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Biomedical subjects

B K Rimer

Publications and source records attributed to B K Rimer.

At least 127 records · Page 7Linked to original sources
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The cancer information service research consortium: an emerging laboratory for cancer control research.

The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to provide accurate, up-to-date information about cancer to the nation. Although the CIS has in the past served as a venue for cancer communications research, up until very recently the research capacity of the CIS was underutilized. In 1993, this situation changed dramatically with funding from the NCI to form the Cancer Information Service Research Consortium (CISRC). In this article the CISRC is described for the first time, including its research agenda and administrative structure. Early indications from the CISRC suggest that the CIS can serve as one of the premiere laboratories in the country for cancer communications and cancer control research. Several factors are suggested for the early success of the CISRC in sustaining this collaborative effort with the CIS. The progress that has been made by the CISRC could provide a useful model for other large health information programs to maximize their contributions to behavioral science and health promotion research, as well as to establish their own program of policy-relevant research.

Community-Institutional Relations↗
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A feasibility test of a brief educational intervention to increase fruit and vegetable consumption among callers to the Cancer Information Service.

BACKGROUND: In this paper, results are reported from a pilot study designed to test the feasibility of a proactive educational intervention delivered to callers of the Cancer Information Service (CIS). METHODS: The study used a randomized two-group design (intervention vs control). Callers assigned to the intervention condition received a brief educational intervention at the end of usual service to increase fruit and vegetable consumption. As part of the intervention, key education messages and materials drawn from the 5 A Day for Better Health program of the National Cancer Institute were provided to CIS callers over the telephone and then reinforced with two follow-up mailings. RESULTS: Results from this pilot study indicated high levels of adherence to protocol by CIS Information Specialists who delivered the intervention to eligible CIS callers. Results obtained from the 4-week telephone follow-up interviews indicated that intervention subjects (n = 142) reported higher consumption of fruits and vegetables, averaging approximately 0.75 servings more per day (P < 0.01) than control subjects (n = 134). CONCLUSION: Nearly 80% of CIS callers endorsed the strategy of providing 5 A Day information at the end of usual service, even if such information was not specifically requested by the caller (i.e., the information was provided to CIS callers proactively.

Adult↗
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Cancer information service-initiated outcalls to promote screening mammography among low-income and minority women: design and feasibility testing.

BACKGROUND: The telephone information service of the Cancer Information Service (CIS) historically is most effective in eliciting calls from higher income, white women. This article describes the design and feasibility of a project that tested the use of telephone outcalls to extend the reach of the telephone information service to underserved women. METHODS: Neighborhoods throughout Colorado were identified using a geodemographic database (INFORUM) that allowed selection of census block groups according to demographic characteristics. Households were assigned randomly to: (1) a control group; (2) an outcall-only group, which received "cold" telephone outcalls promoting screening mammography; and (3) an advance card plus outcall group, which received a card introducing the program prior to the outcall. RESULTS: The use of INFORUM to target low-income, less educated, and black women was largely successful. While quality of intervention delivery was high, the protocol was labor intensive, requiring an average of 40 min to identify and counsel each eligible woman. The advance card did not increase acceptance of the outcalls. CONCLUSIONS: This approach successfully extended the CIS's audience; however, its labor intensity may limit its applicability. Strategies for increasing the efficiency of outcall efforts are suggested.

Aged↗
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Underusers of mammogram screening: stage of adoption in five U.S. subpopulations. The NCI Breast Cancer Screening Consortium.

BACKGROUND: The purpose of this report is to describe the characteristics of women ages 50 to 80 who do not follow commonly accepted mammography screening guidelines. It provides unique understanding of the robustness of characteristics of underusers across five different U.S. subpopulations. METHODS: The data are from the baseline surveys of the five studies of the NCI Breast Cancer Screening Consortium. Stage of adoption of mammography screening and other characteristics of underusers are presented. Polytomous logistic regression analysis was used to explore multivariable associations with stage of adoption in each study site. RESULTS: The five samples studied by the Consortium range in size from 259 to 4,477 women (n = 11,292). The relationship of the perceptions of the pros and cons of mammography with stage of adoption was strikingly similar across the five samples. Other variables consistently associated with stage were a recent receipt of a breast physical examination and recommendation for mammography by a physician. CONCLUSIONS: The findings suggest a need to encourage regular screening through effective communication from a health care provider. Intervention messages should be designed to increase the pros of mammography, decrease the cons, and highlight these differentially according to the woman's stage of adoption.

Aged↗
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Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention.

BACKGROUND: Tailoring is a promising technique for encouraging greater performance of health-related behaviors. Tailored interventions are designed to be more individualized to personal characteristics, in contrast to "standard" interventions where all participants receive the same materials. METHODS: A total of N = 1864 women aged 40-74 were recruited from a staff model HMO and randomly assigned to one of three intervention groups: (a) No Educational Materials, (b) Standard Materials, and (c) Stage-Matched Materials. A provider-directed component was common across all three conditions. The Standard and Stage-Matched groups each received two mailed educational packets after baseline and follow-up telephone interviews. The Stage-Matched intervention was based on the Transtheoretical Model of behavior change. RESULTS: Analyses of n = 1397 women (after all attrition) showed that receipt of mammography after the baseline interview was higher for the Stage-Matched group (63.6%) than for the No Materials group (54.9%; OR = 1.43, 95% CI = 1.10, 1.86). The Standard intervention group was intermediate (58. 5%). The Standard group did not differ from the No Materials group, but did differ from the Stage-Matched group in multivariate analysis. CONCLUSIONS: Stage-matched, tailored materials may be a means to encourage screening mammography. Such interventions can be implemented by telephone and mail.

Adult↗
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Effectiveness of a telephone outcall intervention to promote screening mammography among low-income women.

BACKGROUND: This study evaluated the impact of a telephone outcall intervention (based on the Transtheoretical Model) on screening mammography behavior among lower income, older women. METHODS: A geodemographic database, INFORUM, was used to identify low-income and minority neighborhoods throughout the state of Colorado. Residences were assigned randomly to three study groups: (1) control, (2) outcall only, and (3) advance "invitation" + outcall. Information Specialists of the Cancer Information Service implemented the protocol. Mammography adherence was assessed in telephone interviews conducted 6 months and 2 years after the initial call. RESULTS: Neither intervention had a significant effect on the main outcome, receipt of mammography in the 6-month follow-up period. At 6 months, intentions to have a mammogram were significantly stronger in the intervention groups compared with the control group, particularly among those who were precontemplators at baseline. The 2-year follow-up indicated a small increase in mammography adherence attributable to the advance invitation + outcall, but this effect was restricted to those adherent at baseline. Mammography behavior during the 6-month follow-up period was predicted strongly by decisional balance, intentions, receipt of a physical and clinical breast exam, and previous mammography behavior. CONCLUSIONS: The intervention promoted minimal movement in the stages of change for mammography. Outcall interventions may have promise for encouraging repeat mammography behavior, but more intensive interventions are likely to be necessary to promote behavior change among nonadherent women.

Aged↗
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Increasing fruit and vegetable consumption among callers to the CIS: results from a randomized trial.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the Cancer Information Service (CIS). METHODS: CIS callers assigned to the intervention group received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention subjects. Subjects were interviewed by telephone at both 4-week (n = 1,672) and 4-month (n = 1,286) follow-up. RESULTS: A single-item measure of fruit and vegetable consumption revealed a significant intervention effect of approximately 0.65 servings per day at 4-week follow-up (P < 0.001) and 0.41 servings per day at 4-month follow-up (P < 0.001). Using a seven-item food frequency measure that was also included in the 4-month interviews, a similar intervention effect of 0.34 servings per day was obtained (P = 0.006). The vast majority of CIS callers (88%) endorsed the strategy of providing 5 A Day information proactively. CONCLUSIONS: A brief educational intervention delivered to CIS callers at the end of usual service was associated with an increase in self-reported fruit and vegetable intake.

Adult↗
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Knowledge, satisfaction, and perceived cancer risk among women diagnosed with ductal carcinoma in situ.

The prevalence of ductal carcinoma in situ (DCIS) has increased through more widespread use of screening mammography. Little is known about what women with DCIS understand about their disease and future health. Although there is a wealth of information about the psychological characteristics of women with invasive breast cancer, there is virtually no information about women who have received treatment for DCIS. Seventy-six women diagnosed with DCIS who were identified through the Duke University Tumor Registry completed a mailed self-administered questionnaire including a broad range of items to measure knowledge, satisfaction with care, risk perceptions, and psychological distress. Women with DCIS have knowledge deficits about DCIS and breast cancer, as well as concerns about recurrence and misperceptions about the likelihood for DCIS metastasis. Women were generally satisfied with their care. They were less satisfied with information related to prognosis and with perceived support from their doctors. The results of this study suggest several areas of concern for women diagnosed with DCIS. Data about risk perceptions, knowledge, and attitudes in women diagnosed with DCIS provide important preliminary ideas for future studies. In view of the frequency of the DCIS diagnosis, future investigation should be conducted to build on these findings.

Adaptation, Psychological↗
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Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Climacteric↗
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General performance on a numeracy scale among highly educated samples.

BACKGROUND: Numeracy, how facile people are with basic probability and mathematical concepts, is associated with how people perceive health risks. Performance on simple numeracy problems has been poor among populations with little as well as more formal education. Here, we examine how highly educated participants performed on a general and an expanded numeracy scale. The latter was designed within the context of health risks. METHOD: A total of 463 men and women aged 40 and older completed a 3-item general and an expanded 7-item numeracy scale. The expanded scale assessed how well people 1) differentiate and perform simple mathematical operations on risk magnitudes using percentages and proportions, 2) convert percentages to proportions, 3) convert proportions to percentages, and 4) convert probabilities to proportions. RESULTS: On average, 18% and 32% of participants correctly answered all of the general and expanded numeracy scale items, respectively. Approximately 16% to 20% incorrectly answered the most straightforward questions pertaining to risk magnitudes (e.g., Which represents the larger risk: 1%, 5%, or 10%?). A factor analysis revealed that the general and expanded risk numeracy items tapped the construct of global numeracy. CONCLUSIONS: These results suggest that even highly educated participants have difficulty with relatively simple numeracy questions, thus replicating in part earlier studies. The implication is that usual strategies for communicating numerical risk may be flawed. Methods and consequences of communicating health risk information tailored to a person's level of numeracy should be explored further.

Adult↗
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Computerized prompts for cancer screening in a community health center.

BACKGROUND: We describe the implementation and subsequent use of a computerized health maintenance tracking system in a large, urban, North Carolina community health center (Lincoln Community Health Center) as part of a larger study designed to increase rates of mammography, Papanicolaou tests, and smoking cessation in low-income African-Americans. METHODS: Clinicians from the Lincoln Community Health Center were involved in the design and implementation of the computer system. At each office visit, clinicians received a computerized encounter form indicating needed screening tests, counseling, and immunizations for each randomly selected study patient (n = 1318). RESULTS: Initial clinician compliance rates with filling out the form were 95 percent (mammography), 82 percent (Papanicolaou test), 77 percent (clinician breast examination), and 55 percent (smoking cessation). Cumulative compliance leveled off at 21 months to 65 percent, 57 percent, 53 percent, and 38 percent, respectively, despite multiple reminder strategies. When surveyed, most clinicians thought it was a good reminder system but said they did not always complete the form because of time demands. Costs of adapting and implementing the system were $23,332.08 ($17.70 per study). Per-patient costs would have been reduced further if more patients had been included in the project. CONCLUSIONS: State-of-the-art computer prompting systems can be useful in a community health center; however, even with prompting, clinicians still only addressed health maintenance with their patients about 50 percent of the time. Additional interventions will be needed, particularly in low-income populations, to meet the Healthy People 2000 goals in health promotion.

Adolescent↗
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Factors influencing acceptance of mammography: implications for enhancing worksite cancer control.

PURPOSE: The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. SEARCH METHODS: We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. SUMMARY OF IMPORTANT FINDINGS: A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. MAJOR CONCLUSIONS: Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.

Adult↗
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Multistrategy health education program to increase mammography use among women ages 65 and older.

Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.

Aged↗