Biomedical subjects

M Robyn Andersen

Publications and source records attributed to M Robyn Andersen.

At least 19 recordsLinked to original sources

PubMed2007

Development of an ovarian cancer symptom index: possibilities for earlier detection.

BACKGROUND: Currently, screening for ovarian cancer is not recommended for the general population. Targeting women with specific symptoms for screening has been evaluated only recently, because it was believed that symptoms had limited specificity. METHODS: A case-control study of 149 women with ovarian cancer, including 255 women who were in a screening program and 233 women who were referred for pelvic/abdominal ultrasound, was conducted by inviting women to complete a survey of symptoms. Patients were divided randomly into an exploratory group and a confirmatory group. Symptom types, frequency, severity, and duration were compared between cases and controls. Logistic regression analyses were used to determine which factors independently predicted cancer in the exploratory group and then were used to develop a symptom index, which was tested for sensitivity and specificity in the confirmatory group. RESULTS: Symptoms that were associated significantly with ovarian cancer were pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full when they were present for <1 year and occurred >12 days per month. In a logistic regression analysis, symptoms that were associated independently with cancer were pelvic/abdominal pain (P < .001), increased abdominal size/bloating (P<.001), and difficulty eating/feeling full (P = .010). A symptom index was considered positive if any of those 6 symptoms occurred >12 times per month but were present for <1 year. In the confirmatory sample, the index had a sensitivity of 56.7 for early-stage disease and 79.5% for advanced-stage disease. Specificity was 90% for women age >50 years and 86.7% for women age <50 years. CONCLUSIONS: Specific symptoms in conjunction with their frequency and duration were useful in identifying women with ovarian cancer. A symptom index may be useful for identifying women who are at risk.

Abdominal Pain↗

PubMed2006

Changes in the influence of parents' and close friends' smoking on adolescent smoking transitions.

This paper examined changes in the influence of parents' and close friends' smoking on smoking transitions occurring over the course of adolescence, using a large (N=6,006) longitudinal study. The three grade periods were 5th to 7th (ages 10-12), 7th to 9th (ages 12-14), and 9th to 12th grade (ages 14-17). Smoking transitions examined were: (1) never to trying, (2) trying to monthly, and (3) monthly to daily. Results showed that the influence of parents' smoking was substantial for all three transitions during most of the grade periods and, for the transition from monthly to daily smoking, increased (p=.006) during adolescence. In contrast, the influence of close friends' smoking was strongest for the transition to trying smoking and did not significantly change (all p>.05) for any of the smoking transitions as the adolescent became older. In conclusion, the influence of close friends' smoking on smoking transitions might be stable during adolescence whereas the influence of parents' smoking on the transition to daily smoking might markedly increase across adolescence.

Adolescent↗

PubMed2006

Close friends', parents', and older siblings' smoking: reevaluating their influence on children's smoking.

A number of longitudinal studies have explored the role of friends', parents', and older siblings' smoking in children's smoking acquisition. A reasonable implication of this previous research is that intervention efforts could be beneficially directed toward countering the potential influence of friends' and possibly older siblings' smoking but not parents' smoking. However, methodological limitations of this previous research motivated our reevaluation of the role of friends', parents', and older siblings' smoking in children's smoking. Close friends' smoking status was assessed when children were in 5th grade, whereas parents' and older siblings' smoking status was assessed when children were in 3rd grade. The outcome, children's daily smoking status, was assessed in 12th grade. The setting was 40 Washington state school districts that participated in the long-term Hutchinson Smoking Prevention Project. Participants were the 4,576 families for whom close friends', parents', and older siblings' smoking status as well as children's smoking status were available. The probability that each close friend's smoking influenced the child to smoke daily was 9% (95% CI = 6%-12%), the probability that each parent's smoking influenced the child to smoke daily was 11% (95% CI = 9%-14%), and the probability that each older sibling's smoking influenced the child to smoke daily was 7% (95% CI = 1%-13%). These results suggest that close friends', parents', and siblings' smoking were similarly important influences on children's smoking. Family-focused interventions could be a valuable future direction of prevention research.

Adolescent↗

PubMed2006

Prospective prediction of children's smoking transitions: role of parents' and older siblings' smoking.

AIMS: To use a novel social epidemic probability model to investigate longitudinally the extent to which parents' and older siblings' smoking predict children's smoking transitions. DESIGN: Parents' and older siblings' smoking status was assessed when children were in 3rd grade (baseline). Three smoking transitions were assessed over the period of child/adolescent smoking acquisition (up to 12th grade): (1) transition from never smoking to trying smoking, (2) transition from trying to monthly smoking and (3) transition from monthly to daily smoking. SETTING: Forty Washington State school districts participating in the long term Hutchinson Smoking Prevention Project (HSPP). PARTICIPANTS AND MEASUREMENTS: Participants were the 5520 families for whom data on both parents' and older siblings' baseline smoking status, as well as on children's smoking transitions, were available. FINDINGS: The probability that a smoking parent influenced their child to make the first transition to trying smoking was 32% (95% CI: 27%, 36%); to make the second transition from trying to monthly smoking, 15% (95% CI: 10%, 19%); and to make the third transition from monthly to daily smoking, 28% (95% CI: 21%, 34%). The probability that an older sibling influenced a child to make the first transition to trying smoking was 29% (95% CI: 17%, 39%); to make the second transition from trying to monthly smoking, 0% (95% CI: 0%, 8%); and to make the third transition from monthly to daily smoking, 20% (95% CI: 4%, 33%). CONCLUSIONS: In contrast to previous research, the results provide new evidence suggesting that family smoking influences both initiation and escalation of children's smoking. Results also quantify, in terms of probabilities, the importance of parents' and older siblings' smoking on children's three major smoking transitions. Parents' smoking, as well as older siblings' smoking, are important behaviors to target in preventing adolescents from making smoking transitions.

Adolescent↗

PubMed2005

Childhood friends who smoke: do they influence adolescents to make smoking transitions?

This study investigated longitudinally the extent to which childhood friends who smoke influence adolescents' smoking transitions, and compared that influence with that of parents who smoke. In a sample of 4744 children, results showed that the probability, per close friend, that a smoking close friend influenced the adolescent to make the first transition to trying smoking was 38% (95% CI: 28%, 46%); to make the second transition from trying to monthly smoking, 10% (95% CI: 5%, 15%); and to make the third transition from monthly to daily smoking, 11% (95% CI: 5%, 17%). Compared to parents' smoking, close friends' smoking was 12% (p=0.03) more influential for the first transition, no different for the second transition (p=0.53), and 16% (p=0.01) less influential for the third transition. Results provide new evidence suggesting that childhood close friends who smoke influence not only initiation but also escalation of adolescents' smoking. Results also confirmed the important role of parents' smoking. Targeting both childhood close friends' and parents' smoking would be valuable in prevention research.

Adolescent↗

PubMed2005

Nine-year prediction of adolescent smoking by number of smoking parents.

For scientific and public health reasons, it is important to identify the role of family influences on child smoking acquisition. Using a well-followed (>90%) cohort of 3,012 children and their parents, this study prospectively investigated the influence of smoking by 0 vs. 1 vs. 2 parents when the children were young (3rd grade), on whether the children subsequently became daily smokers. It is the only study to investigate the prediction of child/adolescent smoking at the end of the smoking acquisition period (12th grade) by parental smoking at the start of the period (3rd grade). Logistic regression analyses revealed that having one parent who smokes substantially increases the risk that children will become daily smokers, relative to families where neither parent smokes (OR=1.90, p<.01). There is no evidence that the increased risk depends on parent or child gender. These results suggest the need for public health interventions that inform parents of young children that their own smoking behavior increases their children's risk for future smoking.

Adolescent↗

PubMed2005

Parental smoking cessation and children's smoking: mediation by antismoking actions.

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.

Adolescent↗

PubMed2005

Using a population-based cancer registry for recruitment of newly diagnosed patients with ovarian cancer.

BACKGROUND: Although rarely used for clinical trial recruitment in the United States, population-based registries are a potential resource for identification of patients with cancer for some kinds of research trials. They record fairly detailed information on a cancer patient's condition at the time of diagnosis (stage, histologic types, and other clinical and demographic variables) and record all patients in a geographic area. This information can be used to identify patients eligible for intervention trials. METHODS: Using a cancer registry to identify newly diagnosed patients and their physicians, this study recruited 60 women for a feasibility trial of a psychosocial intervention designed to improve the quality of life for women with ovarian cancer. Active consent from physicians was obtained before contacting patients. RESULTS: Of 441 women identified as potentially eligible from the cancer registry, 364 (82%) were screened for eligibility and 179 (41%) were eventually determined to be eligible. Of the identified eligible women, 60 (34%) were recruited and enrolled in the trial. CONCLUSIONS: This rate of recruitment is within the range of recruitment rates reported in past studies examining efforts to enroll patients in clinical trials at single institutions. These findings suggest that registry-based recruitment efforts may be useful for expanding recruitment to the larger community.

Adaptation, Psychological↗

PubMed2005

Does parental smoking cessation encourage their young adult children to quit smoking? A prospective study.

AIMS: To investigate the extent to which parental early and late smoking cessation predicts their young adult children's smoking cessation. DESIGN: Parental early smoking cessation status was assessed when children were in 3rd grade, parental late smoking cessation was assessed when children were in 11th grade, and young adult children's smoking cessation was assessed 2 years after high school. SETTING: Forty Washington State school districts participated in the Hutchinson Smoking Prevention Project. PARTICIPANTS AND MEASUREMENTS: Participants were the 1553 families in which parents were ever regular smokers who had a young adult child smoking at least weekly at 12th grade who also reported their smoking status 2 years later. Questionnaire data were gathered on parents and their young adult children (49% female and 91% Caucasian) in a cohort with a 94% retention rate. FINDINGS: Parents who quit early had children with 1.8 (OR = 1.80; 95% CI = 1.22, 2.64) times higher odds of quitting smoking for at least 1 month in young adulthood compared to those whose parents did not quit early. In contrast, there was no association (OR = 0.84; 95% CI = 0.47, 1.51) between parents quitting late and their young adult children's smoking cessation. CONCLUSIONS: Parental early smoking cessation is associated with increased odds of their young adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.

Adult↗

PubMed2005

Assertiveness with physicians is related to women's perceived roles in the medical encounter.

Women's self-reported assertiveness with their healthcare providers is associated with their use of cancer screening. Women who report repeating information when they feel their doctors did not hear them, asking their doctors to explain information they do not understand, or reminding their doctors about screening tests, are more likely to receive mammograms than those who report using these assertive behaviors less often. In this study, we examined women's beliefs about their role in medical encounters with their physicians and their use of assertive behaviors, in a convenience sample of 136 women receiving care at an ultrasound clinic for reasons other than pregnancy. We found that women who behaved assertively were more likely to view physicians as advisors to them in their health care and less likely to view their physicians as experts. Data are also presented on the development of a scale designed to assess assertiveness with physicians for use in studies of medical care.

Adult↗

PubMed2004

Examining the cost-effectiveness of cancer screening promotion.

Cost-effectiveness analyses (CEAs) can help to quantify the contribution of the promotion of a screening program to increased participation in screening. The cost-effectiveness (C/E) of screening promotion depends in large part on the endpoints of interest. At the most fundamental level, the C/E of a strategy for promoting screening would focus on the attendance rate, or cost per person screened, and the C/E would be influenced by the costs of promotion, as well as by the size and responsiveness of the target population. In addition, the costs of screening promotion (measured as the cost per additional participant in screening) can be included in a CEA estimate of the screening technology. In this case, depending on the efficacy of the screening test and the costs and influence of the promotion, the C/E of screening may improve or become poorer. In the current study, the authors reviewed the literature on the C/E of cancer screening promotion. The following lessons were learned regarding the C/E of screening and its promotion: 1) high-quality information on the C/E of screening is increasingly available; 2) cost-effective promotion of screening is dependent on cost-effective screening strategies; 3) quality-of-life effects may be important in assessing the overall C/E of screening programs; 4) research efforts aimed at identifying cost-effective approaches to screening promotion are useful but sparse; 5) C/E studies should be better incorporated into well designed effectiveness research efforts; 6) variations in C/E according to intervention characteristics, population characteristics, and context should be evaluated in greater depth; 7) the long-term effects of screening promotion are critical to assessing C/E; 8) the effects of promotion on costs of screening must be better understood; and 9) CEA must be interpreted in light of other information. The authors showed that CEA can be a valuable tool for understanding the merits of health promotion interventions and that CEA is particularly valuable in identifying screening strategies that might be promoted most cost-effectively.

Cost-Benefit Analysis↗

PubMed2004

Worry about ovarian cancer risk and use of screening by high-risk women: how you recruit affects what you find.

Several studies have described the characteristics of women at high-risk for ovarian cancer who are participating in registry studies and high-risk screening programs. These studies have found high-risk women to report high levels of perceived risk and worry about their risk for ovarian cancer. In contrast, population based studies have found that while high-risk women did report high levels of perceived risk, they did not report high levels of worry about their risk. In this study, we examine reports of perceived risk, worry about ovarian cancer, and use of screening by high-risk women recruited to participate in a survey from several recruitment sources. These sources include self-, physician-, and affected patient relative-referral, a fundraising mailer, and a mass mailing to a commercial mailing list. High-risk women recruited via mass mailing were less likely than those recruited via physicians or affected relatives to report either worry about their risk or use of ovarian cancer screening tests.

Adult↗

PubMed2004

Antismoking parenting practices are associated with reduced rates of adolescent smoking.

BACKGROUND: Although parental smoking is clearly one important influence on children's smoking, it is still unclear what are the many mechanisms by which parents influence their children's smoking. Antismoking actions are one potential mechanism. OBJECTIVE: To determine whether parental antismoking actions including having rules about smoking in one's home, using nonsmoking sections of public establishments, or asking others not to smoke in one's presence are associated with adolescents' adoption of smoking. DESIGN: A cross-sectional survey. SETTING: Rural and suburban communities in western Washington State. PARTICIPANTS: Population-based cohort of 3555 adolescents and their parents. MAIN OUTCOME MEASURE: Daily smoking in 12th grade. RESULTS: Adolescents of parents who report having rules about smoking in one's home, using nonsmoking sections of public establishments, or asking others not to smoke in one's presence were significantly less likely to smoke than adolescents of parents who did not engage in antismoking actions. This association of antismoking action and reduced smoking was found for children of both smoking and nonsmoking parents. CONCLUSION: Parents' antismoking actions may help prevent smoking by their teenaged children.

Adolescent↗

PubMed2004

The relationship between perceived risk, affect, and health behaviors.

In this study, we examined the relationship between affect and health behaviors. The study participants were women (n = 1366), aged 18-74 years, who had not been previously diagnosed with breast cancer, who had a working telephone number and address, who spoke English, who planned to be in their present residence for at least 1 year, and who were willing to complete the survey requirements. General anxiety was a significant predictor of eating a low-fat diet, in a quadratic manner (p < .05). General anxiety and breast cancer worry were significant predictors of breast self-examination, in a quadratic fashion (p < .05). None of four independent variables, perceived risk, cancer worry, general anxiety, and general depression scores, were significantly related to mammography use, physical activity, or fruit and vegetable consumption. We must look beyond risk perceptions and family history to understand motivations for health behaviors.

Adolescent↗

PubMed2004

Breast cancer risk counseling improves women's functioning.

Helping people cope with health risks is an important area for research and practice. Counseling offers people the opportunity to relieve their distress and improve the ways in which they manage their health issues. This study was a randomized test of two different counseling methods, genetic and psychosocial counseling, compared to a control group. Eligibility requirements included being between 18 and 74 years old, having at least one relative with breast cancer, not having a family history consistent with carrying a BRCA1/2 mutation for breast cancer risk, having no personal history of breast or ovarian cancer, living within 60 miles of the research institute, and willingness to complete the research requirements of the project. Perceived risk decreased by 50% for participants in the two counseling groups relative to comparison participants. Cancer worry decreased in both counseling groups by one scale point (P < 0.05). These results indicate that counseling can relieve women's negative reactions to breast cancer risk.

Adult↗

PubMed2004

Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women.

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry.

Adult↗

PubMed2004

Assertiveness with physicians: does it predict mammography use?.

In a prior study we found that women's self-reported assertiveness with their healthcare providers was associated with their use of mammography in a population-based cross-sectional sample of women. Women who reported being more assertive, by repeating information if they felt their doctor didn't hear them, asking their doctor to explain information they didn't understand, or reminding their doctor about screening tests, were more likely to have received a mammogram recently than those who reported being less assertive. Here we examined how women's self-reports of assertiveness predicted their use of mammography three years later. We examined this using a population-based sample of 781 women living in rural Washington State who were participating in a trial of mammography promotion. We found that assertive women were younger on average than less assertive women, but that even after controlling for age, education, income, and marital status, women who reported being assertive with their doctor in 1994 were more likely to receive regular mammograms in the next three years than those who did not (OR 2.1; CI 1.5, 2.9). If future studies also suggest that assertiveness predicts use of mammography or other preventive healthcare services, it would be valuable to examine the promotion of assertiveness as a means of improving public health.

Aged↗

PubMed2004

Compliance of average- and intermediate-risk women to semiannual ovarian cancer screening.

OBJECTIVE: To report rates of compliance with an ovarian cancer screening protocol using serum CA125 and transvaginal sonography (TVS), performed semiannually on an alternating schedule, among participants at average or intermediate risk for developing ovarian cancer. METHODS: Two hundred ninety-two women at average or intermediate risk for developing ovarian cancer were randomly assigned to arms of a controlled clinical trial in which they received ovarian cancer screening consisting of serum CA125 alternating with TVS performed semiannually over 18 months, either alone or in combination with ovarian cancer risk education. A computerized tracking system generated screening appointment reminder letters and monitored adherence to scheduled screening. Participants overdue for scheduled screens received follow-up telephone calls consisting of up to four reminder messages left at 1-week intervals, and one to two interim attempts to reach participants between messages. The compliance rate for each screen was calculated as a ratio of the number of participants successfully completing the screen relative to the number expected to attend. Compliance rate by screen was: screen 1 (CA125) (97.3%), screen 2 (TVS) (82.5%), screen 3 (CA125) (79.0%), and screen 4 (TVS) (64.5%). One hundred seventy-two women completed all four screens and were classified as adherent to the screening protocol. Analysis by screening modality suggests that participants were more compliant to screens involving CA125. Age, educational background, distance from screening center, personal or family history of cancer, perceived risk of ovarian cancer, pre-enrollment ovarian cancer screening behavior, receiving an abnormal screen test result, and participation in ovarian cancer risk education sessions were not associated with adherence to the screening protocol or compliance to any of the screens. CONCLUSIONS: Despite extensive follow-up, compliance of average- and intermediate-risk women to an ovarian cancer screening protocol requiring semiannual screening diminishes rapidly. We propose that a semiannual ovarian cancer screening protocol, particularly one including TVS, may be too intensive for use in this population.

Adult↗