1991, issue, the News reported on a new study to examine the benefits of aspirin and vitamin supplements in preventing cancer and heart disease.
The Women’s Health Study, which began recruiting in 1992, is an ongoing randomized double-blind trial of more than 39,000 female health professionals ages 45 and older with no previous history of cancer or heart disease. The women received beta-carotene, vitamin E, aspirin, or a placebo every other day.
Julie E. Buring, Sc.D., of the Brigham & Women’s Hospital and Harvard Medical School, who led the study, said that the trial would provide some of the "definitive information" on prevention of cancer and heart disease with these agents that had been lacking.
But in 1996, results from the Physician’s Health Study, a trial of roughly 22,000 male physicians, suggested that beta-carotene had no statistically significant benefit in protecting against cancer or heart disease.
"If after 13 1/2 years, there was no evidence of benefit [of beta-carotene in men], it was unlikely we would see any benefit in women," said Buring. On Jan. 18, 1996, Buring and her co-workers ended the beta-carotene part of the Women’s Health Study.
The team reported the results they had collected on beta-carotene in the Dec. 15, 1999, Journal of the National Cancer Institute. Like the men in the Physician’s Health Study, women taking 50 mg of beta-carotene every other day did not show a reduced risk for either cancer or heart disease.
The aspirin and vitamin E components of the study are ongoing, and the results should be available by 2004, said Buring. A past trial on male physicians taking aspirin suggested a 44% reduction in risk for first heart attacks.
The Women’s Health Study is the only trial looking at vitamin E in the primary prevention of cancer and heart disease. Observational evidence has suggested the potential for preventive effect against cancer and heart disease.
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