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Biomedical subjects

J K Worden

Publications and source records attributed to J K Worden.

At least 37 records · Page 2Linked to original sources
PubMed1994

Comparability of telephone and household breast cancer screening surveys with differing response rates.

We compared telephone and household surveys as methods for obtaining information about breast cancer screening. The study population was comprised of women age 40 years or older who were permanent residents of two large areas of Florida. We contacted women using random digit dialing for the telephone survey. We used a stratified multistage design for the household survey. Response rates were 49% (telephone) and 77% (household). Distributions of most screening (mammography, clinical examination, and breast self-examination) and demographic variables were comparable for the two surveys; income was higher in the telephone survey. Both surveys underestimated the proportion of older women, based on 1990 Census data.

Adult↗
PubMed1994

Mass media and school interventions for cigarette smoking prevention: effects 2 years after completion.

The long-term cigarette smoking prevention effects of mass media and school interventions were assessed. Adolescents in two communities received both mass media and school interventions; those in two matching communities received only school interventions. Surveys of 5458 students were conducted at baseline in grades 4 through 6 and 2 years after the 4-year interventions were completed, when students were in grades 10 through 12. Students exposed to the media-plus-school interventions were found to be at lower risk for weekly smoking (odds ratio = 0.62, 95% confidence interval = 0.49, 0.78) than those receiving school interventions only, indicating that the effects of the combined interventions persisted 2 years after the interventions' completion.

Adolescent↗
PubMed1993

Continuing education in the physician's office: a pilot study for breast exams.

In response to a recent study indicating that primary care physicians were interested in receiving breast-screening education, an office-based training program was developed and delivered to fourteen physicians in Vermont and Florida. A nonphysician trainer and simulated patient provided instruction and feedback in clinical breast examination and in patient instruction in breast self-examination. Measurements of physician palpation skills before and after the training showed substantial skill improvement, and the office-based session was found to be highly acceptable by all participants.

Breast Neoplasms↗
PubMed1992

Clinical breast examination and breast self-examination. Past and present effect on breast cancer survival.

Increasing attention to self-detection of breast masses and clinical breast examination during this century have contributed to a progressive reduction in the size of breast cancers at detection and a progressive improvement in survival. Mammography is more sensitive than breast palpation for the detection of breast cancer, however, mammography does not detect all palpable cancers and additional interval cancers become palpable between screenings. Breast self-examination, clinical breast examination, and mammography are complementary screening modalities. In populations where mammography is not available or is not appropriate as a screening modality, clinical breast examination and breast self-examination are particularly important.

Breast Neoplasms↗
PubMed1992

Training obstetric and family practice residents to give smoking cessation advice during prenatal care.

OBJECTIVE: Our objective was to determine the effectiveness of training obstetric and family practice residents to provide smoking cessation advice. STUDY DESIGN: The effectiveness of the trained residents' advice was assessed from exit interviews of pregnant smokers taking part in a randomized, controlled trial of smoking cessation advice. Exit interview responses were compared by chi 2 analysis. RESULTS: Training resulted in significant changes in the advice provided by the residents, with greater emphasis on gaining a commitment to smoking behavior change, but not in the average time providing the advice, approximately 3 minutes. Adherence to the protocol was maintained at 80%. Significantly more women who received the brief structured advice agreed to stop smoking (54%) or cut down their cigarette consumption (28%) compared with women in the control group (14% and 6%, respectively), p = 0.0001. CONCLUSION: The structured advice consistently provided by the trained residents was effective in gaining commitments from pregnant smokers to change their smoking behavior.

Family Practice↗
PubMed1992

Prevention of cigarette smoking through mass media intervention and school programs.

OBJECTIVES: In this study we tested the ability of mass media interventions to enhance the efficacy of school cigarette smoking prevention programs. METHODS: For 4 years, students in one pair of communities received media interventions and school programs that had common educational objectives. Students in a matched pair of communities received only the school programs. The combined cohort of 5458 students was surveyed at baseline in grades 4, 5, and 6 and was followed up annually for 4 years. RESULTS: Significant reductions in reported smoking, along with consistent effects on targeted mediating variables, were observed for the media-and-school group. For cigarettes per week the reduction was 41% (2.6 vs 4.4); for smoking cigarettes yesterday the reduction was 34% (8.6% vs 13.1%); and for smoking in the past week the reduction was 35% (12.8% vs 19.8%). No effects were observed for substance use behaviors not targeted by the interventions. CONCLUSIONS: These results provide evidence that mass media interventions are effective in preventing cigarette smoking when they are carefully targeted at high-risk youths and share educational objectives with school programs.

Adolescent↗
PubMed1991

Relative effectiveness of methods of breast self-examination.

This study investigated the effectiveness of different methods of breast self-examination (BSE) on coverage of breast area and lump detection, using a factorial design, pairing three search patterns (concentric circle, radial spoke, vertical strip) with two finger palpation techniques (small circular movements, sliding movements). Ninety-seven female undergraduates were randomly assigned to one of six BSE training conditions which were identical except in the BSE search pattern and finger palpation technique explained by the instructor. Following the 20-min, small-group training, subjects' coverage of breast area was assessed by scoring their BSE performance on a breast board. Lump detection was determined by the number of lumps correctly identified in silicone breast models. Results indicated that the vertical strip pattern was associated with significantly greater coverage of the breast area. There were no significant differences in lump detection; however, the sliding finger palpation technique resulted in significantly more false identifications of lumps.

Breast Neoplasms↗
PubMed1990

A community-wide program in breast self-examination training and maintenance.

This study reports on the effects of innovative community-wide breast self-examination education approaches in increasing breast self-examination frequency and quality, and ability to detect breast lumps during a 1-year training program and a second-year maintenance program. Four Vermont communities were randomly assigned to receive breast self-examination training plus maintenance, training alone, control (with full measurement), and low-measurement control. Random digit dialing telephone surveys were conducted at baseline and at 1- and 2-year follow-up with a panel of 637 women representing all adult women in the first three communities. The low-measurement control community received only baseline and second-year follow-up surveys with a panel of 238 women. Home interviews to determine breast self-examination palpation skills and lump detection on silicone breast models were conducted in first- and second-year follow-up surveys. Results of the first-year follow-up survey indicated significant increases in breast self-examination frequency, quality, and number of lumps detected for women in communities receiving the training program compared with controls; in the second year, women in the community also receiving breast self-examination maintenance showed greater improvement in reported breast self-examination quality and detected more breast lumps than did women in other communities.

Adult↗
PubMed1989

Mammography registry: considerations and options.

Radiologists are being urged to provide high-quality low-cost screening mammography to all women over 40 years of age. A mammography registry coupled with existing cancer registries would permit the quality and effectiveness of screening efforts to be evaluated. Standards of care would be determined that would permit quality assessment at individual centers and that could enhance medicolegal defense. The organizing group should consist of physician users, experts in mammography, statisticians, and administrators. Data regarding the number and type of studies, findings, interpretations, and recommendations could be collected and reported easily and cheaply with a standardized form. The registry could be financed by federal, state, or private funds; the latter are most preferable, but a combination of the three is most feasible. Screening mammography presents a serious public health challenge that is best addressed by the organization and support of a registry by radiologists.

Costs and Cost Analysis↗
PubMed1989

Preventing alcohol-impaired driving through community self-regulation training.

A community education program was designed to train the individual drinker to self-regulate his or her blood-alcohol concentration (BAC) below a level of impairment (.05 g/dl or 11 mmol/L). Drink calculators (cardboard wheels and wallet cards) were disseminated to customers of bars and licensed beverage outlets; bartenders and counter clerks were trained to demonstrate use of the calculators and demonstrations were presented in television spots. Program components were evaluated in three matched Vermont communities, one receiving the full community education program, one receiving the TV spots only, and one serving as control. After six months of intervention, a roadside survey of nighttime drivers (N = 892) indicated 5.3 per cent fewer drivers with BACs above 0.05 g/dl in the community program group and 1.0 per cent fewer in the TV-only group compared to the control group; however, substantially fewer drivers were found above .00 BAC in either program community than in the control. Drivers reporting heavy drinking and youthful drivers both indicated higher utilization of the materials than did other drivers. Although limited in scale and duration, this study suggests that a community education program can be effective in preventing alcohol-impaired driving.

Adult↗
PubMed1989

Physician interest in breast cancer screening education. A survey of Vermont family physicians.

A mailed survey of 141 Vermont family physicians (74% participating) was conducted to determine their breast cancer screening practices and beliefs and their interest in receiving training in breast cancer screening. Of these, only 12% reported that at least three fourths of their female patients older than 50 years received mammograms at least once a year, compared with 33% who reported providing breast self-examination instruction and 35% who administered clinical breast examination with at least three fourths of these patients at least once a year. Nevertheless, 55% of the physicians rated mammography as a very effective breast-screening procedure; 28% rated breast self-examination and 16% rated clinical breast examination as very effective. Three fourths of the physicians showed great interest in learning more about breast palpation, breast self-examination instruction, and mammography. Individual instruction in the office was preferred over a group workshop format, and a trained nonphysician health professional was considered as acceptable as a physician to provide the instruction. Results suggest that breast cancer screening education for family physicians is a high priority, and that physicians will welcome such training, particularly if it is office-based.

Attitude of Health Personnel↗
PubMed1988

Development of a smoking prevention mass media program using diagnostic and formative research.

The process of developing a mass media campaign to prevent smoking among adolescents is described in detail. This campaign supplements a school smoking prevention program and shares educational objectives with the school program but is otherwise independent. It comprises various television and radio 30- and 60-sec "spot" messages. The campaign development process includes identifying educational objectives and strategies for appealing to young people; conducting diagnostic surveys and focus groups to determine target audience interests and perceptions about smoking and media content; suggesting approaches to producers to create preliminary television and radio messages for testing; conducting formative pretests with target groups to select optimal messages and suggest improvements to those messages; producing final messages for media presentation; and developing a media exposure plan to place messages in local media at optimal times for reception by target audiences. The media campaign is being evaluated in a 5-year project with 5,500 adolescents in four communities to determine the additional effect of mass media over a school program alone in preventing smoking.

Adolescent↗
PubMed1988

Why volunteers helped to promote a community breast self-exam program.

Involving volunteers in community health programs is common practice. However, there is little information about specific methods to motivate volunteers to become involved and stay involved. In a community breast self-exam (BSE) education project, volunteers played a major role in the recruitment of women for BSE training presentations given by nurse instructors. Working in a support group capacity, approximately 20 women volunteers in each of two communities completed recruitment tasks such as hosting presentations in their own homes, arranging for presentations for a club or organization, and endorsing the program in the media. At the end of a three-month period, the activities of these volunteers had increased participation of community women in presentations by 50% in one community and 115% in the second community, and the BSE education program had increased both the frequency and quality of BSE practice throughout both communities. Because of the success of the volunteer support group strategy, an interview was conducted with the eleven "super-star" volunteers to assess the motivational factors influencing their initial and continued involvement. Results include a description of common characteristics of these highly motivated volunteers and several recommendations for volunteer administrators or for anyone attempting to recruit and maintain motivated groups of volunteers.

Breast Neoplasms↗
PubMed1987

Breast self-examination practices and attitudes of women with and without a history of breast cancer.

Breast self-examination (BSE) practices and attitudes of three groups of women were compared using a mailed survey. Subjects were 59 women with previous breast cancer, 33 women with previously treated benign breast lump(s), and 80 general-population women with no history of breast disease. Groups were compared on frequency, proficiency, and knowledge of BSE. Determinants of practice were examined using attitudinal variables from the Health Belief Model. Results indicated that the breast cancer group had significantly higher rates of BSE frequency, proficiency, and knowledge than did the general-population group. The breast cancer group perceived cancer to be significantly less threatening than did the other two groups, although the general-population group reported significantly less susceptibility to breast cancer. Within-group analyses revealed that barriers to BSE practice accounted for the greatest amount of variance in BSE frequency in all three groups. These results are discussed.

Attitude to Health↗