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B K Rimer

Publications and source records attributed to B K Rimer.

At least 73 records · Page 4Linked to original sources
PubMed1996

Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants.

Recently, concerns have been raised about risks and benefits of silicone gel implants for breast reconstruction. Using a survey conducted during the silicone controversy that began in 1990, this study examines patient satisfaction in 174 women with silicone breast implants. Overall satisfaction was high; 43 percent indicated complete satisfaction, and only 3 percent stated they were "not at all" satisfied. Satisfaction was correlated with each woman's assessment of how reconstruction met her expectations, particularly expectations about clothes fitting better, feeling whole, looking normal, and having similar-appearing breasts. Higher levels of satisfaction also were associated with lower body mass index and absence of medical problems. While patients appeared satisfied with their reconstructions, 34 percent said they would be completely unlikely to choose silicone implants today. Further research is needed to understand the impact of the silicone breast implant debate on women who have had or may consider breast reconstruction.

Adult↗
PubMed1996

Relationships among objective and subjective risk for breast cancer and mammography stages of change.

This study examined the relationships among objective and subjective risk for breast cancer and mammography stages of change as defined by the Transtheoretical Model. Women who had higher objective risk of breast cancer, as defined by the Gail et al. algorithm (M. H. Gail et al., J. Natl. Cancer Inst., 81: 1879-1886, 1989), were more likely to perceive themselves at greater subjective risk for breast cancer. Among the components of objective risk, family history of breast cancer was the only significant predictor of subjective risk. Both objective and subjective risk individually predicted stages of change, such that higher objective and subjective risk were associated with an increased probability of being in a later stage of adopting mammography. However, when objective and subjective risk were included in a multivariate model, only subjective risk predicted stages of change. In additional multivariate analyses, subjective risk continued to predict mammography stages of change when "con" and "decisional balance" scores were included in separate models. These results suggest that future research may benefit from the explicit integration of personal risk perceptions with elements of the Transtheoretical Model to provide more powerful accounts of behavioral change processes.

Breast Neoplasms↗
PubMed1995

Correlates of mammography among women with low and high socioeconomic resources.

BACKGROUND: Although screening mammography rates have increased, even women with higher incomes and more formal education do not all obtain the exam. This study examined why a modest proportion of higher income/higher education women do not get screened and, conversely, why a small percentage of lower income/lower education women do receive screening. METHODS: Data were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. A total of 3,014 women, ages 40-75, were in the sample. Low-resource women had incomes of less than $20,000 and less than a high school diploma. High-resource women had incomes of $30,000 or more and at least some college education. RESULTS: Correlates of screening status were similar for both resource groups. Recency of Papanicolaou test, recency of clinical breast exam, and regular breast self-examination were associated with higher rates of screening. Four or more persons in a household were associated with lower rates. Among low-resource women, incomes of $10,000-$19,999 were associated with higher likelihood of screening. An income of $50,000 or more was associated with screening among high-resource women. CONCLUSIONS: The fact that several variables were important for both resource groups suggests that targeted interventions could have benefits across a wide population. Nonetheless, in the high-resource group, 2-year rates never exceeded 80% and repeated screening never exceeded 60%. Rates for low-resource women were over 30% lower. Medical care utilization data did not differ between the two resource groups sufficiently to account for the discrepant rates. Improving screening rates in both resource groups remains a major challenge.

Adult↗
PubMed1995

Knowledge, beliefs, and prior screening behavior among blacks and whites reporting for prostate cancer screening.

OBJECTIVES: A survey to determine prostate cancer-related knowledge, beliefs, and prior screening behavior was administered to men participating in prostate cancer screening events at nine major sites in the southeast. Since prostate cancer disproportionately affects blacks, a primary focus of the analysis was to determine if differences in responses exist between racial groups. METHODS: A 20-question, multiple-choice survey to ascertain prostate cancer knowledge and beliefs, demographics, and health care access information was administered at nine major southeastern sites participating in Prostate Cancer Awareness screening events. Potential differences between the responses of blacks and whites were tested using the Cochran-Mantel-Haenszel test (P < 0.05), adjusting for differences among sites. RESULTS: Major findings of this study on 286 black and 1218 white men are as follows: (1) only 28% of black or white men report that their doctor ever discussed a test for prostate cancer with them; (2) blacks were less likely to have a regular doctor (P = 0.03) or ever to have had a digital rectal examination (P < 0.001) or prostate-specific antigen testing (P = 0.005); (3) blacks were less likely to report knowing someone with prostate cancer (P < 0.001) and were more apt to report their acquaintances experiencing post-treatment impotence than whites (P = 0.03); they were less likely to report that "a man with prostate cancer can lead a normal life" (P < 0.001) or that "men can have prostate cancer without symptoms" (P < 0.001); (4) a substantial number of all men did not know that race and/or heredity are risk factors; and (5) "peace of mind" was the leading reason why men (63% of whites and 50% of blacks) attended prostate cancer screening events. CONCLUSIONS: There are a number of similarities among black and white men regarding knowledge and beliefs related to prostate cancer. Important differences, however, in access to screening, perception of the disease and its treatment, and knowledge of risk factors exist between racial groups and represent significant barriers to early detection among African Americans.

Black or African American↗
PubMed1995

Predictors of adoption of mammography in women under age 50.

Women in the University of North Carolina Alumni Heart Study reported their knowledge of and attitudes toward mammography as well as their adoption of mammography by 1991. Personality measured in 1988-1989 at the age of 42 was associated with the pattern of adoption of mammography reported 2 years later. Adoption of regular mammograms was predicted by conscientiousness, extraversion, and lower depression but not by anxiety. After adjusting for 8 traditional predictors of mammography shown to be significant in this population, the previous personality factors did not maintain their significance. When the women were divided into those who reported breast problems and those who did not, the same set of adjustment factors reduced, but did not eliminate, the association of conscientiousness with adoption of mammography for women without breast problems.

Adult↗
PubMed1994

Tailoring smoking cessation for older adults.

BACKGROUND: Older adults are an important audience for smoking cessation programs. Over 4.5 million older adults (older than 65) continue to smoke, and the majority are long term, heavy smokers. There is evidence that smoking cessation programs tailored to older smokers can be effective. American Cancer Society (ACS) materials and programs represent an important opportunity to meet the needs of older smokers. METHODS: This article reviews the rationale for tailoring programs to older adults. A 10-step model is presented. The Clear Horizons program is provided as an example of a tailored program. RESULTS: The Clear Horizons program demonstrated that a tailored program results in significantly higher rates of quitting--20% of Clear Horizons participants reported not smoking at 12 months compared with 15% for the generic guide. CONCLUSIONS: Older smokers were highly responsive to a tailored program. The ACS should consider opportunities for tailoring new and existing programs to meet the needs of older smokers.

Aged↗
PubMed1994

Quitting motives and barriers among older smokers. The 1986 Adult Use of Tobacco Survey revisited.

BACKGROUND: Adults aged 50-74 years comprise more than 20% of the population and more than 22% of all smokers. Smoking is a risk factor for 7 of the 14 major causes of death for older adults, including cancer, heart disease, and lung disease. Moreover, older smokers can experience significant dramatic health benefits from quitting, including improvements in circulation and pulmonary function and declines in risks for heart disease, heart attacks, and stroke. METHODS: Smoking patterns, quitting motives, and barriers among older smokers were examined by comparing responses of older smokers (aged 50-74 years) and younger smokers (aged 21-49 years) who took part in the 1986 Adult Use of Tobacco Survey. RESULTS: Older and younger smokers differed little in current smoking patterns or in past quit attempts, motives, and methods. Survey results show that older smokers are far less likely to accept smoking health harms and more likely to view smoking as a beneficial coping and weight control tactic. CONCLUSIONS: Motivational strategies should be tailored to the unique health beliefs and cultural history of older smokers.

Adult↗
PubMed1994

Future directions in early detection research. A response to Drs. Bloom and Richardson.

We are on the threshold of a new era in behavioral research. New discoveries in basic science, especially in genetics, mean that we know much more about how to prevent cancer and identify populations at risk for the disease. We have witnessed a shift from the use of the Health Belief Model as the dominant theoretical model to the use of Transtheoretical Model. The behavioral research agenda should include more collaborative trials, the use of common outcome measures, operationalization of the Transtheoretical Model, and interaction with geneticists to use the information about genetic causes of cancer. In addition, there should be more attention to the multiple health needs of people. We cannot continue to view cancer separately from other health problems, such as cardiovascular disease and violence.

Attitude to Health↗
PubMed1994

Interventions to increase breast screening. Lifespan and ethnicity issues.

BACKGROUND: In spite of the fact that the value of mammography has been demonstrated, it remains underused by those in need, such as older women and minority women. A consideration of lifespan and ethnicity issues may help in designing interventions designed to overcome the barriers women may face at different stages in their lives as well as the barriers that may be most salient for minority women. METHODS: There now are reports from a number of published trials indicating the value of different kinds of interventions. Interventions can be characterized as individual-directed, system-directed, social network, or multistrategy. Although little is known about what interventions may be specifically appropriate for women in their 40s, both individual-directed and multistrategy interventions have increased use of mammography significantly among women in their 50s, 60s, and 70s, including African American women. CONCLUSIONS: Although there is a considerable distance to go before all American women are getting regular mammograms, progress is being made. Attention to developing tailored interventions sensitive to lifespan and ethnicity concerns may be helpful.

Adult↗
PubMed1994

Use of transdermal nicotine in a state-level prescription plan for the elderly. A first look at 'real-world' patch users.

OBJECTIVE: To assess transdermal nicotine use patterns and outcomes in a population of low-income older smokers. DESIGN: A 6-month telephone follow-up survey of smokers filling prescriptions for transdermal nicotine in the first 3 months of 1992. SETTING: Pennsylvania's Pharmaceutical Assistance Plan for the Elderly, the nation's largest state-level prescription plan for the elderly. POPULATION: A total of 1070 noninstitutionalized male and female smokers aged 65 through 74 years. MAIN OUTCOME MEASURES: Self-reported physician/pharmacist advice and adjunctive treatments, concomitant smoking, and 6-month smoking abstinence. RESULTS: Respondents were predominantly long-term heavy smokers. They used nicotine patches for an average of 5 weeks, with few reporting use beyond 3 months or recalling bothersome side effects. Most of those with previous quit attempts rated quitting with the patch "easier." The 29% self-reported 6-month quit rate observed is encouraging. However, compliance with patch use guidelines was far from ideal in this high-risk population: only 54% of respondents received any initial advice or materials from their physicians or pharmacists, fewer than 2% took part in a formal clinic or one-to-one treatment program, and almost half (47%) smoked while using the patch, including 20% who smoked every day. Concomitant smoking was strongly associated with failure to achieve abstinence (P < .001). More frequent contact with physicians and/or pharmacists was associated with less concomitant smoking (P < .001) and higher quit rates (P = .005). CONCLUSIONS: This survey offers an important first look at problems and prospects for nicotine patch therapy in older adults, with implications for other groups as well. Prospective studies are needed to clarify optimal treatment regimens and adjuncts.

Administration, Cutaneous↗
PubMed1994

Reaching mothers of preschool-aged children with a targeted quit smoking intervention.

Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.

Adult↗
PubMed1994

Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers.

There is new evidence that smokers of all ages benefit from cessation of smoking. Although most older smokers, like younger smokers, prefer to quit on their own, at the time this project was started, there were no materials or programs targeted to older smokers. Using the literature, focus groups with older smokers and a national survey of older smokers, we created Clear Horizons, a self-help guide for older smokers, and a telephone counseling protocol tailored to the needs of older smokers (age 50-74). Smokers were recruited from around the United States and assigned randomly to a control guide, Clearing the Air, Clear Horizons alone or Clear Horizons and two counselor calls. Follow-up of nearly 2000 smokers was conducted by telephone 3, 6, 12 and 24 months after delivery of the self-help guides. This report focuses primarily on results at 3 months because that was the measurement for reactions to the interventions. At the 3 month interview, those in the tailored interventions rated their guides more highly than did those in the control group. They also read more of their guides and were more likely to reread them. Quit rates were significantly higher among smokers who received a combination of the tailored guide and telephone counseling. At 3 months, the combination of the guide and telephone counseling was most effective in helping smokers to quit. By 12 months, both the tailored guide alone and the tailored guide and calls groups had higher quit rates than the control guide but were not statistically different from one another.

Age Factors↗
PubMed1994

Promoting mammography use through progressive interventions: is it effective?

This study evaluated interventions implemented with women in a health maintenance organization who had not utilized their annual free mammogram referral 45 days (step 2) and 95 days (step 3) after its mailing. The step 2 evaluation compared mammography utilization for women randomly assigned to receive a brief reminder letter or no reminder: 42% of the reminder group vs 28% of the control group obtained mammograms. The step 3 evaluation compared utilization for women randomly assigned to receive a second reminder, a letter suggesting a preventive office visit, or telephone counseling: 29% of those who received telephone counseling, 14% of those who received a letter, and 12% of those who received a second reminder obtained mammograms.

Aged↗
PubMed1993

Report of the International Workshop on Screening for Breast Cancer.

BACKGROUND: Over the past 30 years, eight major randomized controlled trials of breast cancer screening--with mammography and/or clinical breast examination--have been conducted. Results from several trials have been updated during the past year, and initial results of three other trials have been reported. PURPOSE: The National Cancer Institute held an International Workshop on Screening for Breast Cancer in February 1993 to conduct a thorough and objective critical review of the world's most recent clinical trial data on breast cancer screening, consider the new evidence, assess the current state of knowledge, and identify issues needing further research. METHODS: Investigators representing the eight randomized controlled trials of breast cancer screening in women aged 40-74 presented published and unpublished data. Evidence relating to the effectiveness of breast cancer screening in different age groups, especially women aged 40-49, was presented. RESULTS: For women aged 40-49, randomized controlled trials consistently demonstrated no benefit from screening in the first 5-7 years after study entry. A meta-analysis of six trials found a relative risk of 1.08 (95% confidence interval = 0.85-1.39) after 7 years' follow-up. After 10-12 years of follow-up, none of four trials have found a statistically significant benefit in mortality; a combined analysis of Swedish studies showed a statistically insignificant 13% decrease in mortality at 12 years. Only one trial (Health Insurance Plan) has data beyond 12 years of follow-up, and results show a 25% decrease in mortality at 10-18 years. Statistical significance of this result is disputed, however. In women aged 50-69, all studies show mortality reductions; three of four studies show reductions of about 30% at 10-12 years after study entry. Results from two of these trials were statistically significant. Too few women over age 70 have been included in studies for adequate analysis. CONCLUSIONS: For women aged 40-49, randomized controlled trials of breast cancer screening show no benefit 5-7 years after entry. At 10-12 years, benefit is uncertain and, if present, marginal; thereafter, it is unknown. For women aged 50-69, screening reduces breast cancer mortality by about a third. Currently available data for women age 70 or older are inadequate to judge the effectiveness of screening. IMPLICATIONS: Randomized trials have provided stronger scientific evidence regarding the effectiveness of screening for breast cancer than for any other cancer. However, much still needs to be learned. Periodic gatherings of scientists in the field should speed the process.

Adult↗
PubMed1993

Silicone controversy: a survey of women with breast cancer and silicone implants.

BACKGROUND: During the past 3 years, there has been a highly publicized debate concerning the potential medical complications of silicone breast implants. There have been no studies that have addressed the effect of this controversy on women with a history of breast cancer who have undergone breast reconstruction with silicone implants. PURPOSE: This study was undertaken to understand the concerns of such women regarding their breast reconstructions and to assess what impact the silicone implant controversy had on them. METHODS: One hundred seventy-four randomly selected women who had undergone reconstructive surgery with silicone implants subsequent to mastectomy for treatment of breast cancer were interviewed by telephone from February through May 1992. (A moratorium on use of silicone breast implants, imposed by the Food and Drug Administration, extended from January through April 1992.) These women, a subset of 359 mastectomy/reconstruction patients of one university-based plastic surgeon, had their first permanent prostheses placed between 1985 and 1990. The interview included questions designed to elicit information about women's experiences with reconstruction and reactions to the controversy. RESULTS: All study participants were aware of the controversy surrounding silicone implants. Seventy-six percent stated that breast reconstruction helped them cope with cancer, and only 16% had regrets about reconstruction. Many respondents had misconceptions about the nature of possible complications from silicone implants. Fifty-five percent were worried about the implants, yet only 13% considered having them removed as a result of the controversy. Only 27% indicated they would be completely likely to choose silicone implants again. The majority of women were unwilling to accept substantial risks of complications from implants, but there was variability in the level of risk that respondents would tolerate. CONCLUSIONS: A majority of women who have had breast reconstruction using silicone implants after treatment of breast cancer believe that implants helped them cope with the cancer. However, a sizeable proportion of such women are worried about possible medical complications that may develop as a consequence of silicone breast implants. Many would likely not choose these implants today. IMPLICATIONS: The true risks associated with silicone implants will ultimately be known. In the meantime, health care providers need to address patients' concerns about these implants. Information and guidance regarding the potential benefits and risks of breast implant devices should be provided to women with breast cancer who are considering treatment options.

Adult↗