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Richard A, Rohrmann S, Schmid SM, Tirri BF, Huang DJ, Güth U, Eichholzer M. Lifestyle and health-related predictors of cervical cancer screening attendance in a Swiss population-based study. Cancer Epidemiol 2015; 39:870-6. [DOI: 10.1016/j.canep.2015.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022]
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Jung FUCE, Luck-Sikorski C, Wiemers N, Riedel-Heller SG. Dietitians and Nutritionists: Stigma in the Context of Obesity. A Systematic Review. PLoS One 2015; 10:e0140276. [PMID: 26466329 PMCID: PMC4605484 DOI: 10.1371/journal.pone.0140276] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022] Open
Abstract
Aim Negative attitudes towards people with obesity are common even in health care settings. So far, the attitudes and causal beliefs of dietitians and nutritionists have not been investigated systematically. The aim of this article was to review the current state of quantitative research on weight-related stigma by dietitians and nutritionists. Method A systematic literature review was conducted in 2014 using PubMed, PsycINFO, Web of Science and Cochrane Library. Results Eight studies were found that differ in regard to study characteristics, instruments and the origin of the sample. Six out of eight studies reported weight stigma expressed by dietitians and nutritionists. Their believed causes of obesity indicated a defined preference for internal factors rather than genetics or biology. Discussion Results of studies were not homogenous. The degree of negative attitudes by dietitians and nutritionists towards people with obesity appeared to be slightly less pronounced compared to the general public and other health care professionals. Stigma and its consequences should be included into educational programs to optimally prepare dietitians and nutritionists.
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Affiliation(s)
- Franziska U. C. E. Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
- * E-mail:
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - Nina Wiemers
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Daly B, Olopade OI. A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin 2015; 65:221-38. [PMID: 25960198 DOI: 10.3322/caac.21271] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022] Open
Abstract
It is well known that there is a significant racial divide in breast cancer incidence and mortality rates. African American women are less likely to be diagnosed with breast cancer than white women but are more likely to die from it. This review explores the factors that may contribute to the racial survival disparity. Consideration is paid to what is known about the role of differences in tumor biology, genomics, cancer screening, and quality of cancer care. It is argued that it is the collision of 2 forces, tumor biology and genomics, with patterns of care that leads to the breast cancer mortality gap. The delays, misuse, and underuse of treatment for African American patients are of increased significance when these patients are presenting with more aggressive forms of breast cancer. In the current climate of health care reform ushered in by the Affordable Care Act, this article also evaluates interventions to close the disparity gap. Prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment. Lastly, areas of future investigation and policy initiatives aimed at reducing the racial survival disparity in breast cancer are discussed.
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Affiliation(s)
- Bobby Daly
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- Walter L. Palmer Distinguished Service Professor and Director Center for Clinical Cancer Genetics, Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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Hellmann SS, Njor SH, Lynge E, von Euler-Chelpin M, Olsen A, Tjønneland A, Vejborg I, Andersen ZJ. Body mass index and participation in organized mammographic screening: a prospective cohort study. BMC Cancer 2015; 15:294. [PMID: 25880028 PMCID: PMC4404005 DOI: 10.1186/s12885-015-1296-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is the leading cancer among women, and early diagnosis is essential for future prognosis. Evidence from mainly cross-sectional US studies with self-reported exposure and outcome found positive association of body mass index (BMI) with non-participation in mammographic screening, but hardly addressed the influence of potential effect-modifiers. We studied the association between objective measures of BMI and participation in mammographic screening in a Danish prospective cohort, and explored the influence of menopausal status, hormone therapy (HT), previous screening participation, and morbidities on this relationship. Methods A total of 5,134 women from the Diet, Cancer, and Health cohort who were invited to population based mammographic screening in Copenhagen were included in analysis. Women were 50–64 years old at inclusion (1993–97) when their height and weight were measured and covariates collected via questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) for the association between BMI and mammographic screening participation were estimated by logistic regression, adjusted for other breast cancer risk factors and morbidities. Effect modification was evaluated by an interaction term and tested by Wald test. Results Underweight (BMI < 18.5 kg/m2, OR: 95% CI; 2.24: 1.27-3.96) and obese women of class II (BMI 35–40 kg/m2, 1.54: 0.99-2.39) and III (BMI ≥ 40 kg/m2, 1.81: 0.95-3.44) had significantly higher odds of non-participation than women with normal weight. This association was limited to postmenopausal women (Wald test p = 0.08), with enhanced non-participation in underweight (2.83: 1.52-5.27) and obese women of class II and III (1.84: 1.15-2.95; 2.47: 1.20-5.06) as compared to normal weight postmenopausal women. There was no effect modification by HT, previous screening participation, or morbidities, besides suggestive evidence of enhanced non-participation in diabetic overweight and obese women. Conclusions Underweight and very obese postmenopausal women were significantly less likely to participate in mammographic screening than women with normal weight, while BMI was not related to screening in premenopausal women. Effect of BMI on mammographic screening participation was not significantly modified by HT, previous screening participation, or morbidities.
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Affiliation(s)
- Sophie Sell Hellmann
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Sisse Helle Njor
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Anja Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Ilse Vejborg
- Diagnostic Imaging Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Zorana Jovanovic Andersen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
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Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16:319-26. [PMID: 25752756 PMCID: PMC4381543 DOI: 10.1111/obr.12266] [Citation(s) in RCA: 639] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.
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Affiliation(s)
- SM Phelan
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
| | - DJ Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical CenterMinneapolis, Minnesota, USA
- Department of Medicine, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - MW Yeazel
- Department of Family Medicine and Community Health, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - WL Hellerstedt
- Division of Epidemiology and Community Health, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - JM Griffin
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
| | - M van Ryn
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
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Miller S, Rafanan L, Keihany S, Reyes-Ortiz CA. The relationship between body mass index and cancer screening utilization among older women in Latin American and Caribbean cities. J Women Aging 2015; 27:3-16. [PMID: 25551260 DOI: 10.1080/08952841.2014.905403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To examine the relationship between body mass index and cancer screening utilization, we analyzed data from six cities of the Health, Well-Being and Aging in Latin America and the Caribbean Study on 5,230 women aged 60 and older, from 1999 to 2000. We found that underweight women were less likely to have had a mammogram, a breast self-exam, and a Pap smear, relative to normal-weight women. However, overweight or obese women were more likely to have a breast self-exam and a Pap smear. Thus, being underweight had a role for decreased cancer screening utilization among older women in Latin American cities, but not being overweight or obese, which was associated with decreased cancer screening in most previous studies.
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Affiliation(s)
- Stephen Miller
- a Texas College of Osteopathic Medicine , Fort Worth , TX
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58
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Masters RK, Hummer RA, Powers DA, Beck A, Lin SF, Finch BK. Long-term trends in adult mortality for U.S. Blacks and Whites: an examination of period- and cohort-based changes. Demography 2014; 51:2047-73. [PMID: 25403151 PMCID: PMC4420626 DOI: 10.1007/s13524-014-0343-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Black-white differences in U.S. adult mortality have narrowed over the past five decades, but whether this narrowing unfolded on a period or cohort basis is unclear. The distinction has important implications for understanding the socioeconomic, public health, lifestyle, and medical mechanisms responsible for this narrowing. We use data from 1959 to 2009 and age-period-cohort (APC) models to examine period- and cohort-based changes in adult mortality for U.S. blacks and whites. We do so for all-cause mortality among persons aged 15-74 as well as for several underlying causes of death more pertinent for specific age groups. We find clear patterns of cohort-based reductions in mortality for both black men and women and white men and women. Recent cohort-based reductions in heart disease, stroke, lung cancer, female breast cancer, and other cancer mortality have been substantial and, save for breast cancer, have been especially pronounced for blacks. Period-based changes have also occurred and are especially pronounced for some causes of death. Period-based reductions in blacks' and whites' heart disease and stroke mortality are particularly impressive, as are recent period-based reductions in young men's and women's mortality from infectious diseases and homicide. These recent period changes are more pronounced among blacks. The substantial cohort-based trends in chronic disease mortality and recent period-based reductions for some causes of death suggest a continuing slow closure of the black-white mortality gap. However, we also uncover troubling signs of recent cohort-based increases in heart disease mortality for both blacks and whites.
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Affiliation(s)
- Ryan K Masters
- Department of Sociology and Institute of Behavioral Science, University of Colorado at Boulder, UCB 327 Ketchum 214, Boulder, CO, 80309, USA,
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Gudzune KA, Bennett WL, Cooper LA, Clark JM, Bleich SN. Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships. Obesity (Silver Spring) 2014; 22:1952-5. [PMID: 24942593 PMCID: PMC4149586 DOI: 10.1002/oby.20808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/27/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. METHODS In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. RESULTS Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p < 0.01] than nonshoppers. No significant differences in reporting high trust in current PCPs were found. CONCLUSIONS A subset of patients with overweight/obesity doctor shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Bussière C, Sicsic J, Pelletier-Fleury N. The effects of obesity and mobility disability in access to breast and cervical cancer screening in france: results from the national health and disability survey. PLoS One 2014; 9:e104901. [PMID: 25133662 PMCID: PMC4136821 DOI: 10.1371/journal.pone.0104901] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/15/2014] [Indexed: 12/01/2022] Open
Abstract
Objectives We aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women. Methods The data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications. Results Compared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score. Conclusion Obesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.
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Kann S, Schmid SM, Eichholzer M, Huang DJ, Amann E, Güth U. The impact of overweight and obesity on breast cancer: data from Switzerland, so far a country little affected by the current global obesity epidemic. Gland Surg 2014; 3:181-97. [PMID: 25207211 PMCID: PMC4139123 DOI: 10.3978/j.issn.2227-684x.2013.12.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/03/2013] [Indexed: 12/26/2022]
Abstract
This review presents results from the project "The Impact of Overweight/Obesity on Breast Cancer: data from Switzerland". Swiss data is interesting because the general female population is distinctive in two areas when compared to that of most other industrialized countries: Switzerland has comparatively low rates of overweight (22-23%) and obesity (7-8%) and has rather stable rates of overweight and obesity. The entire project comprised three major issues: (I) etiology of breast cancer (BC). There is a consistently shown association between obesity and postmenopausal BC risk in countries with high obesity prevalence rates in the literature. In our Swiss study group, however, we did not find higher rates of overweight and obesity in postmenopausal BC cases than in the general population. A possible explanation for this observation may be a curvilinear dose-response relationship between BMI and postmenopausal BC risk, so that an increased risk may only be observed in populations with a high prevalence of obese/very obese women; (II) tumor characteristics. BMI was significantly associated with tumor size; this applied not only to the cases where the tumor was found by self-detection, but also to lesions detected by radiological breast examinations. In addition, a higher BMI was positively correlated with advanced TNM stage, unfavorable grading and a higher St. Gallen risk score. No associations were observed between BMI and histological subtype, estrogen receptor status, HER2 status and triple negative BC; (III) patient compliance and persistence towards adjuvant BC therapy. Many studies found that the prognosis of overweight/obese BC patients was significantly lower than that of normal weight patients. However, failure of compliance and persistence towards therapy on the part of the patient is not a contributing factor for this observed unfavorable prognosis. In most therapy modes, patients with increasing BMI demonstrated greater motivation and perseverance towards the recommended treatment.
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Philip EJ, Shelton RC, Thompson HS, Efuni E, Itzkowitz S, Jandorf L. Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation? Cancer Causes Control 2014; 25:1227-31. [PMID: 24946743 DOI: 10.1007/s10552-014-0415-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/10/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans. METHODS This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai's Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline. RESULTS The mean BMI of the sample was 31.17 kg/m(2), with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight status. Adjusting for age, gender, race/ethnicity, family history of colorectal cancer, smoking status, comorbid conditions, income, marital status, insurance, and education, obesity status was not significantly associated with screening behavior among the entire sample (adjusted OR 0.81, CI 0.49-1.32, p = 0.39) or among stratified race/ethnicity and gender groups. CONCLUSIONS These findings suggest that obesity may not negatively influence receipt of colonoscopy screening in the context of patient navigation among minority participants. Further studies are needed to determine whether this finding will be observed in other populations, with and without the assistance of a patient navigator.
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Affiliation(s)
- Errol J Philip
- Memorial Sloan Kettering Cancer Center, 641 Lexington Street, 7th Floor, New York, NY, 10022, USA,
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63
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Wernli KJ, Hubbard RA, Johnson E, Chubak J, Kamineni A, Green BB, Rutter CM. Patterns of colorectal cancer screening uptake in newly eligible men and women. Cancer Epidemiol Biomarkers Prev 2014; 23:1230-7. [PMID: 24793956 DOI: 10.1158/1055-9965.epi-13-1360] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake. METHODS We identified a cohort of 81,223 men and women who were members of Group Health and turned 50 years old from 1996 to 2010. We ascertained receipt of colorectal cancer screening within five years. Time to screening was estimated by year of cohort entry using cumulative incidence curves and Cox proportional hazards models-estimated patient characteristics associated with screening uptake. RESULTS Stool-based screening tests were the most common, 72% of first screening tests. The proportion of individuals initiating colorectal cancer screening via colonoscopy increased from 8% in 1996 to 1998 to 33% in 2008 to 2010. Patient factors associated with increased colorectal cancer screening were: turning 50 more recently (2008-2010; Ptrend < 0.0001) or Asian race [HR, 1.14; 95% confidence interval (CI), 1.10-1.19]. Patient factors associated with decreased screening were: being a woman (HR, 0.70; 95% CI, 0.68-0.72), Native American (HR, 0.68; 95% CI, 0.60-0.78), or Pacific Islander race (HR, 0.82; 95% CI, 0.72-0.95), and having prevalent diabetes (HR, 0.78; 95% CI, 0.75-0.82) and higher body mass index (Ptrend < 0.0001). CONCLUSIONS Patient characteristics associated with initiation of colorectal cancer screening in a newly eligible population are similar to characteristics associated with overall screening participation in all age-eligible adults. Our results identify patient populations to target in outreach programs. IMPACT Disparities in receipt of colorectal cancer screening are evident from onset of an age-eligible cohort, identifying key groups for future interventions for screening.
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Affiliation(s)
- Karen J Wernli
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Rebecca A Hubbard
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Eric Johnson
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Jessica Chubak
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Aruna Kamineni
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Beverly B Green
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
| | - Carolyn M Rutter
- Authors' Affiliation: Group Health Research Institute, Seattle, Washington
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64
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Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, Hardeman R, Perry S, van Ryn M. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring) 2014; 22:1201-8. [PMID: 24375989 PMCID: PMC3968216 DOI: 10.1002/oby.20687] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/14/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. METHODS A web-based survey was completed by 4,732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bias: a feeling thermometer and the anti-fat attitudes test. RESULTS A majority of students exhibited implicit (74%) and explicit (67%) weight bias. Implicit weight bias scores were comparable to reported bias against racial minorities. Explicit attitudes were more negative toward obese people than toward racial minorities, gays, lesbians, and poor people. In multivariate regression models, implicit and explicit weight bias was predicted by lower BMI, male sex, and non-Black race. Either implicit or explicit bias was also predicted by age, SES, country of birth, and specialty choice. CONCLUSIONS Implicit and explicit weight bias is common among 1st year medical students, and varies across student factors. Future research should assess implications of biases and test interventions to reduce their impact.
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Affiliation(s)
- Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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65
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Eichholzer M, Huang DJ, Modlasiak A, Schmid SM, Schötzau A, Rohrmann S, Güth U. Impact of body mass index on prognostically relevant breast cancer tumor characteristics. ACTA ACUST UNITED AC 2014; 8:192-8. [PMID: 24415969 DOI: 10.1159/000350002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study analyzes the association of body mass index (BMI) and prognostically relevant breast cancer (BC) characteristics in a country that has been rather spared of the global obesity epidemic. PATIENTS AND METHODS Based on 20-year data (1999-2009, n = 1,414) of the prospective relational BC database of the University Hospital Basel, Switzerland, the associations between BMI, tumor size and stage, histological subtype, grading, hormonal receptor status, HER2 status and 'triple-negative' status were evaluated. Multivariate analysis considered BMI and patient's age. RESULTS The association between increasing BMI and the above-mentioned variables were as follows (results described in each case: Beta-coefficient or odds ratio, 95% confidence interval, p value): tumor size, (1) entire cohort: 0.03 (0.01-0.05), p < 0.001, (2) tumor found by self-palpation: 0.05 (0.03-0.07), p < 0.001, (3) tumor found by radiological examination: 0.03 (0-0.07), p = 0.044; advanced TNM stage: 1.16 (1.02-1.31), p = 0.022; histological subtype: 1.04 (0.89-1.22), p = 0.602; unfavorable grading: 1.11 (1.00-1.25), p = 0.057; positive estrogen receptor status: 0.95 (0.83-1.09), p = 0.459; positive HER2 status: 0.92 (0.74-1.15), p = 0.467; presence of a 'triple-negative' carcinoma: 1.19 (0.93-1.52), p = 0.165. Consideration of only postmenopausal BC patients (n = 1,063) did attenuate the results, but did not change the direction of the associations with BMI. CONCLUSION BMI was positively associated with TNM stage, grading and tumor size for tumors that were found by self-detection, as well as for those lesions detected by radiological breast examinations.
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Affiliation(s)
- Monika Eichholzer
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Basel, Switzerland
| | - Dorothy J Huang
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland
| | - Alexandra Modlasiak
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland
| | - Seraina M Schmid
- Department of Gynecology and Obstetrics, Breast center, Hospital Grabs, Basel, Switzerland
| | - Andreas Schötzau
- Schötzau and Simmen Institute for Biomathematics, Basel, Switzerland
| | - Sabine Rohrmann
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Basel, Switzerland
| | - Uwe Güth
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland ; Department of Gynecology and Obstetrics, Breast center, Cantonal Hospital Winterthur, Switzerland
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Hilbert A, Braehler E, Haeuser W, Zenger M. Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity (Silver Spring) 2014; 22:79-85. [PMID: 23836723 DOI: 10.1002/oby.20561] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. DESIGN AND METHODS In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. RESULTS In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. CONCLUSIONS The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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67
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Clinical Prevention. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_7-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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68
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Lafata JE, Cooper G, Divine G, Oja-Tebbe N, Flocke SA. Patient-physician colorectal cancer screening discussion content and patients' use of colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2014; 94:76-82. [PMID: 24094919 PMCID: PMC3865022 DOI: 10.1016/j.pec.2013.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 08/05/2013] [Accepted: 09/07/2013] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The US Preventive Services Task Force recommends using the 5As (i.e., Assess, Advise, Agree, Assist and Arrange) when discussing preventive services. We evaluate the association of the 5As discussion during primary care office visits with patients' subsequent colorectal cancer (CRC) screening use. METHODS Audio-recordings of n=443 periodic health exams among insured patients aged 50-80 years and due for CRC screening were joined with pre-visit patient surveys and screening use data from an electronic medical record. Association of the 5As with CRC screening was assessed using generalized estimating equations. RESULTS 93% of patients received a recommendation for screening (Advise) and 53% were screened in the following year. The likelihood of screening increased as the number of 5A steps increased: compared to patients whose visit contained no 5A step, those whose visit contained 1-2 steps (OR=2.96 [95% CI 1.16, 7.53]) and 3 or more steps (4.98 [95% CI 1.84, 13.44]) were significantly more likely to use screening. CONCLUSIONS Physician CRC screening recommendations that include recommended 5A steps are associated with increased patient adherence. PRACTICE IMPLICATIONS A CRC screening recommendation (Advise) that also describes patient eligibility (Assess) and provides help to obtain screening (Assist) may lead to improved adherence to CRC screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Virginia Commonwealth University, Richmond, USA; Henry Ford Health System, Detroit, USA.
| | - Greg Cooper
- Case Western Reserve University, Cleveland, USA
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Dugué PA, Lynge E, Rebolj M. Mortality of non-participants in cervical screening: Register-based cohort study. Int J Cancer 2013; 134:2674-82. [DOI: 10.1002/ijc.28586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | - Elsebeth Lynge
- Department of Public Health; University of Copenhagen; Copenhagen, Denmark
| | - Matejka Rebolj
- Department of Public Health; University of Copenhagen; Copenhagen, Denmark
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Choi KH, Heo J, Kim S, Jeon YJ, Oh M. Factors Associated With Breast and Cervical Cancer Screening in Korea. Asia Pac J Public Health 2013; 25:476-86. [DOI: 10.1177/1010539513506601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated factors associated with breast and cervical cancer screening using data from a nationwide community survey. A nationwide cross-sectional study was performed in all 253 administrative districts of Korea. The breast and cervical cancer screening rate was negatively associated with the obesity (β = −2.91, 95% confidence interval [CI] = −4.73 to −1.03; β = −1.93, 95% CI = −3.43 to −0.43), positively associated with the European Quality of Life-5 Dimensions scale (β =2.53, 95% CI = 0.24 to 4.81; β = 2.51, 95% CI = 0.68 to 4.34). Moreover, higher alcohol consumption rate was negatively related to screening rates for breast cancer, while areas with higher proportion of diabetes were found to have higher screening rates. Area with higher rate of osteoarthritis had a lower screening rate for cervical cancer. This study showed breast and cervical cancer screening was associated with particular area characteristics. This ecological approach is thought to be a major complement to measures of health attributes.
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Affiliation(s)
- Kyung-Hyun Choi
- Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | | | - Soyeun Kim
- Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | | | - Myungju Oh
- CHA Bundang Medical Center, CHA University, Bundang, Korea
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71
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Adjaye-Gbewonyo K, Sabatino SA, White MC. Exploring opportunities for colorectal cancer screening and prevention in the context of diabetes self-management: an analysis of the 2010 National Health Interview Survey. Transl Behav Med 2013; 3:72-81. [PMID: 24073162 DOI: 10.1007/s13142-012-0187-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Because diabetes is associated with increased colorectal cancer (CRC) risk, it is important that people with diabetes receive CRC screenings according to guidelines. In addition, many diabetes self-care recommendations are associated with a reduced risk of CRC. This study aims to identify potential opportunities for enhancing CRC prevention within the context of diabetes management. Using data from 1,730 adults with diabetes aged 50-75 years who responded to the 2010 National Health Interview Survey, we calculated population estimates of behaviors consistent with US Preventive Services Task Force guidelines for CRC screening and American Diabetes Association recommendations for diabetes care. We examined bivariate associations between CRC screening and selected diabetes self-care behaviors associated with CRC risk. Results were stratified by demographic characteristics. Thirty-nine percent of adults with diagnosed diabetes were not up-to-date with CRC screenings. Sixteen percent smoked and 2 % exceeded alcohol intake recommendations. Among those capable of exercise, 69 and 90 % did not meet aerobic exercise and resistance training recommendations, respectively. CRC screening was generally not associated with diabetes self-care behaviors. Among some demographic groups, CRC screening was associated with adequate aerobic activity, not smoking, and being overweight or obese. Many adults with diabetes do not follow guidelines for CRC screening or recommendations for diabetes care that may also reduce CRC risk. Thus, opportunities may exist to jointly promote CRC screening and prevention and diabetes self-management among adults with diabetes.
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Affiliation(s)
- Kafui Adjaye-Gbewonyo
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-55, Atlanta, GA 30341 USA ; Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building 7th floor, Boston, MA 02115 USA
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Abstract
Mobile mammography services are typically offered as a means to increase access and adherence to mammography screenings. As mobile mammography becomes a viable strategy to increase screening, a 3 year study of such a state-wide program in WV found surprisingly high rates of obesity within the study population. Thus, the objectives were to: (1) describe the demographic characteristics and comorbidities of women who utilized the WV program, and (2) determine the association between body mass index (BMI) and personal health and screening history, preventive care and wellness behaviors, nutrition and exercise behaviors, and demographics. Data collected from 1,099 women, age 40 and above, were analyzed using descriptive statistics, bivariate analyses, and a multivariate regression model. The majority (60.4 %) were married, had an income <$25,000 (59.2 %), and had health insurance (53.5 %). Major comorbidities were hypertension (49 %) and high cholesterol (43.9 %). Based on BMI scores, 884 participants were either overweight (26.6 %), mildly obese (27.7 %), moderately obese (15.1 %), or severely obese (11.1 %). Bivariate analyses indicated that increasing BMI was significantly associated with factors such as having hypertension or diabetes, limited daily activities, perceived health, and not smoking or drinking. The regression model was significant (p < 0.001; R2 = 0.425) indicating that women who engaged in preventive care behaviors were less likely to be obese than those who did not. The WV mobile mammography program appeared to attract women who were disproportionately obese and had multiple comorbidities, thus providing a great opportunity for targeted interventions related to improving preventive care and screening behaviors.
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73
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Robinson JA, Burke AE. Obesity and hormonal contraceptive efficacy. WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:453-66. [PMID: 24007251 PMCID: PMC4079263 DOI: 10.2217/whe.13.41] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy.
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MESH Headings
- Bariatric Surgery
- Body Mass Index
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Agents, Female/therapeutic use
- Contraceptive Devices, Female
- Contraceptives, Oral, Hormonal/pharmacokinetics
- Contraceptives, Oral, Hormonal/therapeutic use
- Contraceptives, Postcoital/pharmacokinetics
- Contraceptives, Postcoital/therapeutic use
- Counseling
- Drug Implants/pharmacokinetics
- Drug Implants/therapeutic use
- Estrogens/pharmacokinetics
- Estrogens/therapeutic use
- Female
- Humans
- Intrauterine Devices
- Obesity/metabolism
- Obesity/surgery
- Pregnancy
- Pregnancy, Unplanned
- Progestins/pharmacokinetics
- Progestins/therapeutic use
- Women's Health
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Affiliation(s)
- Jennifer A Robinson
- Department of Gynecology & Obstetrics, Johns Hopkins University Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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74
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Decker KM, Turner D, Demers AA, Martens PJ, Lambert P, Chateau D. Evaluating the Effectiveness of Cervical Cancer Screening Invitation Letters. J Womens Health (Larchmt) 2013; 22:687-93. [DOI: 10.1089/jwh.2012.4203] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kathleen M. Decker
- Screening Programs, CancerCare Manitoba, Winnipeg Manitoba, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg Manitoba, Canada
| | - Donna Turner
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg Manitoba, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg Manitoba, Canada
| | - Alain A. Demers
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg Manitoba, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg Manitoba, Canada
| | - Patricia J. Martens
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg Manitoba, Canada
| | - Pascal Lambert
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg Manitoba, Canada
| | - Daniel Chateau
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg Manitoba, Canada
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The link between women's body image disturbances and body-focused cancer screening behaviors: a critical review of the literature and a new integrated model for women. Body Image 2013; 10:149-62. [PMID: 23265838 DOI: 10.1016/j.bodyim.2012.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/07/2012] [Accepted: 11/20/2012] [Indexed: 11/20/2022]
Abstract
A large body of literature demonstrates the association between body image disturbances and health compromising behaviors among women (e.g., pathological eating, substance use, inappropriate exercise). However, given that disturbed body image is a pervasive problem, it is likely inversely related to health maintenance behaviors. Cancer screenings for breast, skin, and cervical cancer represent an important type of health maintenance behavior, yet adherence rates are low. Given the body-focused nature of these screenings, body image may be a salient predictor. This paper reviews the literature on the relationship between body image disturbances and cancer screening behaviors among women culminating in the proposal of a theoretical model. This model posits that body shame and body avoidance predict performance of cancer screenings and that variables drawn from the cancer literature, including risk perception, health anxiety, subjective norms, and self-efficacy, may moderate this relationship. Clinical implications and suggestions for research are discussed.
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76
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Batina NG, Trentham-Dietz A, Gangnon RE, Sprague BL, Rosenberg MA, Stout NK, Fryback DG, Alagoz O. Variation in tumor natural history contributes to racial disparities in breast cancer stage at diagnosis. Breast Cancer Res Treat 2013; 138:519-28. [PMID: 23417335 DOI: 10.1007/s10549-013-2435-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/28/2013] [Indexed: 11/26/2022]
Abstract
Black women tend to be diagnosed with breast cancer at a more advanced stage than whites and subsequently experience elevated breast cancer mortality. We sought to determine whether there are racial differences in tumor natural history that contribute to these disparities. We used the University of Wisconsin Breast Cancer Simulation Model, a validated member of the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network, to evaluate the contribution of racial differences in tumor natural history to observed disparities in breast cancer incidence. We fit eight natural history parameters in race-specific models by calibrating to the observed race- and stage-specific 1975-2000 U.S. incidence rates, while accounting for known racial variation in population structure, underlying risk of breast cancer, screening mammography utilization, and mortality from other causes. The best fit models indicated that a number of natural history parameters must vary between blacks and whites to reproduce the observed stage-specific incidence patterns. The mean of the tumor growth rate parameter was 63.6 % higher for blacks than whites (0.18, SE 0.04 vs. 0.11, SE 0.02). The fraction of tumors considered highly aggressive based on their tendency to metastasize at a small size was 2.2 times greater among blacks than whites (0.41, SE 0.009 vs. 0.019, SE 0.008). Based on our simulation model, breast tumors in blacks grow faster and are more likely to metastasize earlier than tumors in whites. These differences suggest that targeted prevention and detection strategies that go beyond equalizing access to mammography may be needed to eliminate breast cancer disparities.
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Affiliation(s)
- Nataliya G Batina
- Department of Industrial and Systems Engineering, University of Wisconsin, 1513 University Avenue, Madison, WI 53706, USA
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77
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Consedine NS. The demographic, system, and psychosocial origins of mammographic screening disparities: prediction of initiation versus maintenance screening among immigrant and non-immigrant women. J Immigr Minor Health 2012; 14:570-82. [PMID: 21904869 DOI: 10.1007/s10903-011-9524-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disparities in breast screening are well documented. Less clear are differences within groups of immigrant and non-immigrant minority women or differences in adherence to mammography guidelines over time. A sample of 1,364 immigrant and non-immigrant women (African American, English Caribbean, Haitian, Dominican, Eastern European, and European American) were recruited using a stratified cluster-sampling plan. In addition to measuring established predictors of screening, women reported mammography frequency in the last 10 years and were (per ACS guidelines at the time) categorized as never, sub-optimal (<1 screen/year), or adherent (1+ screens/year) screeners. Multinomial logistic regression showed that while ethnicity infrequently predicted the never versus sub-optimal comparison, English Caribbean, Haitian, and Eastern European women were less likely to screen systematically over time. Demographics did not predict the never versus sub-optimal distinction; only regular physician, annual exam, physician recommendation, and cancer worry showed effects. However, the adherent categorization was predicted by demographics, was less likely among women without insurance, a regular physician, or an annual exam, and more likely among women reporting certain patterns of emotion (low embarrassment and greater worry). Because regular screening is crucial to breast health, there is a clear need to consider patterns of screening among immigrant and non-immigrant women as well as whether the variables predicting the initiation of screening are distinct from those predicting systematic screening over time.
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Affiliation(s)
- Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
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78
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Friedman AM, Hemler JR, Rossetti E, Clemow LP, Ferrante JM. Obese women's barriers to mammography and pap smear: the possible role of personality. Obesity (Silver Spring) 2012; 20:1611-7. [PMID: 22370590 PMCID: PMC3378788 DOI: 10.1038/oby.2012.50] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obese women are at increased risk of developing and dying from cancer, but are less likely than nonobese women to receive cancer screening examinations. Our qualitative study explores obese women's barriers to Pap smears and mammograms in greater depth than previous research. We also seek to understand why some obese women undergo screening whereas others do not. A purposive sample of moderately to severely obese women over age 40 was recruited from community-based organizations, health clinics, and retail establishments. Semi-structured in-depth interviews (N = 33) informed by the Theory of Care-Seeking Behavior and three prior focus groups of obese women (N = 18) were recorded and transcribed. Qualitative analysis was iterative, using a grounded theory approach involving a series of immersion/crystallization cycles. Participants verified many barriers to cervical and breast cancer screening previously identified in the general population, including fear, modesty, competing demands, and low perceived risk. Participants also highlighted several weight-related barriers, including insensitive comments about weight and equipment and gowns that could not accommodate them. Comparison of participants who were up-to-date with both Pap smears and mammograms with those not up-to-date with either screening showed no discernable differences in these barriers, however. Instead, we found that the participants who followed through on their cancer screenings may share certain personality traits, such as conscientiousness or self-regulatory ability, that allow them to complete difficult or feared tasks. Our research therefore suggests that personality may act as an important mediator in health behavior, and should be taken into account in future theoretical models and health behavior interventions, particularly for obese women.
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Affiliation(s)
- Asia M Friedman
- Research Division, Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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79
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Messina CR, Lane DS, Anderson JC. Body mass index and screening for colorectal cancer: gender and attitudinal factors. Cancer Epidemiol 2012; 36:400-8. [PMID: 22386859 PMCID: PMC4230010 DOI: 10.1016/j.canep.2012.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Overweight/obese women and men are at increased risk for colorectal cancer (CRC) incidence and mortality. Research examining body mass index (BMI) and CRC screening has had mixed results. A clearer understanding of the extent to which high-BMI subgroups are screened for CRC is needed to inform planning for CRC screening promotions targeting BMI. METHODS Data were obtained from a random, population-based sample of women and men at average-risk for CRC (aged 50-75 years) during 2004 (n = 1098). Multiple logistic regression analyses were conducted to evaluate whether BMI category was significantly associated with the probability of reporting recent CRC screening and with the probability of agreeing with statements denoting attitudes/perceptions about CRC and screening. Attitudes/perceptions about CRC and screening were evaluated as potential mediators and moderators of the association between BMI category and CRC screening. RESULTS After controlling for characteristics associated with CRC screening, overweight and obese women were each 40% less likely to have CRC screening than women with normal-BMI (OR = 0.6, 95% CI:0.4-0.9 and OR = 0.6, 95% CI:0.3-0.9). BMI category was unrelated to screening among men. Obese women (but not men) were less aware than normal-BMI women that obesity increased risk for CRC (OR = 0.5, 95% CI:0.3-0.9) and less worried about CRC (OR = 0.5, 95% CI:0.3-0.8). However, findings suggest that attitudes/perceptions about CRC and screening did not mediate or moderate the association between BMI category and CRC screening. CONCLUSION Overweight/obese women are at increased risk for CRC because of their greater BMI and their propensity not to screen for CRC. Study findings suggest that potentially modifiable perceptions, e.g., lack of awareness of risk for CRC and less worry about CRC, in this subgroup may not explain the relationship between BMI category and reduced screening.
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Affiliation(s)
- Catherine R. Messina
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Dorothy S. Lane
- Department of Preventive Medicine, HSC L3, Rm 086, Stony Brook University, Stony Brook NY 11794-8036
| | - Joseph C. Anderson
- Department of Gastroenterology, University of Connecticut, 263 Farmington Avenue Farmington, CT 06030 and VA Outcomes Group, VA Medical Center, 215 Main Street, Gastroenterology (111E), White River Junction, Vermont 05009
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80
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Park JK, Park HA, Park JJ, Cho YG. Obesity and Screening Compliance for Breast and Cervical Cancer in Korean Women. Asian Pac J Cancer Prev 2012; 13:3271-4. [DOI: 10.7314/apjcp.2012.13.7.3271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Artandi MK. Conceptual basis and clinical rationale for the development of a multidisciplinary weight management center. INTERNATIONAL JOURNAL OF OBESITY SUPPLEMENTS 2012; 2:S43-S46. [PMID: 25018870 PMCID: PMC4089699 DOI: 10.1038/ijosup.2012.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Overweight (body mass index (BMI) 25 kg m−2) or obesity (BMI 30>kg m−2) affects more than two-thirds of Americans. Overweight and obesity are commonly associated with multiple coexisting conditions, such as hypertension, diabetes, dyslipidemia, cardiovascular disease, obstructive sleep apnea and cancer. Lifestyle modification can induce a modest weight loss, which is associated with the prevention or improvement of many of these comorbidities. A combination of diet, exercise and behavioral therapy is considered the cornerstone of treatment for all overweight and obese individuals. As the etiology and therapy of obesity is complex, what is needed for these patients is a multidisciplinary clinic where specialists from different disciplines share their knowledge and participate in the treatment of the obese patient.
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Affiliation(s)
- M K Artandi
- Department of Medicine, Stanford University School of Medicine , Stanford, CA, USA
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82
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Leone LA, Campbell MK, Allicock M, Pignone M. Colorectal cancer screening and physical activity promotion among obese women: an online evaluation of targeted messages. JOURNAL OF HEALTH COMMUNICATION 2012; 17:1187-203. [PMID: 22775294 PMCID: PMC4201496 DOI: 10.1080/10810730.2012.665422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Obese women are at higher risk for several cancers, but are less likely than normal weight women to engage in cancer prevention behaviors such as screening and physical activity. Targeted health messages may help increase healthy behaviors among vulnerable groups such as obese women. Using findings from focus groups with obese women, the authors created targeted messages to promote colorectal cancer screening and physical activity among obese women. The messages addressed psychosocial constructs, such as benefits and barriers to colorectal cancer screening and exercise, which were relevant to the target population. Messages were tested online with women age 50 years and older (N = 181). Participants were stratified by weight (obese vs. nonobese) and randomized to review either 10 targeted (intervention) or 10 generic (control) messages. Study outcomes included elaboration about the messages, message relevance and trustworthiness, and behavioral intentions. The authors used moderation and subgroup analyses to determine whether the intervention messages were better received by certain women. They found no differences in elaboration, behavioral intentions, relevance, or trustworthiness between intervention and control for either weight group. However, exercise intentions increased more (p = .06) among inactive obese women who received intervention messages (+2.9) compared with those who were in the control group (+1.2). Intervention messages also produced more elaboration among women who viewed their weight as a barrier to screening or exercise. Tailoring intervention messages for obese women on the basis of behavior and barriers may improve outcomes more than giving the same messages to all obese women.
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Affiliation(s)
- Lucia A Leone
- The Lineberger Comprehensive Cancer Center, and the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA.
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83
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Leone LA, Allicock M, Pignone MP, Johnson LS, Walsh JF, Campbell MK. Cancer screening patterns by weight group and gender for urban African American church members. J Community Health 2012; 37:299-306. [PMID: 21800187 DOI: 10.1007/s10900-011-9445-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obese white women have lower rates of cancer screening compared to non-obese women. This study will determine if a relationship exists between weight and adherence to cancer screening guidelines among African Americans. We used multivariate logistic regression to examine the relationship between being up-to-date with cancer screening (colorectal, breast, cervical, and prostate) and weight group (normal, overweight, obese I, obese II+) using data from older (age 50+) members (N = 955) of 20 African American churches in Michigan and North Carolina. CRC testing rates were examined using multiple definitions to account for differences in screening rates vs. polyp surveillance rates. After adjusting for confounders, we found relationships between weight group and up-to-date CRC (P = 0.04) and PSA (P = 0.004) testing for men and mammography (P = 0.03) for women. Compared to normal-weight men, obese I men were more likely to be up-to-date with CRC (OR 2.35, 95%CI 1.02-5.40) and PSA (OR 4.24 95%CI 1.77-10.17) testing. CRC screening rates were lower when individuals with polyps were excluded from the analysis; however, patterns by weight remained the same. Contrary to previous research, we did not find lower rates of cancer screening among obese African Americans. Instead, we found that normal-weight African American men had lower screening rates than any other group. As we did not consistently find lower screening rates among obese African Americans, targeting this group for increased screening promotion may not be the most effective way to reduce weight-related cancer disparities.
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Affiliation(s)
- Lucia A Leone
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB#7590, Chapel Hill, NC 27599-7590, USA.
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84
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514;+10.1002/cncr.27514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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85
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012; 118:2338-66. [PMID: 22460733 PMCID: PMC4586174 DOI: 10.1002/cncr.27514] [Citation(s) in RCA: 329] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/03/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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86
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Maruthur NM, Bolen S, Gudzune K, Brancati FL, Clark JM. Body mass index and colon cancer screening: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2012; 21:737-46. [PMID: 22492832 DOI: 10.1158/1055-9965.epi-11-0826] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing. METHODS We conducted a systematic review to determine whether obesity is associated with lower rates of colon cancer screening. We searched the PubMed, CINAHL, and Cochrane Library databases. Two investigators reviewed citations, abstracts, and articles independently. Two investigators abstracted study information sequentially and evaluated quality independently using standardized forms. We included all studies in our qualitative syntheses. We used random effects meta-analyses to combine those studies providing screening results by the following body mass index (BMI) categories: Normal, 18.5-24.9 kg/m(2) (reference); overweight, 25-29.9 kg/m(2); class I obesity, 30-34.9 kg/m(2); class II obesity, 35-39.9 kg/m(2); and class III obesity, ≥ 40 kg/m(2). RESULTS Of 5,543 citations, we included 23 articles. Almost all studies were cross-sectional and ascertained BMI and screening through self-report. BMI was not associated with colon cancer screening overall. The subgroup of obese white women reported lower rates of colon cancer screening compared with those with a normal BMI with combined ORs (95% CI) of 0.87 (0.82-0.93), 0.80 (0.65-0.99), and 0.73 (0.58-0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity. CONCLUSIONS Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared with those with a normal BMI. IMPACT Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.
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Affiliation(s)
- Nisa M Maruthur
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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87
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514; 10.1002/cncr.27514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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88
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Haakinson DJ, Leeds SG, Dueck AC, Gray RJ, Wasif N, Stucky CCH, Northfelt DW, Apsey HA, Pockaj B. The impact of obesity on breast cancer: a retrospective review. Ann Surg Oncol 2012; 19:3012-8. [PMID: 22451232 DOI: 10.1245/s10434-012-2320-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Obesity has been linked to many adverse health consequences, including breast cancer; however, the impact on clinical presentation, tumor characteristics, and survival outcomes has yet to be clearly defined. METHODS Retrospective review of a prospectively collected database of patients treated at a single institution for invasive breast cancer from 2000-2008 comparing two groups: nonobese (body mass index of <30) and obese (body mass index of ≥ 30) patients. Continuous variables, categorical variables, and survival data were analyzed. RESULTS Of 1352 total patients, 76% were classified as nonobese and 24% were obese. When comparing age, obese patients presented less frequently than nonobese patients <50 years old (10% vs. 90%), and when comparing patients >50 years old (18% vs. 82%, P = 0.0019). Obese patients were more likely to present with disease detected by imaging when compared to nonobese patients (67% vs. 56%, P = 0.0006). Obese patients had larger tumors (1.7 cm vs. 1.4 cm, P < 0.001) and higher rates of lymph node (LN) metastases (31% vs. 25%, P = 0.026). On multivariate analysis, obesity was associated with nonpalpable tumors, larger tumors, a higher incidence of LN metastasis, lower incidence of Her2 positivity, lower incidence of multifocality, and less likely to undergo reconstruction after mastectomy. CONCLUSIONS Obese patients clinically present at older ages with mammographically detected breast cancer at more advanced stages than nonobese patients. Strategies to encourage screening among the obese patient population are important.
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89
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Cohen SS, Murff HJ, Signorello LB, Blot WJ. Obesity and colorectal cancer screening among black and white adults. Cancer Causes Control 2012; 23:709-16. [PMID: 22441878 DOI: 10.1007/s10552-012-9940-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/06/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE To examine whether body mass index is associated with reduced colorectal cancer (CRC) screening in a large population of black and white adults. METHODS Cross-sectional data collected at baseline for 9,547 black men, 14,515 black women, 3,519 white men, and 7,245 white women aged 50-79 enrolled in the Southern Community Cohort Study from 2002 to 2009 were used to examine odds ratios (OR) with 95 % confidence intervals (CI) for the use of colonoscopy or sigmoidoscopy in relation to body mass index (BMI) categories (<18.5, 18.5-24.9 (referent), 25-29.9, 30-34.9, 35-39.9, and 40+ (extreme obesity), kg/m(2)) using logistic regression controlling for age, education, income, health insurance status, last physician visit, cigarette smoking, and alcohol consumption. RESULTS Increased BMI was not associated with reduced CRC screening among whites (OR (95 % CI) for BMI ≥ 40 = 1.02 (0.71-1.46) for white men and 0.99 (0.83-1.19) for white women), and odds of CRC screening were increased with high BMI among blacks (OR (95 % CI) for BMI ≥ 40 = 1.34 (1.03-1.74) for black men and 1.13 (0.98-1.29) for black women). Extreme obesity was associated with reduced odds of CRC screening only among white women in subgroup analyses limited to those with health insurance or income ≥$25,000/year. CONCLUSIONS Elevated BMI was not a deterrent to CRC screening overall in this population. In light of low overall screening rates for colorectal cancer nationally, efforts to increase screening in all individuals should remain the focus of public health initiatives.
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Affiliation(s)
- Sarah S Cohen
- International Epidemiology Institute, Rockville, MD 20850, USA.
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90
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Damiani G, Federico B, Basso D, Ronconi A, Bianchi CBNA, Anzellotti GM, Nasi G, Sassi F, Ricciardi W. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health 2012; 12:99. [PMID: 22305108 PMCID: PMC3314546 DOI: 10.1186/1471-2458-12-99] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 02/03/2012] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15, 486 women aged 50-69 years for mammography and one of 35, 349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.81; 95% CI = 1.63-2.01). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.
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Affiliation(s)
- Gianfranco Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Bruno Federico
- Department of Health and Sport Sciences, Università di Cassino, Via S. Angelo snc, 03043 Cassino (FR), Italy
| | - Danila Basso
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Ronconi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Gian Marco Anzellotti
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriella Nasi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Franco Sassi
- Health Division, Directorate for Employment, Labour and Social Affairs, OECD-Organization for economic Cooperation and Development, 2 rue André Pascal, 75775 Paris, Cedex 16, France
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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91
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Nielson CM, Srikanth P, Orwoll ES. Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res 2012; 27:1-10. [PMID: 23348758 DOI: 10.1002/jbmr.1486] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/24/2011] [Accepted: 11/29/2011] [Indexed: 11/11/2022]
Abstract
In Western societies, mean body weight has increased dramatically in older people, and a similar trend exists in Asia. Yet insufficient attention has been directed to the problem of osteoporotic fractures in the overweight and obese. Many, if not most, osteoporotic fractures occur in overweight or obese people, and obese men may be particularly susceptible. We discuss the potential implications of these findings, including the challenge of identifying individuals at highest risk, screening and treatment strategies, and future research directions.
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Affiliation(s)
- Carrie M Nielson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97201, USA
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92
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Gudzune KA, Huizinga MM, Cooper LA. Impact of patient obesity on the patient-provider relationship. PATIENT EDUCATION AND COUNSELING 2011; 85:e322-e325. [PMID: 21282029 PMCID: PMC3101320 DOI: 10.1016/j.pec.2011.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/22/2010] [Accepted: 01/04/2011] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Health professionals' weight bias may impair obese patients' interactions with providers. However, few studies have examined how negative provider attitudes affect the patient-provider relationship for obese patients. We hypothesized that higher patient body mass index (BMI) would be negatively associated with patient-provider relationship quality. METHODS We analyzed data from the 2007 Health Tracking Household Survey. BMI was the independent variable, and patient-perceived quality of the patient-provider relationship was the outcome. We performed log-binominal regression analyses accounting for complex survey design to examine the association of BMI with the patient-provider relationship. RESULTS Of the 15,197 adult survey respondents, the 6427 who answered the quality of care questions were eligible for analysis. Overall, 29% had a normal range BMI, 34% were overweight, and 37% were obese. We found few differences in ratings of the patient-provider relationship for overweight and obese respondents when compared to respondents with a normal range BMI. CONCLUSION These unexpected findings may have occurred due to patients' inability to perceive providers' weight bias, measurement error in questionnaire items, or decreasing weight bias among health professionals. PRACTICE IMPLICATIONS Patient's positive perceptions of providers may indicate promise for health professionals acting as motivators of behavior change in obese patients.
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Affiliation(s)
- Kimberly Anne Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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93
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Littman AJ, Koepsell TD, Forsberg CW, Boyko EJ, Yancy WS. Preventive care in relation to obesity: an analysis of a large, national survey. Am J Prev Med 2011; 41:465-72. [PMID: 22011416 DOI: 10.1016/j.amepre.2011.07.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/21/2011] [Accepted: 07/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reports from the 1990s observed lower receipt of preventive care services among obese individuals, but a few recent studies in older adults and Department of Veterans Affairs (VA) patients have failed to do so. Additional studies, using population-based samples, are needed to understand whether disparities in care by obesity continue to exist in the U.S. PURPOSE To investigate whether receipt of preventive care services varies in relation to BMI. METHODS This study used data from the 2008 and 2009 Behavioral Risk Factor Surveillance System (analyzed in 2011), a state-based national telephone survey of non-institutionalized U.S. adults, to examine associations between receipt of preventive services (influenza and pneumococcal vaccination; cholesterol and HIV screening; fecal occult blood test; colonoscopy/sigmoidoscopy, mammogram, and Pap) and BMI category (normal, 18.5-24.9; overweight, 25-29.9; obese Class I, 30-34.9; obese Class II, 35-39.9; and obese Class III, ≥40), after adjusting for confounding factors. RESULTS Receipt was lower for mammography and Pap testing (6.1 and 5.6 percentage points, respectively, relative to normal weight women) in obese Class III women. For immunizations, cholesterol screening, and colon cancer screening, receipt was similar or greater in overweight and obese individuals. CONCLUSIONS This study suggests that for most services, obese individuals received as much if not more preventive health care as normal-weight individuals. Although these findings are reassuring, the evidence for disparities for cervical and breast cancer screening in obese women demonstrates that efforts to ensure more equitable service delivery are still needed.
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Affiliation(s)
- Alyson J Littman
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington 98101, USA.
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94
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Nahleh Z. Breast cancer, obesity and hormonal imbalance: a worrisome trend. Expert Rev Anticancer Ther 2011; 11:817-9. [PMID: 21707275 DOI: 10.1586/era.11.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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95
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Tekkel M, Veideman T, Rahu M. Use of mammography, Pap test and prostate examination by body mass index during the developmental period of cancer screening in Estonia. Public Health 2011; 125:697-703. [DOI: 10.1016/j.puhe.2011.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 05/25/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
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96
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Marcus Thygeson N, Solberg LI, Asche SE, Fontaine P, Gregory Pawlson L, Scholle SH. Using fuzzy set qualitative comparative analysis (fs/QCA) to explore the relationship between medical "homeness" and quality. Health Serv Res 2011; 47:22-45. [PMID: 22092269 DOI: 10.1111/j.1475-6773.2011.01303.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Determine, using fuzzy set qualitative comparative analysis (fs/QCA), the relationship between patient-centered medical home (PCMH) systems and quality in 21 NCQA recognized medical homes. DATA SOURCES/STUDY SETTING Primary data collected in 2009, including measures of optimal diabetes care (ODC), preventive services up-to-date (PSUTD), patient experience (PEX), survey data assessing PCMH capabilities (PPC-RS), and other clinic characteristics. STUDY DESIGN Cross-sectional study identifying associations between PPC-RS domains, demographic, socioeconomic, and co-morbidity measures, and quality outcomes. DATA COLLECTION/EXTRACTION METHODS PPC-RS scores were obtained by surveying clinic leaders. PSUTD and ODC scores were obtained from provider performance data. PEX data were obtained from patient surveys. Demographic, socioeconomic, and co-morbidity data were obtained from EMR and census data. PRINCIPAL FINDINGS fs/QCA identified associations between all three outcomes and PCMH capabilities: ODC and team-based care; PSUTD and preventive services systems; and all three outcomes and provider performance reporting systems. Previous statistical analysis of this data had failed to identify these relationships. CONCLUSIONS fs/QCA identified important associations that were overlooked using conventional statistics in a small-N health services data set. PCMH capabilities are associated with quality outcomes.
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Affiliation(s)
- Nels Marcus Thygeson
- Center for Healthcare Innovation, Allina Hospitals & Clinics, Minneapolis, MN 55407-1321, USA.
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97
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Reiter PL, Linnan LA. Cancer Screening Behaviors of African American Women Enrolled in a Community-Based Cancer Prevention Trial. J Womens Health (Larchmt) 2011; 20:429-438. [PMID: 21332413 DOI: 10.1089/jwh.2010.2245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: African American women have increased mortality rates for cervical, breast, and colorectal cancers, yet not all receive the recommended screening tests for these cancers. We characterized the cancer screening behaviors of African American women enrolled in a community-based cancer prevention trial. Methods: We examined cross-sectional data from 1123 African American customers aged ≥18 years from 37 beauty salons in North Carolina who completed the North Carolina BEAUTY and Health Project baseline survey. Mixed logistic regression models were used to identify correlates of receiving cervical, breast, and colorectal cancer screening tests within recommended screening guidelines. Results: Overall, 94% (1026 of 1089) of women aged ≥18 years reported receiving a Pap smear test within the last 3 years, 70% (298 of 425) of women aged ≥40 years reported receiving a mammography within the last year, and 64% (116 of 180) of women aged ≥50 years were considered to be within recommended screening guidelines for colorectal cancer. Age was correlated with recent Pap smear testing and mammography. Women who reported receiving a recent Pap smear test were more likely to report a mammogram in the last year, and women with a recent mammogram were more likely to be within recommended screening guidelines for colorectal cancer. Many women reported multiple barriers to getting recommended cancer screening tests. Conclusions: Almost all women reported receiving a Pap smear test within the last 3 years. Future interventions should focus on increasing breast and colorectal cancer screening among African American women.
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Affiliation(s)
- Paul L Reiter
- Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina
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98
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Fagan HB, Wender R, Myers RE, Petrelli N. Obesity and Cancer Screening according to Race and Gender. J Obes 2011; 2011:218250. [PMID: 22220270 PMCID: PMC3246761 DOI: 10.1155/2011/218250] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/24/2011] [Indexed: 12/21/2022] Open
Abstract
The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the relationship between weight and screening in men is inconsistent, while there is a trend towards lower CRC screening in higher weight women.
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Affiliation(s)
- Heather Bittner Fagan
- Department of Family and Community Medicine, Christiana Care Health System, 1400 North Washington Street, Room 328, Wilmington, DE 19801, USA
- *Heather Bittner Fagan:
| | - Richard Wender
- Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nicholas Petrelli
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE 19713, USA
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99
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van Ravesteyn NT, Schechter CB, Near AM, Heijnsdijk EAM, Stoto MA, Draisma G, de Koning HJ, Mandelblatt JS. Race-specific impact of natural history, mammography screening, and adjuvant treatment on breast cancer mortality rates in the United States. Cancer Epidemiol Biomarkers Prev 2010; 20:112-22. [PMID: 21119071 DOI: 10.1158/1055-9965.epi-10-0944] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND U.S. Black women have higher breast cancer mortality rates than White women despite lower incidence. The aim of this study is to investigate how much of the mortality disparity can be attributed to racial differences in natural history, uptake of mammography screening, and use of adjuvant therapy. METHODS Two simulation models use common national race, and age-specific data for incidence, screening and treatment dissemination, stage distributions, survival, and competing mortality from 1975 to 2010. Treatment effectiveness and mammography sensitivity are assumed to be the same for both races. We sequentially substituted Black parameters into the White model to identify parameters that drive the higher mortality for Black women in the current time period. RESULTS Both models accurately reproduced observed breast cancer incidence, stage and tumor size distributions, and breast cancer mortality for White women. The higher mortality for Black women could be attributed to differences in natural history parameters (26-44%), use of adjuvant therapy (11-19%), and uptake of mammography screening (7-8%), leaving 38% to 46% unexplained. CONCLUSION Black women appear to have benefited less from cancer control advances than White women, with a greater race-related gap in the use of adjuvant therapy than screening. However, a greater portion of the disparity in mortality appears to be due to differences in natural history and undetermined factors. IMPACT Breast cancer mortality may be reduced substantially by ensuring that Black women receive equal adjuvant treatment and screening as White women. More research on racial variation in breast cancer biology and treatment utilization is needed.
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Affiliation(s)
- Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC Room AE-134, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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100
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Aldrich T, Hackley B. The impact of obesity on gynecologic cancer screening: an integrative literature review. J Midwifery Womens Health 2010; 55:344-56. [PMID: 20630361 DOI: 10.1016/j.jmwh.2009.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/08/2009] [Accepted: 10/08/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Evidence indicates lower rates of breast and cervical cancer screening among obese compared to nonobese women. This integrative review examines the association between gynecologic cancer screening and body weight, as well as potential barriers to screening. METHODS A literature search of standard computerized databases was conducted for peer-reviewed articles published between 1950 and January 2009. RESULTS Twenty-three studies met the criteria for review. Of the 17 studies that evaluated rates of cervical cancer screening, 13 found obese women significantly less likely than their nonobese counterparts to have had a recent Papanicolaou test, a trend that was stronger in white women when compared to African American women. Eight of the 15 studies examining routine mammography found an inverse association between increasing body weight and recent screening, although findings generally pertained only to women who were white and/or severely obese. Possible barriers to care included embarrassment and perceived weight stigma in the clinical setting, lack of appropriately sized examination equipment, and poor patient-provider communication. DISCUSSION Further research is needed to clarify the challenges that obese women face in accessing care and to evaluate strategies such as ensuring the availability of appropriate equipment and supplies, the use of alternative screening methodologies, and more culturally sensitive counseling approaches that may improve screening rates in obese women.
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