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Biomedical subjects

K Glanz

Publications and source records attributed to K Glanz.

At least 37 records · Page 2Linked to original sources
PubMed1999

Correlates of intentions to obtain genetic counseling and colorectal cancer gene testing among at-risk relatives from three ethnic groups.

OBJECTIVES: An understanding of factors associated with interest in genetic counseling and intentions to obtain colorectal cancer susceptibility testing is an important foundation for developing education, counseling, and genetic services and policies. MATERIALS AND METHODS: A survey was mailed to first-degree relatives of patients diagnosed with colorectal cancer. The respondents (n = 426, 77% response rate) are siblings and adult children of Caucasian, Japanese, and Hawaiian ethnicity. Data collection was guided by a conceptual framework and included questions on demographics, family cancer history, predisposing factors (cancer worry, perceived risk, well-being), and enabling factors (decision preferences, social support, and health care factors). Logistic regression analysis on two binary dependent variables (interest in counseling and intentions to get genetic testing) was performed using Generalized Estimating Equations to account for family clusters. RESULTS: Forty-five % of respondents were interested in genetic counseling, and 26% "definitely" intended to get genetic testing for colon cancer when available. For counseling interest, the most important predictors were education, Hawaiian ethnicity, cancer worry, and family support. Cancer worry, perceived risk, and age (older) were directly, and Japanese ethnicity was inversely, associated with testing intentions. CONCLUSIONS: High rates of interest in cancer genetic testing are similar to those found in other studies. Ethnic differences reveal a paradox between objective population risk (higher for Japanese) and greater concerns (among Hawaiians). The substantial lack of awareness of family history warrants further research. Culturally sensitive education and counseling are needed for managing the likely high demand for personalized information about hereditary cancer risk.

Adult↗
PubMed1999

Underreporting of family history of colon cancer: correlates and implications.

Scientific advances in cancer genetics, risk counseling, and management of high-risk individuals require information about familial cancer history. Because some people may not report, or may be unaware of, cancer in their families, it is important to examine the extent of underreporting of family history. We mailed a survey to first-degree relatives of patients with histologically confirmed diagnoses of colorectal cancer (CRC) before age 60 (n = 426, 77% response rate). Analyses examined the extent of underreporting of family history and its predictors (demographics, cancer characteristics, knowledge, and communication) and correlates (cancer worry, perceived risk). Logistic regression analysis was performed using generalized estimating equations to account for family clusters. Despite confirmed diagnosis of CRC in a parent or sibling, 25.4% of respondents reported having no first-degree relative with colon cancer. In multivariate models, the most significant predictor of awareness of a relative's CRC was the stage-at-diagnosis; also, males and those with low knowledge about colon cancer were significantly less aware. Awareness of a relative's CRC was associated with higher cancer worry and risk perception, and being a college graduate contributed independently to increased risk perception. Sole dependence on mailed self-administered questionnaires may lead to substantial underreporting of familial colon cancers, especially those that are in situ or localized.

Adult↗
PubMed1998

Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption.

OBJECTIVE: To examine the self-reported importance of taste, nutrition, cost, convenience, and weight control on personal dietary choices and whether these factors vary across demographic groups, are associated with lifestyle choices related to health (termed health lifestyle), and actually predict eating behavior. DESIGN: Data are based on responses to 2 self-administered cross-sectional surveys. The main outcomes measured were consumption of fruits and vegetables, fast foods, cheese, and breakfast cereals, which were determined on the basis of responses to questions about usual and recent consumption and a food diary. SUBJECTS/SETTING: Respondents were a national sample of 2,967 adults. Response rates were 71% to the first survey and 77% to the second survey (which was sent to people who completed the first survey). STATISTICAL ANALYSES: Univariate analyses were used to describe importance ratings, bivariate analyses (correlations and t tests) were used to examine demographic and lifestyle differences on importance measures, and multivariate analyses (general linear models) were used to predict lifestyle cluster membership and food consumption. RESULTS: Respondents reported that taste is the most important influence on their food choices, followed by cost. Demographic and health lifestyle differences were evident across all 5 importance measures. The importance of nutrition and the importance of weight control were predicted best by subject's membership in a particular health lifestyle cluster. When eating behaviors were examined, demographic measures and membership in a health lifestyle cluster predicted consumption of fruits and vegetables, fast foods, cheese, and breakfast cereal. The importance placed on taste, nutrition, cost, convenience, and weight control also predicted types of foods consumed. APPLICATIONS: Our results suggest that nutritional concerns, per sc, are of less relevance to most people than taste and cost. One implication is that nutrition education programs should attempt to design and promote nutritious diets as being tasty and inexpensive.

Adult↗
PubMed1998

Skin cancer prevention for children, parents, and caregivers: a field test of Hawaii's SunSmart program.

BACKGROUND: Children are at particular risk for sun exposure, a major cause of skin cancer. Parents and caregivers can help protect children by educating them about practicing safe sun habits, serving as role models, and providing supportive environments. OBJECTIVE: We evaluated SunSmart, a cancer prevention program for 6- to 8-year-old children, their parents, and outdoor recreation staff. METHODS: The intervention included staff training, on-site activities for children, interactive take-home booklets, behavior-monitoring scoreboards, incentives, providing sunscreen, and encouraging sun safe environments and policies. The program was evaluated by baseline and follow-up surveys of parents and recreation staff, monitoring forms, and on-site observations. RESULTS: There were positive changes in all major outcomes, including knowledge; sun protection habits of parents, children, and staff; readiness to change; sun protection policies; and sun protection norms. The changes ranged from improvements of 3% to more than 20%, and several changes were statistically significant. CONCLUSION: The results demonstrated the feasibility and short-term impact of Hawaii's SunSmart program and suggested areas for refinement and expansion.

Caregivers↗
PubMed1998

Nationwide implementation of guided supermarket tours in The Netherlands: a dissemination study.

The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department.

Attitude of Health Personnel↗
PubMed1998

Impact of work site health promotion on stages of dietary change: the Working Well Trial.

The stages of change construct has been applied to healthful dietary behavior in cross-sectional studies. This report examines associations of stages of change with diet prospectively and addresses whether (1) baseline stage of change predicts participation, (2) forward changes in stage movement were greater in treatment work sites, and (3) change in stage was associated with adoption of healthful diets, using data from a cohort of 11,237 employees. Findings indicate that persons in later stages of change reported higher participation levels. Employees from intervention work sites who were in preaction stages at baseline were much more likely to shift into action and maintenance stages than controls. Changes in dietary stage of change were associated with decreases in fat intake and increases in fiber, fruit and vegetable intake. Net change in diet due to the intervention was modest. Stage of change appears to be useful for understanding mediators of health promotion intervention effectiveness.

Adult↗
PubMed1998

The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake.

A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

Adult↗
PubMed1998

Psychosocial correlates of healthful diets among male auto workers.

A better understanding of factors associated with healthful eating practices can improve the design and evaluation of dietary intervention programs. Up to now, little information has been available about these factors in high-risk but healthy populations. This article presents findings of a study of psychosocial factors, including stage of change, and their relationship to patterns of consumption of dietary fat, fiber, and fruits and vegetables in a population of males at increased risk of colorectal cancer. Data are from the baseline survey for the Next Step Trial, a randomized, controlled trial of worksite nutrition and colorectal cancer screening promotion interventions. The respondents (n = 2764) were actively employed or retired auto workers at increased colorectal cancer risk. The psychosocial constructs measured were predisposing factors (benefits, motivation, knowledge; eight items; Cronbach alpha = 0.50), enabling factors (barriers, norms, social support; six items; Cronbach alpha = 0.55), and stages of change for adopting diets lower in fat and higher in fiber/fruits and vegetables. The measures of diet, assessed with a food frequency questionnaire, were intakes of fat, fiber, and servings of fruits and vegetables. There were strong and statistically significant positive associations between both predisposing and enabling scale scores and stages of change for fat and fiber. The percentage of respondents in maintenance stage ranged from 4-80% for fat and 11-81% for fiber, across low to high predisposing scale scores; for enabling scale scores, ranges were 11-71% for fat and 22-81% for fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, with the greatest change observed between action and maintenance. Correlations with dietary outcomes were significantly greater for predisposing factors (r = -0.30 for fat and 0.36 for fiber) than for enabling factors (r = -0.23 for fat and 0.28 for fiber). Multiple regression models, which included the predisposing and enabling factor scales, stage of change, and covariates related to diet, explained a total of between 16 and 27% of the variance in diet. Predisposing and enabling factors are significantly associated with of stage of change and current diet in this high-risk sample of male auto workers. Stage of change is the strongest correlate examined and seems to serve as a mediating factor for dietary change. Results from the Next Step Trial will provide additional data on whether and how health promotion interventions influence these factors, and whether such changes are associated with dietary change.

Aged↗
PubMed1997

Are awareness of dietary fat intake and actual fat consumption associated?--a Dutch-American comparison.

OBJECTIVES: To compare dietary fat intake, the accuracy of individuals' awareness about their fat intake, and sociodemographic and psychosocial correlates of awareness, in Dutch and American samples of employed adults. A discrepancy between objective dietary intake data and subjective self-evaluation of dietary fat consumption has been recognized in the past and might undermine healthy diet promotion interventions, and this is important because people who believe that their diets are healthful are less likely to be interested in making changes. Further, international comparisons have not been examined to date. DESIGN: Data collected for the baseline surveys of the 'Healthy Bergeijk' study in the Netherlands and the 'Working Well Trial' in the United States were compared. SUBJECTS: Working adults from a Dutch community health intervention study (n = 768) and an American worksite health promotion trial (n = 15,440). MAIN OUTCOME MEASURES: Objectively assessed dietary fat intake, measured by food frequency questionnaires, and subjective ratings of fat intake (self-rated fat intake). RESULTS: Findings show that the Dutch respondents had higher objectively assessed fat intake and lower subjective ratings of fat intake (P < 0.001). American respondents perceived their diets as higher in fat, more often stated their intentions to reduce fat intake, and were slightly more likely to make realistic estimates of their dietary fat. Dutch subjects were significantly more likely to underestimate their fat intakes. In both samples, women were most likely to underestimate their fat consumption and the most educated persons were most likely to be realistic. CONCLUSIONS: A substantial proportion of adults, both in the United States and the Netherlands, lack accurate awareness about how much fat they consume, though errors tend to be in opposite directions in the two countries. This study is an important first step toward broadening our international understanding of human dietary behavior for disease prevention.

Adult↗
PubMed1997

Review of nutritional attitudes and counseling practices of primary care physicians.

I review major issues covered at the International Workshop on Nutritional Attitudes and Practices of Primary Care Physicians and synthesize some of the key findings presented at this workshop and found in the scientific literature. After presenting the rationale for managing nutritional problems in primary health care, I discuss the extent of both practice and international differences. Next, the determinants of attitudes and practices, in terms of both individual and system-level factors, are examined. Various types of interventions and the available data regarding their efficacy are reviewed. I then raise a variety of considerations regarding research methodologies and describe work in progress. Finally, suggestions are advanced regarding opportunities for increasing and improving physicians efforts to manage nutritional concerns and for pursuing promising future directions for better health through nutrition.

Attitude of Health Personnel↗
PubMed1997

Dietary Change.

Explore the source record for details and available documents.

Child↗
PubMed1996

Black-white differences in factors influencing mammography use among employed female health maintenance organization members.

OBJECTIVE: This study examined racial differences in knowledge, attitudes and practices related to breast cancer screening of black and white women health maintenance organization members over age 40 who are employed at 75 worksites in Pennsylvania and New Jersey in the US. DESIGN: Data are from telephone interviews of 1677 women (20% black). The interviews queried background factors and concepts from the Health Belief Model. RESULTS: Compared to whites blacks were younger and less likely to be married or to have family history of breast cancer. They were also more likely to underestimate their cancer risk and to fear radiation, and less likely to have a doctor advise them to get mammograms. Black and white women did not differ in terms of self-reported mammography use. The results of multivariate modeling suggest that different set of knowledge and belief variables may explain mammography adherence among black and white women. CONCLUSION: These findings have implications for clinical prevention and for patient and community health education in minority populations.

Adult↗
PubMed1996

Work site-based cancer prevention: primary results from the Working Well Trial.

OBJECTIVES: This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS: The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS: There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS: Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.

Cross-Sectional Studies↗
PubMed1995

Psychosocial correlates of healthful diets: baseline results from the Working Well Study.

BACKGROUND: This report examines psychosocial factors related to selection of healthful diets. Understanding why people select healthful diets can lead to rational design and evaluation of nutrition intervention programs. METHODS: Data are from 16,287 respondents to the baseline survey for the Working Well Trial, a randomized, controlled trial of worksite-based health promotion. The psychosocial constructs we measured were predisposing factors (beliefs, perceived benefits, and motivation; 5 items, Cronbach's alpha = 0.65) and enabling factors (barriers, norms, and social support; 6 items, Cronbach's alpha = 0.57). The healthful diet outcomes were intakes of fat, fiber, and servings of fruits and vegetables (from a food frequency questionnaire) and intention and self-efficacy to decrease fat and increase fruits and vegetables. RESULTS: Based on a 5-point scale (1 = low to 5 = high), the mean predisposing factor scale score was much higher than the enabling factor scale score (3.77 vs 2.50, P < 0.001). Comparing respondents in the highest category of the predisposing scale to those in the lowest, mean percentage of energy from fat was 22.4% lower (-9 percentage points), fiber was 85.2% higher (+4.6 g/1,000 kcal), and fruits and vegetables were 100% higher (+1.6 servings/day) (all trends, P < 0.001). Associations were similar, but much weaker, for the enabling scale. Multiple regression models, which included covariates related to diet and the predisposing and enabling scales, explained a total of between 13 and 26% of the variance in diet and intention to change diet. After control for covariates, the predisposing scale remained a significant and strong predictor of diet and intention to change diet but the enabling scale explained small and nonsignificant amounts of variance. CONCLUSIONS: Predisposing factors are strong predictors of current diet and intention to change diet. Final results from the Working Well Trial will provide more information on whether enabling factors can be enhanced by intervention and whether these changes result in healthier eating patterns.

Adult↗
PubMed1995

Nutrition assessment and counseling practices: attitudes and interests of primary care physicians.

This survey examined the nutrition-related practices and office services of primary care physicians, and their preferred nutrition topics and educational methods. Respondents were 960 physicians from across the United States who were members of the Society of General Internal Medicine. A four-page mailed questionnaire with 21 items queried background information, nutrition-related clinical practices and office support systems, perceived self-efficacy for nutrition assessment and counseling, and nutrition-related educational preferences. Two-thirds of the respondents said they personally provided nutrition counseling. They reported moderate self-efficacy for nutrition counseling and lower confidence for using specific relapse prevention strategies. Greatest interest in further education related to chronic disease prevention and nutrition for the elderly, provided in convenient formats for practicing physicians.

Attitude of Health Personnel↗