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Halbert CH, Bellamy S, Bowman M, Briggs V, Delmoor E, Purnell J, Rogers R, Weathers B, Kumanyika S. Effects of integrated risk counseling for cancer and cardiovascular disease in African Americans. J Natl Med Assoc 2010; 102:396-402. [PMID: 20533774 DOI: 10.1016/s0027-9684(15)30574-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We evaluated a risk counseling intervention designed to enhance understanding about risk factors for cancer and cardiovascular disease, to improve self-efficacy for diet and physical activity, and to increase intentions to eat healthier and be physically active. METHODS We conducted a quasi-experimental study developed by academic investigators and community stakeholders to evaluate the effects of integrated risk counseling in a community-based sample of African American adults (n = 101). The intervention provided education about the overlap in risk factors for cancer and cardiovascular disease and included components from motivational interviewing. RESULTS Changes in behavioral intentions were not statistically significant (p > .05). Participants reported significantly greater levels of self-efficacy for diet (t = 2.25, p = .03) and physical activity (t = 2.55, p = .01), and significantly increased perceived risks of developing colon cancer (chi2 = 3.86, p = .05) and having a heart attack (chi2 = 4.50, p = .03). CONCLUSIONS Integrated risk counseling may have some benefits among African Americans.
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Affiliation(s)
- Chanita Hughes Halbert
- Center for Community-Based Research and Health Disparities, Department of Psychiatry, University of Pennsylvania, Philadelphia USA.
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252
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Objective and subjective breast cancer risk: relationships with natural killer cell activity and psychological distress in healthy women. Cancer Nurs 2010; 33:411-20. [PMID: 20562616 DOI: 10.1097/ncc.0b013e3181dc37a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer (BC) risk, based on either known risk factors (objective) or self-assessment (subjective), may influence natural killer cell activity (NKCA) directly or through psychological distress. OBJECTIVE The main objective of this study was to examine the relationships of objective and subjective BC risks with NKCA and a mediating role of psychological distress in a community sample of healthy women. METHODS In a cross-sectional descriptive study, a convenience sample of 117 healthy women (mean age, 36.5 years) completed questionnaires for BC risk and psychological distress and provided blood for NKCA measurement. RESULTS Objective and subjective BC risks were positively correlated (P < .001). Regression analyses revealed that objective BC risk had a significant negative relationship with NKCA at the 12.5:1 effector-to-target cell ratio (P = .011), whereas subjective risk was not associated with NKCA at any effector-to-target cell ratio tested. Only subjective risk had a positive association with both BC-specific (P = .002) and general (P < .001) psychological distress. Psychological distress failed to mediate the relationship between subjective risk and NKCA. CONCLUSIONS Objective BC risk had a limited but significant relationship with NKCA. Subjective risk was highly associated with psychological distress but was not associated with NKCA. IMPLICATIONS FOR PRACTICE Despite the limited relationships between BC risk and NKCA, the impact of BC risk on other tumor defense mechanisms needs to be further explored. Collective findings in this area will suggest early preventive strategies for monitoring BC risk and maintaining better tumor defense in healthy women.
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253
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Griva F, Anagnostopoulos F, Madoglou S. Mammography screening and the theory of planned behavior: suggestions toward an extended model of prediction. Women Health 2010; 49:662-81. [PMID: 20183107 DOI: 10.1080/03630240903496010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mammography screening is probably the most effective method for the early detection of breast cancer. Existing models of health behavior, such as the theory of planned behavior, could improve their predictive validity and, therefore, their ability to promote health-related interventions by identifying additional factors associated with health decision making. This review provides an overview of research on factors related to mammography screening within the context of the theory of planned behavior and identifies the potential benefits of adding motivational factors, such as time perspective, optimism, and risk perception, in an attempt to enhance its explanatory power.
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Affiliation(s)
- Fay Griva
- Department of Psychology, Panteion University, Athens, Greece
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Price MA, Butow PN, Charles M, Bullen T, Meiser B, McKinley JM, McLachlan SA, Phillips KA. Predictors of breast cancer screening behavior in women with a strong family history of the disease. Breast Cancer Res Treat 2010; 124:509-19. [PMID: 20364401 DOI: 10.1007/s10549-010-0868-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/20/2010] [Indexed: 01/06/2023]
Abstract
This study applied the self-regulation model to examine cognitive and emotional predictors of screening in unaffected women with a strong family history of breast cancer. 748 unaffected female members of an Australian registry of multiple-case breast cancer families formed the sample. Participants completed a baseline psychosocial questionnaire and a screening questionnaire 3 years later. Multinomial logistic regression was employed to determine predictors of under- and over-screening according to national guidelines. At follow-up 16% of women under-screened and 10% over-screened with mammography; 55% under-screened with clinical breast examination (CBE); and 9% over-screened with breast self-examination (BSE). Of the women found screening according to guidelines for mammography 72% reported ever having received specific recommendations for mammography screening from a health professional. Compared to appropriate screeners, under-screeners on mammography were less likely to have received a screening recommendation (as were under-screeners on CBE), were younger and reported lower perceived breast cancer risk, but were at higher relative risk (RR) of breast cancer and were more likely to report elevated depression. Over-screeners on mammography were more likely to be younger and have a lower RR of breast cancer. Over-screeners on BSE reported elevated cancer-specific anxiety, were less likely to be university educated and more likely to have received a recommendation for BSE. Under- and over-screening is common in women with a strong family history of breast cancer. Evaluation of interventions targeting perceived risk of breast cancer, anxiety and depression are needed to ensure women obtain accurate advice from relevant specialists and enact screening recommendations.
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Affiliation(s)
- Melanie A Price
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW, 2006, Australia.
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255
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Genetic testing and risk interpretation: How do women understand lifetime risk results? JUDGMENT AND DECISION MAKING 2010. [DOI: 10.1017/s1930297500000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractGenetic screening for BRCA1 and BRCA2 gives women the opportunity for early detection, surveillance, and intervention. One key feature of genetic testing and counseling is the provision of personal lifetime risk. However, little attention has been paid to how women interpret lifetime risk information, despite the fact that they base screening, treatment and family planning decisions on such information. To study this vital issue, we set out to test the ability of women to choose the most appropriate interpretation of National Cancer Institute’s (NCI) message about lifetime risk of developing cancer for a woman with altered BRCA1 and BRCA2 genes. Participants included 277 women who had not undergone genetic testing or had cancer and 207 women who had undergone genetic testing or had cancer. Over 50% of the women who had not undergone genetic testing or had cancer and 40% of those who had undergone genetic testing or had cancer misunderstood NCI’s information. Furthermore, in line with a growing body of research, we found that high numeracy level (objective or subjective) is positively associated with a woman’s ability to correctly interpret NCI’s message.
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256
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Linnenbringer E, Roberts JS, Hiraki S, Cupples LA, Green RC. "I know what you told me, but this is what I think:" perceived risk of Alzheimer disease among individuals who accurately recall their genetics-based risk estimate. Genet Med 2010; 12:219-27. [PMID: 20139767 PMCID: PMC2921681 DOI: 10.1097/gim.0b013e3181cef9e1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study evaluates the Alzheimer disease risk perceptions of individuals who accurately recall their genetics-based Alzheimer disease risk assessment. METHODS Two hundred forty-six unaffected first-degree relatives of patients with Alzheimer disease were enrolled in a multisite randomized controlled trial examining the effects of communicating APOE genotype and lifetime Alzheimer disease risk information. RESULTS Among the 158 participants who accurately recalled their Alzheimer disease risk assessment 6 weeks after risk disclosure, 75 (47.5%) believed their Alzheimer disease risk was more than 5% points different from the Alzheimer disease risk estimate they were given. Within this subgroup, 69.3% believed that their Alzheimer disease risk was higher than what they were told (discordant high), whereas 30.7% believed that their Alzheimer disease risk was lower (discordant low). Participants with a higher baseline risk perception were more likely to have a discordant-high risk perception (P < 0.05). Participants in the discordant-low group were more likely to be APOE epsilon4 positive (P < 0.05) and to score higher on an Alzheimer disease controllability scale (P < 0.05). CONCLUSION Our results indicate that even among individuals who accurately recall their Alzheimer disease risk assessment, many people do not take communicated risk estimates at face value. Further exploration of this clinically relevant response to risk information is warranted.
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Affiliation(s)
- Erin Linnenbringer
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan 48106-1248, USA.
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257
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Halbert CH, Kessler L, Troxel AB, Stopfer JE, Domchek S. Effect of genetic counseling and testing for BRCA1 and BRCA2 mutations in African American women: a randomized trial. Public Health Genomics 2010; 13:440-8. [PMID: 20234119 DOI: 10.1159/000293990] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 08/31/2009] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Limited empirical data are available on the effects of genetic counseling and testing among African American women. OBJECTIVE To evaluate the effects of genetic counseling and testing in African American women based on different levels of exposure: (a) women who were randomized to culturally tailored (CTGC) and standard genetic counseling (SGC) to women who declined randomization (non-randomized group), (b) participants and non-participants in genetic counseling, and (c) BRCA1 and BRCA2 (BRCA1/2) test result acceptors and decliners. DESIGN Randomized trial of genetic counseling conducted from February 2003 to November 2006. MEASURES We evaluated changes in perceived risk of developing breast cancer and cancer worry. RESULTS Women randomized to CTGC and SGC did not differ in terms of changes in risk perception and cancer worry compared to decliners. However, counseling participants had a significantly greater likelihood of reporting reductions in perceived risk compared to non-participants (p = 0.03). Test result acceptors also had a significantly greater likelihood of reporting decreases in cancer worry (p = 0.03). However, having a cancer history (p = 0.03) and a BRCA1/2 prior probability (p = 0.04) were associated with increases in cancer worry. CONCLUSIONS Although CTGC did not lead to significant improvements in perceived risk or psychological functioning, African American women may benefit from genetic counseling and testing. Continued efforts should be made to increase access to genetic counseling and testing among African American women at increased risk for hereditary disease. But, follow-up support may be needed for women who have a personal history of cancer and those with a greater prior probability of having a BRCA1/2 mutation.
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Affiliation(s)
- C H Halbert
- Center for Community-Based Research and Health Disparities, University of Pennsylvania, Philadelphia, PA 19104, USA.
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258
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Cabrera E, Blanco I, Yagüe C, Zabalegui A. The impact of genetic counseling on knowledge and emotional responses in Spanish population with family history of breast cancer. PATIENT EDUCATION AND COUNSELING 2010; 78:382-388. [PMID: 19948386 DOI: 10.1016/j.pec.2009.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 10/12/2009] [Accepted: 10/25/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess a genetic counseling intervention measuring the distress, cancer risk perception, anxiety, worry and level of knowledge in people with familial history of breast cancer. METHODS One group pre- and post-test design. A total of 212 individuals completed a baseline questionnaire, 88.6% completed a second questionnaire one month later and 75.4% six months later. RESULTS Counseling intervention significantly increased the knowledge level of the individuals who received genetic education and significantly decreased the cancer worry levels. Persons with low perception of their cancer risk also had low worry levels. There were no significant changes over time in cancer risk perception or in quality of life. CONCLUSION Counseling in a high risk population seems to decrease cancer worry and to increase cancer knowledge thus enabling a counselee to take well-informed decisions. Furthermore, according to our results, such interventions do not increase anxiety and do not modify the quality of life, but do not adjust their cancer risk perception. PRACTICE IMPLICATIONS Providing individuals at increased risk of breast cancer genetic services seem to enhance their understanding of breast cancer without causing adverse psychological effects or changes in their quality of life, and it could improve their preventive behaviours.
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Affiliation(s)
- Esther Cabrera
- International University of Catalonia, Faculty of Medicine and Health Sciences, Department of Nursing, 08195 Barcelona, Spain.
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259
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Orom H, Kiviniemi MT, Underwood W, Ross L, Shavers VL. Perceived cancer risk: why is it lower among nonwhites than whites? Cancer Epidemiol Biomarkers Prev 2010; 19:746-54. [PMID: 20160278 PMCID: PMC2836595 DOI: 10.1158/1055-9965.epi-09-1085] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. METHODS Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). RESULTS Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = -0.40, -0.34, and -0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. CONCLUSIONS Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of one's family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information.
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Affiliation(s)
- Heather Orom
- The School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA.
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260
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Abstract
OBJECTIVE Exploration of complicated grief focusing on the relationship of post-traumatic stress disorder (PTSD) and complicated grief in a population of women at high risk for developing breast cancer. Special reference is made to women who have experienced a material death. METHOD We reflected on the clinical attributes of the Revlon UCLA High Risk Clinic population in terms of their own perceived risk of developing breast cancer. For part of our population, their perceived risk was coupled with their reactions to the loss of their mothers to breast cancer. We compared and contrasted this pattern of reactions to those described by Licihtenthal et al. (2004) in their developmental review of complicated grief as a distinct disorder. RESULTS We concluded that our population of women differed from Lichtenthal et al.'s (2004) model for complicated grief. Lichtenthal's group postulated that the key element of complicated grief involves the protracted nature of separation anxiety and distress and excludes PTSD. In our populations, the daughter with complicated grief experiences a combination of separation anxiety and a type of PTSD involving anxiety over the perceived certainty of her own future diagnosis of breast cancer. It was noteworthy that Lichtenthal's model population was composed of individuals caring for terminally ill spouses. Significantly, the spousal caretakers did not have an ongoing genetic link to their partners whereas our population is genetically linked. We postulate that this accounts for the unique presentation of complicated grief and ptsd in our population. SIGNIFICANCE OF RESULTS We submit that this combination of complicated grief and PTSD requires a cognitive reframing of their perceived inevitability of developing breast cancer and desensitization techniques to help high risk women pursue preventative health care rather than avoiding it.
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261
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DeFrank JT, Brewer N. A model of the influence of false-positive mammography screening results on subsequent screening. Health Psychol Rev 2010; 4:112-127. [PMID: 21874132 PMCID: PMC3160720 DOI: 10.1080/17437199.2010.500482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.
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Affiliation(s)
- Jessica T. DeFrank
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Noel Brewer
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
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262
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Caruso A, Vigna C, Marozzo B, Sega FM, Sperduti I, Cognetti F, Savarese A. Subjective versus objective risk in genetic counseling for hereditary breast and/or ovarian cancers. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2009; 28:157. [PMID: 20025726 PMCID: PMC2806303 DOI: 10.1186/1756-9966-28-157] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/21/2009] [Indexed: 12/03/2022]
Abstract
Background Despite the fact that genetic counseling in oncology provides information regarding objective risks, it can be found a contrast between the subjective and objective risk. The aims of this study were to evaluate the accuracy of the perceived risk compared to the objective risk estimated by the BRCApro computer model and to evaluate any associations between medical, demographic and psychological variables and the accuracy of risk perception. Methods 130 subjects were given medical-demographic file, Cancer and Genetic Risk Perception, Hospital Anxiety-Depression Scale. It was also computed an objective evaluation of the risk by the BRCApro model. Results The subjective risk was significantly higher than objective risk. The risk of tumour was overestimated by 56%, and the genetic risk by 67%. The subjects with less cancer affected relatives significantly overestimated their risk of being mutation carriers and made a more innacurate estimation than high risk subjects. Conclusion The description of this sample shows: general overestimation of the risk, inaccurate perception compared to BRCApro calculation and a more accurate estimation in those subjects with more cancer affected relatives (high risk subjects). No correlation was found between the levels of perception of risk and anxiety and depression. Based on our findings, it is worth pursuing improved communication strategies about the actual cancer and genetic risk, especially for subjects at "intermediate and slightly increased risk" of developing an hereditary breast and/or ovarian cancer or of being mutation carrier.
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Affiliation(s)
- Anita Caruso
- Prevention and Training Activities in Psycho-Oncology, National Cancer Institute Regina Elena, Rome, Italy.
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263
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Purtzer MA. Processes Inherent in Mammography-Screening Decisions of Rarely or Never-Screened Women. West J Nurs Res 2009; 32:199-217. [DOI: 10.1177/0193945909350740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast cancer is a significant cause of mortality and morbidity. A strong association exists between survival and early detection through regular mammography. Impoverished women underuse this life-saving screening, resulting in a disproportionate cancer burden. The study purpose is to discover the process of rarely or never-screened women’s mammography-screening decisions. The sample consists of five rural, low-income, uninsured, and rarely or never-screened women. Grounded theory methodology is used to generate a new theoretical explanation of mammography-screening decision making. Findings include the central conceptual categories, intuitive dominance and intuitive certainty, which contribute toward an intuitive decision-making default. This intuitive thinking style weaves throughout two interrelated categories: (a) scarce, supportive, relational resources for learning and (b) dichotomous health care—seeking behaviors. Implications focus on a nontraditional client assessment whereby nurses can facilitate relational-based knowledge construction. Recommendations for future research include examination of the process of integrating intuition with reasoned thought for more fully informed decisions.
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264
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Joseph G, Burke NJ, Tuason N, Barker JC, Pasick RJ. Perceived susceptibility to illness and perceived benefits of preventive care: an exploration of behavioral theory constructs in a transcultural context. HEALTH EDUCATION & BEHAVIOR 2009; 36:71S-90S. [PMID: 19805792 PMCID: PMC2941192 DOI: 10.1177/1090198109338915] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes how the social context of transculturation (cultural change processes) and transmigration (migration in which relationships are sustained across national boundaries) can directly influence use of mammography screening. The authors conducted semistructured interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behavior (Behavioral Constructs and Culture in Cancer Screening study). Iterative analyses identified themes of the transcultural domain: colonialism, immigration, discrimination, and therapeutic engagement. In this domain, the authors examine two key behavioral theory constructs, perceptions of susceptibility to illness and perceptions of benefits of preventive medical care. The findings raise concerns about interventions to promote mammography screening primarily based on provision of scientific information. The authors conclude that social context affects behavior directly rather than exclusively through beliefs as behavioral theory implies and that understanding contextual influences, such as transculturation, points to different forms of intervention.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, CA 94143, USA.
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265
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Stewart SL, Rakowski W, Pasick RJ. Behavioral constructs and mammography in five ethnic groups. HEALTH EDUCATION & BEHAVIOR 2009; 36:36S-54S. [PMID: 19805790 PMCID: PMC2921882 DOI: 10.1177/1090198109338918] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intention, self-efficacy, perceived susceptibility, perceived benefits, and subjective norms are key constructs of health behavior theories; their predictive validity for cancer screening has not been ascertained in multiethnic populations. Participants were 1,463 African American, Chinese, Filipina, Latina, and White women aged 40 to 74 interviewed by telephone in their preferred languages. The relationship between baseline constructs and mammography 2 years later was assessed using multivariable logistic regression. Intention predicted mammography overall and among Whites (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 2.4, 10), with racial/ethnic differences in association (p = .020). Self-efficacy predicted mammography overall and among Whites (OR = 3.5, 95% CI = 1.1, 11), with no racial/ethnic interaction. Perceived benefits and subjective norms were associated with screening overall and in some racial/ethnic groups. These results generally support cross-cultural applicability of four of the five constructs to screening with mixed predictive value of measures across racial/ethnic groups. Additional in-depth inquiry is required to refine assessment of constructs.
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Affiliation(s)
- Susan L Stewart
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143-0981, USA.
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266
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You MS. The Study of Health-Risk Perception: Implications for Health Services Research. HEALTH POLICY AND MANAGEMENT 2009. [DOI: 10.4332/kjhpa.2009.19.3.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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267
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Kwak MS, Choi KS, Park S, Park EC. Perceived risk for gastric cancer among the general Korean population: a population-based survey. Psychooncology 2009; 18:708-15. [PMID: 19025890 DOI: 10.1002/pon.1458] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We measured the perceived risk for developing gastric cancer and investigated how a range of socio-demographic, lifestyle, health, and psychological factors were associated with risk perception in a population-based sample in Korea. METHODS This study was based on the 2006 Korean National Cancer Screening Survey conducted by the National Cancer Center, in which trained interviewers met face-to-face with participants selected by a nationally representative random sampling. The participants included 1673 adults, aged 40 years or older, who had not previously been diagnosed with cancer. Simple and multiple ordinal regression were used to determine the associations between perceived risk and socio-demographic, lifestyle, health, and psychological factors. RESULTS Almost half of the subjects (48.3%) thought their chance of developing gastric cancer was lower than that of other men or women of the same age. A higher level of worry concerning gastric cancer was strongly associated with a higher perceived risk for gastric cancer development. Those who drink alcohol two or more days per week, and who are unmarried all perceived their risk as being higher. However, those without a previous gastric cancer screening, a personal history of gastric disease, or a good overall health status had a lower perceived risk for gastric cancer development. CONCLUSION This study found comparative optimism about the risk for developing gastric cancer in a Korean population. It is necessary to increase people's ability to accurately perceive their risk for cancer.
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Affiliation(s)
- Min-Son Kwak
- National Cancer Control Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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268
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Abstract
Genetic testing for adult-onset diseases is now available. One such test is for the mutations present in the BRCA gene that result in a significantly higher risk for the development of breast cancer or ovarian cancer. Women who have one of these mutations face difficult choices in terms of increased surveillance or prophylactic surgeries. Examining experiences of women with BRCA mutations can serve as an exemplar for other populations at risk for genetically associated adult-onset diseases.
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Affiliation(s)
- Rebekah Hamilton
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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269
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Park K, Chang SJ, Kim HC, Park EC, Lee ES, Nam CM. Big gap between risk perception for breast cancer and risk factors: nationwide survey in Korea. PATIENT EDUCATION AND COUNSELING 2009; 76:113-119. [PMID: 19157765 DOI: 10.1016/j.pec.2008.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 11/12/2008] [Accepted: 12/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore perceived risk of breast cancer among Korean women and to investigate factors associated with perceived risk of breast cancer. METHODS A telephone survey using random digit dialing was conducted with an age- and region-stratified random sample of women in Korea. The study population consisted of 1000 women who participated in telephone surveys in which a 21-item questionnaire was administered. RESULTS This study showed a significant level of comparative optimism in breast cancer risk perception in Korean women with an average risk of breast cancer. According to the multivariate analysis, younger age, family history of breast cancer, and history of benign breast disease were the factors associated with higher perceived comparative risk of breast cancer. CONCLUSION The finding that a limited number of breast cancer risk factors were related to perceived risk of breast cancer is worrying because women with other risk factors for breast cancer may believe themselves to be at lower risk. PRACTICE IMPLICATIONS It is necessary for women to understand their risk factor profiles to avoid biased optimism or pessimism.
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Affiliation(s)
- Keeho Park
- Cancer Information and Education Branch, National Cancer Center, Republic of Korea
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270
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Chung S, Mehta K, Shumway M, Alvidrez J, Perez-Stable EJ. Risk perception and preference for prevention of Alzheimer's disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:450-8. [PMID: 19900252 PMCID: PMC4383096 DOI: 10.1111/j.1524-4733.2008.00482.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To understand how older adults perceive their risk of Alzheimer's Disease (AD) and how this may shape their medical care decisions, we examined whether presence of established risk factors of AD is associated with individuals' perceived risk of AD, and with preference for preventing AD. PARTICIPANTS Data came from the US Health and Retirement Study participants who were asked questions on AD risk perception (N = 778). MEASUREMENTS Perceived risk of AD was measured by respondents' estimate of their percent chance (0-100) developing AD in the next 10 years. Preference for AD prevention was measured with questions eliciting willingness to pay for a drug to prevent AD. ANALYSIS Multivariate linear regressions were used to estimate correlates of perceived risk and preference for prevention. RESULTS Better cognitive functioning and physical activity are associated with decreased perceived risk. Neither age nor cardiovascular disease is associated with perceived risk. African Americans have lower perceived risk than non-Latino whites; the difference is wider among people age 65 and above. Only 4% to 7% of the variation in perceived risk was explained by the model. Preference for prevention is stronger with increased perceived risk, but not with the presence of risk factors. Persons with better cognitive functioning, physical functioning, or wealth status have a stronger preference for prevention. CONCLUSION Some known risk factors appear to inform, but only modestly, individuals' perceived risk of AD. Furthermore, decisions about AD prevention may not be determined by objective needs alone, suggesting a potential discrepancy between need and demand for AD preventive care.
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Affiliation(s)
- Sukyung Chung
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94301, USA.
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271
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Bodurtha J, Quillin JM, Tracy KA, Borzelleca J, McClish D, Wilson DB, Jones RM, Quillin J, Bowen D. Mammography screening after risk-tailored messages: the women improving screening through education and risk assessment (WISER) randomized, controlled trial. J Womens Health (Larchmt) 2009; 18:41-7. [PMID: 19105686 DOI: 10.1089/jwh.2007.0703] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIMS A randomized trial investigated the impact of risk-tailored messages on mammography in diverse women in the Virginia Commonwealth University Health System's gynecology clinics. METHODS From 2003 to 2005, 899 patients > or =40 years of age were randomized to receive risk-tailored information or general information about breast health. Multiple logistic regression analyses summarize their breast health practices at 18 months. RESULTS At baseline, 576 (64%) women reported having a mammogram in the past year. At 18-month follow-up, mammography rates were 72.6% in the intervention group and 74.2% in the control group (N.S.). Women (n = 123) who reported worrying about breast cancer "often" or "all the time" had significantly higher mammography rates with the intervention (85.0%) vs. the controls (63.5%). No significant differences existed in clinical breast examination, self-examination, or mammography intentions between the two study arms. However, intervention women with lower education reported significantly fewer clinical breast examinations at follow-up. CONCLUSIONS The brief intervention with a risk-tailored message did not have a significant effect overall on screening at 18 months. However, among those who worried, mammography rates in the intervention group were higher. Individual characteristics, such as worry about breast cancer and education status, may impact interventions to improve breast cancer prevention practices.
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Affiliation(s)
- Joann Bodurtha
- Human and Molecular Genetics, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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272
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Pilarski R. Risk Perception Among Women at Risk for Hereditary Breast and Ovarian Cancer. J Genet Couns 2009; 18:303-12. [DOI: 10.1007/s10897-009-9227-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/18/2009] [Indexed: 01/28/2023]
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273
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Burger IM, Kass NE. Screening in the dark: ethical considerations of providing screening tests to individuals when evidence is insufficient to support screening populations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:3-14. [PMID: 19326299 PMCID: PMC3115566 DOI: 10.1080/15265160902790583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
During the past decade, screening tests using computed tomography (CT) have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions.
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274
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Fernández ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, Vernon SW. Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health 2009; 99:936-43. [PMID: 19299678 DOI: 10.2105/ajph.2008.136713] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women. METHODS Participants were women 50 years and older who were nonadherent to mammography (n = 464) or Papanicolaou (Pap) test (n = 243) screening guidelines. After the collection of baseline data, lay health workers implemented the Cultivando la Salud (CLS; Cultivating Health) intervention. Data collectors then interviewed the participants 6 months later. RESULTS At follow-up, screening completion was higher among women in the intervention group than in the control group for both mammography (40.8% vs 29.9%; P < .05) and Pap test (39.5% vs 23.6%; P < .05) screening. In an intent-to-treat analysis, these differences remained but were not significant. The intervention increased mammography self-efficacy, perceived susceptibility, perceived survivability, perceived benefits of mammography, subjective norms, and processes of change. The intervention also significantly increased Pap test self-efficacy, perceived benefits of having a Pap test, subjective norms, and perceived survivability of cancer. It did not change Pap test knowledge, perceived susceptibility, or perceptions about negative aspects of Pap test screening. CONCLUSIONS Our results add to the evidence concerning the effectiveness of lay health worker interventions for increasing Pap test screening and mammography. Future research should explore the effectiveness of CLS in other Hispanic groups, the mechanisms through which interpersonal communication influences decisions about screening, and how effective interventions such as CLS can best be adopted and implemented in community-based organizations or other settings.
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Affiliation(s)
- María E Fernández
- Center for Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, 7000 Fannin St, Suite 2558, Houston, TX 77030, USA.
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275
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Wong N. Investigating the effects of cancer risk and efficacy perceptions on cancer prevention adherence and intentions. HEALTH COMMUNICATION 2009; 24:95-105. [PMID: 19280453 PMCID: PMC2743453 DOI: 10.1080/10410230802676474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This study examined the interaction between comparative cancer risk and efficacy perceptions on individuals' adherence for colon, prostate, and breast cancer screenings, intentions to get these screenings in the future, and intentions to adopt health lifestyle behaviors in the next year. A national probability sample of 2,226 adults ages 40 to 70 was surveyed. Overall, a positive interaction effect was found between comparative risk and efficacy on several outcomes. There were some methodological limitations worth noting, but the findings do have implications for health campaigns, particularly the need to increase efficacy beliefs about reducing cancer risks within the general population.
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Affiliation(s)
- Norman Wong
- Department of Communication, University of Oklahoma, Norman, OK 73019-2081, USA.
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276
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Lijovic M, Davis SR, Fradkin P, Bradbury J, La China M, Schwarz M, Wolfe R, Farrugia H, Bell RJ. The relationship between knowledge of family history and cancer characteristics at diagnosis in women newly-diagnosed with invasive breast cancer. Fam Cancer 2009; 8:299-305. [DOI: 10.1007/s10689-009-9236-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
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277
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Marlow LAV, Waller J, Wardle J. The impact of human papillomavirus information on perceived risk of cervical cancer. Cancer Epidemiol Biomarkers Prev 2009; 18:373-6. [PMID: 19190156 DOI: 10.1158/1055-9965.epi-08-0357] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a need to develop public education about the link between human papillomavirus (HPV) and cervical cancer. Explaining that a sexually transmitted virus causes cervical cancer may affect perceived risk of cervical cancer. We hypothesized that presenting HPV information would have differential effects depending on age and screening attendance. Data were collected during face-to-face interviews with a sample of British women age 16 to 75 years who had not heard of HPV before (n = 965). A repeated measures design was used, assessing perceived risk of cervical cancer before and after providing information about HPV. Perceived risk was assessed using a comparative risk measure with a five-point response scale. Preinformation, the mean perceived risk score was 2.64 (SE, 0.03). Overall, presentation of HPV information did not have an effect on perceived risk of cervical cancer [chi(2)(1) = .72; P = 0.396], but as expected, there was a significant time by age interaction for the change in perceived risk [chi(2)(5) = 33.56; P < 0.001], which increased in the youngest age group (16-25 years) and decreased in the oldest age group (65-75 years). In a separate analysis with women in the screening age range (25-64 years; n = 709), there was a significant time by screening attendance interaction [chi(2)(1) = 5.25; P = 0.022], with an increase in perceived risk among women who did not regularly attend screening. This is the first study to examine the effect of HPV information on perceived risk across different population groups. Interventions to increase awareness of HPV could benefit from tailoring information to prescreening age, screening age, and postscreening age women.
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Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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278
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Lende DH, Lachiondo A. Embodiment and breast cancer among African American women. QUALITATIVE HEALTH RESEARCH 2009; 19:216-228. [PMID: 19056698 DOI: 10.1177/1049732308328162] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
African American women have historically been screened for breast cancer less than other women, contributing to higher mortality rates. Previous research has focused on social and cultural factors, such as discrimination and religiosity, as shaping African American women's screening practices. This article extends this research by (a) examining the decisions and justifications of African American women with regard to screening practices, and (b) using a theoretical focus on embodiment to better understand women in relation to their own bodies. Ethnographic research consisted of 5 months of participant observation at an Indiana (USA) breast cancer care center, and 15 in-depth, semi-structured interviews along the continuum of screening practices. The results showed that embodied understandings of the body, personal (rather than biomedical) considerations of screening and treatment, and the quality of doctor/patient interactions all play a significant role in women's decisions about whether to screen for breast cancer or not. Based on these results and a review of the literature, six ways to include embodiment in public health initiatives are outlined.
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279
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Hur HK, Park SM, Kim CH, Park JK, Koh SB, Kim GY. Development of an Integrated Breast Health Program for Prevention of Breast Cancer among Middle-aged Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2009. [DOI: 10.4069/kjwhn.2009.15.1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hea Kung Hur
- Professor, Department of Nursing, Yonsei University Wonju College of Medicine, Korea
| | - So Mi Park
- Associate professor, Department of Nursing, Yonsei University Wonju College of Medicine, Korea
| | - Chang Hee Kim
- Full-time Instructor, Department of Nursing, Hyejeon College, Korea
| | - Jong-Ku Park
- Professor, Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| | - Sang Baek Koh
- Associate professor, Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| | - Gi Yon Kim
- Associate professor, Department of Nursing, Yonsei University Wonju College of Medicine, Korea
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280
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Bowie JV, Wells AM, Juon HS, Sydnor KD, Rodriguez EM. How old are African American women when they receive their first mammogram? Results from a church-based study. J Community Health 2008; 33:183-91. [PMID: 18369711 DOI: 10.1007/s10900-008-9092-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
African American women in the U.S. have the highest breast cancer mortality though not the highest breast cancer incidence. This high mortality rate has been attributed in part to discrepancies in screening between African American and White women. Although this gap in mammography utilization is closing, little is known about what has been and is driving the screening practices of African American women, in particular age at first mammogram. This study examined the rates of breast cancer screening in an African American community sample from eight churches in greater Baltimore, Maryland and investigated the association between various factors and age at first mammogram. Participants were 213 women ages 22-89 years. About 77% of women had ever had a mammogram. Over 40% had their first mammogram before age 40. Women who first screened before age 40 had greater odds than women who had never screened of being knowledgeable about screening guidelines, of having received a physician recommendation to screen, and of having three or more female relatives who had been screened. Women who first screened at or after age 40 were more likely to have stronger religious beliefs of health than women who never had screened. These findings suggest the importance of reinforcing factors in screening behavior for African American women and have implications for physician training and public health education about breast cancer screening. A better understanding of African American women's mammography practice including early screening is needed to reduce this population's disproportionate breast cancer mortality risk.
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Affiliation(s)
- Janice V Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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281
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Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 2008; 17:2913-23. [PMID: 18990731 DOI: 10.1158/1055-9965.epi-07-0633] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.
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Affiliation(s)
- Mary A Gerend
- Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
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282
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Hiraki S, Chen CA, Roberts JS, Cupples LA, Green RC. Perceptions of familial risk in those seeking a genetic risk assessment for Alzheimer's disease. J Genet Couns 2008; 18:130-6. [PMID: 18949541 DOI: 10.1007/s10897-008-9194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 09/12/2008] [Indexed: 11/29/2022]
Abstract
Perceived risk is a complex concept that influences the genetic counseling process and can affect client coping and behavior. Although the association between family history and risk perception is well recognized in the literature, no studies have explored this relationship specifically in those seeking genetic susceptibility testing for a common chronic condition. REVEAL is a randomized trial assessing the impact of APOE disclosure and genetic risk assessment for Alzheimer's disease (AD). Using baseline REVEAL data, we hypothesized that there would be a significant association between the degree of AD family history and risk perception of AD, and that this relationship would be stronger in those who believed that genetics is a very important AD risk factor. In our sample of 293 participants, we found that a higher self-perceived risk of AD was associated with strength of family history of AD (p < 0.001), belief in genetics as an important AD risk factor (p < 0.001), being female (p < 0.001) and being Caucasian (p = 0.02). These results are the first to demonstrate the association between family history and risk perception in persons volunteering for genetic susceptibility testing for a common complex disease.
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Affiliation(s)
- Susan Hiraki
- Dept of Neurology, Boston University School of Medicine, Boston, MA, USA.
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283
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Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk. Br J Cancer 2008; 99:1007-12. [PMID: 18827822 PMCID: PMC2567085 DOI: 10.1038/sj.bjc.6604672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Although the effectiveness of mammography for women under the age of 50 years with a family history of breast cancer (FHBC) has not yet been proven, annual screening is being offered to these women to manage breast cancer risk. This study investigates women's awareness and interpretation of their familial risk and knowledge and views about mammographic screening. A total of 2231 women from 21 familial/breast/genetics centres who were assessed as moderate risk (17–30% lifetime risk) or high risk (>30% lifetime risk) completed a questionnaire before their mammographic screening appointment. Most women (70%) believed they were likely, very likely or definitely going to develop breast cancer in their lifetime. Almost all women (97%) understood that the purpose of mammographic screening was to allow the early detection of breast cancer. However, 20% believed that a normal mammogram result meant there was definitely no breast cancer present, and only 4% understood that screening has not been proven to save lives in women under the age of 50 years. Women held positive views on mammography but did not appear to be well informed about the potential disadvantages. These findings suggest that further attention should be paid to improving information provision to women with an FHBC being offered routine screening.
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284
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Graves KD, Huerta E, Cullen J, Kaufman E, Sheppard V, Luta G, Isaacs C, Schwartz MD, Mandelblatt J. Perceived risk of breast cancer among Latinas attending community clinics: risk comprehension and relationship with mammography adherence. Cancer Causes Control 2008; 19:1373-82. [PMID: 18704716 DOI: 10.1007/s10552-008-9209-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 07/08/2008] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe breast cancer risk perceptions, determine risk comprehension, and evaluate mammography adherence among Latinas. METHODS Latina women age >or=35, primarily from Central and South America, were recruited from community-based clinics to complete in-person interviews (n = 450). Risk comprehension was calculated as the difference between numeric perceived risk and Gail risk score. Based on recommended guidelines from the year data were collected (2002), mammography adherence was defined as having a mammogram every one to two years for women >or=40 years of age. RESULTS Breast cancer risk comprehension was low, as 81% of women overestimated their risk and only 6.9% of women were high risk based on Gail risk scores. Greater cancer worry and younger age were significantly associated with greater perceived risk and risk overestimation. Of women age eligible for mammography (n = 328), 29.0% were non-adherent to screening guidelines. Adherence was associated with older age, (OR = 2.99, 95% CI = 1.76-5.09), having insurance (OR = 1.81, 95% CI = 1.03-3.17), greater acculturation (OR = 1.18, 95% CI = 1.02-1.36), and higher breast cancer knowledge (OR = 2.03, 95% CI = 1.21-3.40). CONCLUSIONS While most Latinas over-estimated their breast cancer risk, older age, having insurance, being more acculturated, and having greater knowledge were associated with greater screening adherence in this Latino population. Perceived risk, risk comprehension, and cancer worry were not associated with adherence. In Latinas, screening interventions should emphasize knowledge and target education efforts at younger, uninsured, and less acculturated mammography-eligible women.
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Affiliation(s)
- Kristi D Graves
- Department of Oncology, Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, 20007, USA,
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285
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The impact of family history of breast cancer and cancer death on women's mammography practices and beliefs. Genet Med 2008; 10:621-5. [DOI: 10.1097/gim.0b013e31817c0355] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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286
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Younge SN, Salem D, Bybee D. Risk Revisited: The Perception of HIV Risk in a Community Sample of Low-Income African American Women. JOURNAL OF BLACK PSYCHOLOGY 2008. [DOI: 10.1177/0095798408320633] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the high rate of HIV infection among low-income African American women, research suggests that perceptions of HIV risk among this population are not elevated compared to other groups. It is evident that an individual’s subjective perception of risk is based on a multiplicity of both internal and external factors, including relationship context and cultural worldview. This study examines the contribution of cultural worldview to low-income African American women’s HIV risk perception. A hierarchical linear regression was conducted on a community sample of low-income African American women (N = 196). Results demonstrate that when partner infidelity was controlled, financial independence and interpersonal control were significant predictors of perceived HIV risk, with lack of power related to elevated levels of perceived risk. When relationship power and HIV knowledge were taken into account, cultural worldview was a significant negative predictor of perceived risk, with high levels of fatalism associated with low perceived risk. Findings suggest that knowledge alone is not enough to explain HIV risk perception. The role of cultural worldview must be taken into account.
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287
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Lower adherence to screening mammography guidelines among ethnic minority women in America: a meta-analytic review. Prev Med 2008; 46:479-88. [PMID: 18295872 PMCID: PMC2920292 DOI: 10.1016/j.ypmed.2008.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 12/30/2007] [Accepted: 01/08/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study investigates the association between ethnic minority status and receiving a screening mammogram within the past 2 years among American women over 50. METHOD The findings from 33 studies identified from interdisciplinary research databases (1980 to 2006) were synthesized. Separate pooled analyses compared white non-Hispanics to African Americans (28 outcomes), Hispanics (18 outcomes), and Asian/Pacific Islanders (10 outcomes). RESULTS Using the random effects model, results showed that African Americans were screened less than white non-Hispanics at a marginal level (OR 0.87, 95% CI 0.75, 1.00). Larger and significant discrepancies were observed for Hispanics (OR 0.65, 95% CI 0.50, 0.85) and Asian/Pacific Islanders (OR 0.63, 95% CI 0.39, 0.99) compared to white non-Hispanics. However, among studies controlling for socioeconomic status, ethnic differences in mammography screening were no longer significant for African Americans (OR 1.05, 95% CI 0.71, 1.76), Hispanics (OR 1.08, 95% CI 0.64, 1.93), or Asian/Pacific Islanders (OR 1.08, 95% CI 0.64, 1.93). Subgroup analyses further showed that geographical region, sampling method, and data collection strategy significantly impacted results. CONCLUSIONS This study found evidence that ethnic minority-screening mammography differences exist but were impacted by socioeconomic status. Implications for interpreting existing knowledge and future research needs are discussed.
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288
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Ford ME, Havstad SL, Fields ME, Manigo B, McClary B, Lamerato L. Effects of baseline comorbidities on cancer screening trial adherence among older African American men. Cancer Epidemiol Biomarkers Prev 2008; 17:1234-9. [PMID: 18463399 PMCID: PMC3424636 DOI: 10.1158/1055-9965.epi-08-0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the effects of baseline comorbidities on screening adherence in a sample of older African American men (ages >or=55 years) enrolled in a case management intervention in a cancer screening trial. METHODS Baseline comorbidity data were obtained from 683 African American men who were randomly assigned to a case management intervention group (n = 344) or to a case management control group (n = 339). The effects of comorbidities on the screening adherence rates of each group were then assessed. RESULTS No statistically significant interactions were found between each health history characteristic and the intervention. Therefore, analyses were not stratified by intervention status. In general, participants with comorbidities were no less likely to adhere to trial screening than participants without comorbidities. Exceptions were current smokers and participants with chronic bronchitis. Current smokers were less likely than others to adhere to the prostate-specific antigen test (P = 0.02) and the digital rectal examination for prostate cancer screening (P = 0.01), to the chest X-ray for lung cancer screening (P < 0.01), and to the flexible sigmoidoscopy for colorectal cancer screening (P = 0.04). Participants with chronic bronchitis had lower rates of adherence to the chest X-ray (P = 0.06). Having a relative with cancer positively influenced adherence to the digital rectal examination (P = 0.05). CONCLUSIONS Overall, older African American men with comorbidities appear to be very good candidates for participation in longitudinal cancer screening trials. However, smoking had a statistically significant and deleterious effect on adherence to all types of screening.
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Affiliation(s)
- Marvella E Ford
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, PO Box 250955, Charleston, SC 29425, USA.
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289
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Payne K, Nicholls S, McAllister M, Macleod R, Donnai D, Davies LM. Outcome measurement in clinical genetics services: a systematic review of validated measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:497-508. [PMID: 18489673 DOI: 10.1111/j.1524-4733.2007.00259.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This systematic review aimed to inform researchers and policymakers about what validated outcome measures are available to evaluate clinical genetics services (CGS) and the need for new measures. METHODS Validated outcome measures used to evaluate CGS were identified from a systematic literature review. Subjective outcome measures were assumed to have been validated only if some form of psychometric assessment was reported. RESULTS A total of 1688 titles and abstracts were identified, and 61 articles met the inclusion criteria for the final review, which covered 67 validated outcome measures. There were 37 nongenetics-specific and 30 genetics-specific measures identified. No single validated outcome measure encompassed all potential patient benefits from using a CGS. A variety of different domains were identified, including anxiety and depression, coping, decision-making, distress, family environment, health status, knowledge, mood, perception of risk, perceived personal control, psychological impact, quality of life, satisfaction and expectations, self-esteem, spiritual well-being, and worry. Some important aspects of patient benefit from CGS are not covered by existing outcome measures. CONCLUSIONS New research is necessary to develop the array of outcome measures required to quantify the benefits CGS offer patients living with the effects of genetic conditions. These need to be suitable for use in prospective evaluation studies to provide robust evidence for decision-makers to inform service development and commissioning. This includes prioritization of the existing validated outcome measures in terms of their usefulness and relevance to the measurement and valuation of patient benefits from a CGS.
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Affiliation(s)
- Katherine Payne
- Nowgen, The North West Genetics Knowledge Park, Manchester, UK.
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290
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Kessler L, Domchek S, Stopfer J, Halbert CH. BRCA1 and BRCA2 risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer. ACTA ACUST UNITED AC 2008; 11:193-200. [PMID: 18417966 DOI: 10.1159/000116879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe BRCA1 or BRCA2 (BRCA1/2) risk perceptions among African American women at increased risk for hereditary breast-ovarian cancer and to identify factors having independent associations with these perceptions. METHODS Risk perceptions were evaluated by self-report during a structured telephone interview among African American women (n = 162) at increased risk for hereditary cancer who were recruited from oncology clinics, general medical practices, and community oncology resources. RESULTS The majority of women (75%) believed that it was likely that they had a BRCA1/2 mutation. Women ages 50 and younger and those with greater cancer-specific worry were most likely to believe that they had a BRCA1/2 mutation. CONCLUSIONS Although BRCA1/2 risk perceptions may be consistent with objective risk levels among African American women, discussion about the basis of risk perceptions may enhance provision of genetic counseling and testing in this population.
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Affiliation(s)
- Lisa Kessler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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291
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Uncovering an Existential Barrier to Breast Self-exam Behavior. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2008; 44:260-274. [PMID: 19255593 DOI: 10.1016/j.jesp.2007.05.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present research applies an analysis derived from terror management theory to the health domain of breast examination, and in doing so uncovers previously unrecognized factors that may contribute to women's reluctance to perform breast self-examinations (BSEs). In Study 1, when concerns about mortality were primed, reminders of human beings' physical nature (i.e., creatureliness) reduced intentions to conduct BSEs compared to reminders of humans' uniqueness. In Study 2, women conducted shorter exams on a breast model (an experience found to increase death-thought accessibility) when creatureliness was primed compared to a uniqueness and no essay condition. In Study 3, after a creatureliness prime, women performed shorter BSEs when a placebo did not provide an alternative explanation for their discomfort compared to when it did. Advances for theory and breast self-exam promotion are discussed.
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292
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Dailey AB, Kasl SV, Jones BA. Does gender discrimination impact regular mammography screening? Findings from the race differences in screening mammography study. J Womens Health (Larchmt) 2008; 17:195-206. [PMID: 18321171 PMCID: PMC3086046 DOI: 10.1089/jwh.2006.0257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED ABSTRACT Objective: To determine if gender discrimination, conceptualized as a negative life stressor, is a deterrent to adherence to mammography screening guidelines. METHODS African American and white women (1451) aged 40-79 years who obtained an index screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this study. This logistic regression analysis includes the 1229 women who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was determined. Gender discrimination was measured as lifetime experience in seven possible situations. RESULTS Gender discrimination, reported by nearly 38% of the study population, was significantly associated with nonadherence to mammography guidelines in women with annual family incomes of > or =$50,000 (OR 1.99, 95% CI 1.33, 2.98) and did not differ across racial/ethnic group. CONCLUSIONS Our findings suggest that gender discrimination can adversely influence regular mammography screening in some women. With nearly half of women nonadherent to screening mammography guidelines in this study and with decreasing mammography rates nationwide, it is important to address the complexity of nonadherence across subgroups of women. Life stressors, such as experiences of gender discrimination, may have considerable consequences, potentially influencing health prevention prioritization in women.
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Affiliation(s)
- Amy B Dailey
- Department of Epidemiology and Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, Florida 32610, USA.
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293
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McQueen A, Swank PR, Bastian LA, Vernon SW. Predictors of perceived susceptibility of breast cancer and changes over time: a mixed modeling approach. Health Psychol 2008; 27:68-77. [PMID: 18230016 PMCID: PMC2819176 DOI: 10.1037/0278-6133.27.1.68] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine predictors of perceived susceptibility to breast cancer and assess differences across three dependent measures. DESIGN Annual surveys were completed by US women veterans (N = 3,758) participating in a repeat mammography intervention trial. Multivariable non-linear mixed model analyses examined individual- and group-level changes in perceived susceptibility to breast cancer. DEPENDENT MEASURES Three single-item measures of perceived susceptibility to breast cancer (percent risk, ordinal risk, and comparative risk likelihood). Predictors included demographic, health status, health behavior, affect, knowledge, and subjective norm variables. RESULTS Breast symptoms and greater cancer worry increased perceived susceptibility for all three measures. Other predictors varied by dependent measure. Random change, indicating individual variability, was observed for percent risk only. CONCLUSION Despite small model effect sizes, breast symptoms and cancer worry were consistent predictors and may be good targets for messages designed to influence women's perceived susceptibility to breast cancer. Researchers may benefit from using measures of perceived susceptibility with larger response scales, but additional measurement research is needed. Combining indicators of perceived susceptibility may be undesirable when different predictors are associated with different measures.
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Affiliation(s)
- Amy McQueen
- Center for Health Promotion & Prevention Research, University of Texas School of Public Health, Houston 77030, USA.
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294
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McQueen A, Vernon SW, Meissner HI, Rakowski W. Risk perceptions and worry about cancer: does gender make a difference? JOURNAL OF HEALTH COMMUNICATION 2008; 13:56-79. [PMID: 18307136 DOI: 10.1080/10810730701807076] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Risk perceptions and worry are important constructs in many theoretical frameworks used to develop cancer screening interventions. Because most cancers for which we have early detection or prevention strategies are gender specific, few investigations have examined gender differences. We examined gender differences in the magnitude of, and associations with, perceived risk and worry by cancer type. Our sample included 939 men and 1,580 women >or= 50 years old with no history of relevant cancers from the 2003 Health Information National Trends Survey (HINTS). Dependent variables included absolute and comparative perceived risk and worry for gender-specific (breast/prostate) and colon cancers. We examined demographics, health status, health behaviors, cancer beliefs, and cancer communication variables as correlates. Linear regression analyses and pairwise contrasts were conducted with SUDAAN. Men reported greater comparative perceived risk for developing cancers, whereas women reported more frequent cancer worry. For both genders, perceived risk and worry were lowest for colon cancer. Correlates of perceived risk and worry varied, and several associations were moderated by gender. Different risk messages and intervention strategies may be needed to influence males' and females' perceived cancer risk and worry. All effect sizes were small, and future prospective research is needed to confirm our findings.
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Affiliation(s)
- Amy McQueen
- Center for Health Promotion and Prevention Research, University of Texas, School of Public Health, Houston, Texas 77030, USA.
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295
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Deroche T, Stephan Y, Brewer BW, Scanff CL. Predictors of perceived susceptibility to sport-related injury. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.06.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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296
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Deroche T, Stephan Y, Lecocq G, Le Scanff C. Les déterminants psychologiques de la blessure physique du sportif: une revue de littérature. PSYCHOLOGIE FRANCAISE 2007. [DOI: 10.1016/j.psfr.2007.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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297
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Sivell S, Elwyn G, Gaff CL, Clarke AJ, Iredale R, Shaw C, Dundon J, Thornton H, Edwards A. How risk is perceived, constructed and interpreted by clients in clinical genetics, and the effects on decision making: systematic review. J Genet Couns 2007; 17:30-63. [PMID: 17968638 DOI: 10.1007/s10897-007-9132-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 09/28/2007] [Indexed: 12/18/2022]
Abstract
As an individual's understanding of their genetic risk may influence risk management decisions, it is important to understand the ways in which risk is constructed and interpreted. We systematically reviewed the literature, undertaking a narrative synthesis of 59 studies presenting data on the ways in which individuals perceive, construct and interpret their risk, and the subsequent effects. While most studies assessed perceived risk quantitatively, the combined evidence suggests individuals find risk difficult to accurately quantify, with a tendency to overestimate. Rather than being a stand-alone concept, risk is something lived and experienced and the process of constructing risk is complex and influenced by many factors. While evidence of the effects of perceived risk is limited and inconsistent, there is some evidence to suggest high risk estimations may adversely affect health and lead to inappropriate uptake of medical surveillance and preventative measures by some individuals. A more focused approach to research is needed with greater exploration of the ways in which risk is constructed, along with the development of stronger theoretical models, to facilitate effective and patient-centered counseling strategies.
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Affiliation(s)
- Stephanie Sivell
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK.
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298
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Beery TA, Williams JK. Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders. ACTA ACUST UNITED AC 2007; 11:111-23. [PMID: 17627380 DOI: 10.1089/gte.2006.0527] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although clinical genetic testing is available for over 1,000 inherited disorders, consequences of predictive genetic testing have been most extensively examined for hereditary breast and ovarian cancer (HBOC), hereditary colon cancer, and Huntington disease (HD). These focus primarily on psychological, ethical, legal, and social aspects of genetic testing. Genetic testing may also provide information that can lead to behaviors that promote health and reduce risk for disease, reflecting options available for the disorder for which the person is at risk. However, regardless of condition, people completing a genetic test may inform relatives about the results of the test and implications for their risk to develop the condition. Literature on risk reduction behaviors and communication focuses on families with HBOC or colorectal cancer. Few reports document behaviors for other conditions. This paper presents a systematic review of the research literature on risk reduction and health promotion behaviors following clinical genetic testing for adult onset conditions, primarily HBOC, familial colon cancers, and HD. Insights gleaned from this review are discussed as a basis for planning monitoring of health promotion and risk-reduction behaviors for genetic testing for present and future use.
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Affiliation(s)
- Theresa A Beery
- Institute for Nursing Research, University of Cincinnati College of Nursing, Cincinnati, Ohio 45221-0038, USA.
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299
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Luszczynska A, Gunson KSE. Predictors of asking medical personnel about handwashing: the moderating role of patients' age and MRSA infection status. PATIENT EDUCATION AND COUNSELING 2007; 68:79-85. [PMID: 17582725 DOI: 10.1016/j.pec.2007.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 05/10/2007] [Accepted: 05/10/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The study investigates patients' behaviours protective of methicillin-resistant Staphylococcus aureus (MRSA), asking doctors and nurses about handwashing before examination, and its relations with the Theory of Planned Behaviour (TPB) variables and knowledge. We expected that MRSA infection status and age might moderate relations between the behaviour and its predictors. METHODS A total of 171 individuals (59% with MRSA; 54% of 65 years or older) who had contact with the Patients Association and MRSA Support groups filled out questionnaires. RESULTS Across the groups beliefs about ability to control own behaviour were the best predictors of intention and behaviour, except for non-MRSA patients older than 65 years, for whom knowledge about MRSA infection remained the sole predictor of behaviour. The amount of explained variance of behaviour was twice as high among younger patients compared to older ones. CONCLUSIONS The study indicates limitations of the predictive value of the TPB among older patients. The results support the importance of beliefs about ability to control own behaviour in predicting an error-preventive action. PRACTICE IMPLICATIONS Enhancing control beliefs may promote asking medical personnel about handwashing. Interventions aiming MRSA prevention should target different cognitions or knowledge depending on patients' age and MRSA infection status.
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Affiliation(s)
- Aleksandra Luszczynska
- University of Sussex, Brighton, United Kingdom; Warsaw School of Social Psychology, Wroclaw, Poland.
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300
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Cabeza E, Esteva M, Pujol A, Thomas V, Sánchez-Contador C. Social disparities in breast and cervical cancer preventive practices. Eur J Cancer Prev 2007; 16:372-9. [PMID: 17554211 DOI: 10.1097/01.cej.0000236243.55866.b0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.
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Affiliation(s)
- Elena Cabeza
- Department of Public Health, Balearic Department of Health and Consumer Affairs, Palma de Mallorca, Spain.
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