Health Literacy and Pap Testing in Insured Women

Several studies have found a link between health literacy and participation in cancer screening. Most, however, have relied on self-report to determine screening status. Further, until now, health literacy measures have assessed print literacy only. The purpose of this study was to examine the relationship between participation in cervical cancer screening (Papanicolaou [Pap] testing) and two forms of health literacy—reading and listening. A demographically diverse sample was recruited from a pool of insured women in Georgia, Massachusetts, Hawaii, and Colorado between June 2009 and April 2010. Health literacy was assessed using the Cancer Message Literacy Test-Listening and the Cancer Message Literacy Test-Reading. Adherence to cervical cancer screening was ascertained through electronic administrative data on Pap test utilization. The relationship between health literacy and adherence to evidence-based recommendations for Pap testing was examined using multivariate logistic regression models. Data from 527 women aged 40 to 65 were analyzed and are reported here. Of these 527 women, 397 (75 %) were up to date with Pap testing. Higher health literacy scores for listening but not reading predicted being up to date. The fact that health literacy listening was associated with screening behavior even in this insured population suggests that it has independent effects beyond those of access to care. Patients who have difficulty understanding spoken recommendations about cancer screening may be at risk for underutilizing screening as a result.     

Gail model breast cancer risk components are poor predictors of risk perception and screening behavior

Summary The Gail model is being used increasingly to determine individual breast cancer risk and to tailor preventive health recommendations accordingly. Although widely known to the medical and biostatistical communities, the risk factors included in the model may not be salient to the women to whom the model is being applied. This study explored the relationship of the individual Gail model risk factors to perceived risk of breast cancer and prior breast cancer screening among women with a family history of breast cancer. Data from baseline interviews with 969 women found a striking disparity between the objective risk factors included in the model and the accuracy of perceived risk and screening behaviors of this population, particularly among women over the age of 50 years.Risk perception accuracy was unrelated to all of the Gail model risk factors for all age groups. Reported mammography adherence was only associated with having had a breast biopsy in both age groups. Breast self examination (BSE) practice was independent of all measured factors for both age groups. These findings support the need for further research to identify additional determinants of risk perception and motivators of screening behavior.     

Predicting Breast and Colon Cancer Screening Among English-as-a-Second-Language Older Chinese Immigrant Women to Canada

Little is known about the cancer screening behaviors of older ESL Chinese immigrant women. To explore predictors of colon and breast cancer screening in this population, 103 Mandarin- and Cantonese-speaking immigrant women ages 50 years and older were recruited. Participants completed questionnaires to evaluate screening behaviors, health literacy, and demographic characteristics. Eighty-five percent self-reported that they were current breast cancer screeners, and 75% were current colon cancer screeners. Recommendation from a physician, having a female physician, and high or moderate proficiency in English predicted current mammography screening. Physician recommendation, first language, and self-efficacy predicted use of colon cancer screening. Bivariate analyses also revealed an association between use of colon cancer screening and greater health literacy and longer residency in Canada. Important predictors of screening emerged that potentially informs interventions to increase cancer prevention among older Chinese immigrants. The essential role of physician recommendation was identified for both breast and colon cancer screening.     

Improving rates of cervical cancer screening and Pap smear follow-up for low-income women with limited health literacy

Adult literacy is an independent and important predictor of health behavior. In 1993, the National Adult Literacy Survey conducted by the U.S. Department of Education demonstrated that one-third of the U.S. population over age 16 (44 million adults) is functionally illiterate. Several studies link low health literacy to self-reported poor health status, poor health behavior, and inadequate knowledge about disease. Epidemiologic studies of cancer prevention have not detected strong racial and ethnic disparities in disease detection and progression, resulting in an emphasis on behavioral and intervention-based research. Low literacy presents a wide-reaching barrier to disease prevention that, unlike race/ethnicity, is potentially modifiable. Here, we explore the relationship between health literacy and health behaviors related to cervical cancer prevention in an effort to address concerns about low rates of screening and follow-up in vulnerable populations. Our goal is to improve our understanding of the health impact of low literacy among urban women and to inspire interventions that will promote disease prevention behaviors in this population, particularly with regard to cervical cancer.     

Association of Cervical Cancer Screening with Knowledge of Risk Factors,Access to Health Related Information,Health Profiles,and Health Competence Beliefs among Community-Dwelling Women in Japan

Objective: The aim of this study was to evaluate the past attendance for cervical cancer screening with knowledge of risk factors, access to health-related information, health profiles and health competence beliefs among Japanese women. Methods: Women ages 25, 30, 35, 40, 45, 50, 55, and 60 were contacted cross-sectionally as part of a project for the Japanese Ministry of Health, Labour and Welfare in Nikaho, Akita prefecture Japan between June 2010 and March 2011, and 249 women were analyzed for the current study. The questionnaire asked about past cervical cancer screening. Knowledge of each cervical cancer risk factor was determined on a four-point scale. A barriers to information access scale was utilized to assess the degree of difficulty in accessing health-related information. Health profiles were measured using the EuroQOL EQ-5D. Perceived health competence was measured using a scale (PHCS). The association was evaluated with odds ratios with 95% confidence interval were calculated from a logistic regression analysis after adjustment for age and potential confounders. The trend across the level was also assessed. Results: Women who knew that sexual intercourse at young age was a risk factor were significantly more likely to have participated in cervical cancer screening sometime in their lives (p for trend =0.02). Women who had pain/discomfort and those who had anxiety/depression were significantly more likely to have participated in cervical screening within the past two years (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.04–3.94; OR: 2.32, 95% CI: 1.05–5.16, respectively). Women with higher PHCS were significantly more likely to have attended for cervical screened at some point in their lives (p=0.04). Conclusion: This study observed that specific knowledge of cervical cancer risk factors, health profiles and PHCS were associated with the past attendance for cervical cancer screening among women in a community. Further researches are warranted.     

Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study

Purpose

Some cancers are largely preventable through modification of certain behavioral risk factors and preventive screening, even among those with a family history of cancer. This study examined the associations between (1) family cancer history and cancer screening, (2) family history and cancer preventive lifestyle behaviors, and (3) cancer screening and lifestyle behaviors.

Methods

Data were from the 2009 California Health Interview Survey (n = 12,603). Outcomes included screening for breast cancer (BC) and colorectal cancer (CRC) and six cancer preventive lifestyle behaviors, based on World Cancer Research Fund recommendations. Multivariate logistic regression analyses, stratified by gender and race–ethnicity, examined associations. Predicted probabilities of cancer screening by family cancer history, race–ethnicity, and sex were computed.

Results

Family history of site-specific cancer—CRC for men and women, and BC for women—was associated with higher probability of cancer screening for most groups, especially for CRC, but was largely unrelated to other lifestyle behaviors. In the few cases in which family history was significantly associated with lifestyle—for example, physical activity among White and Latino males, smoking among White and Asian females—individuals with a family history had lower odds of adherence to recommendations than those with no family history. Greater overall adherence to lifestyle recommendations was associated with higher odds of up-to-date CRC screening among White and Asian males, and lower odds among Asian females (no significant association with BC screening); this relationship did not vary by family cancer history.

Conclusion

The fact that family history of cancer is not associated with better lifestyle behaviors may reflect shared behavioral risks within families, or the lack of knowledge about how certain lifestyle behaviors impact personal cancer risk. Findings can inform interventions aimed at lifestyle behavioral modification for individuals at increased cancer risk due to family history.     

Health Literacy,Mammogram Awareness and Screening Among Tertiary Hospital Women Patients

In spite of high mortality rates and prevalence, breast cancer awareness and screening is low among Turkish women. This study aimed to determine level of health literacy, mammogram awareness, and screening among tertiary hospital women patients. A cross-sectional study was conducted with 519 patients aged between 40 and 69. A questionnaire was applied to women patients including demographic characteristics, health behaviors, mammogram awareness and screening, and health literacy tool. Mammogram awareness and screening were questioned according to the Turkish Breast Cancer Screening Standard. To assess health literacy level, the Rapid Estimate of Adult Literacy in Medicine was used. Over half of the women were aware of the mammogram age and 23.1 % had a mammogram within 2 years. Limited health literacy was high among patients, and it was significantly associated with lower mammogram awareness (OR 6.53; 95% CL 1.46–9.13) and screening (OR 1.12; 95% CL 0.45–2.80). Health literacy can be an advantageous opportunity on focal point of national cancer screening. Breast cancer education program and public health campaigns should be arranged according to women health literacy level.     

Health Literacy and Breast Cancer Screening among Mexican American Women in South Texas

Breast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR] = 2.92; 95% confidence interval [CI] = 1.62–5.28), to have had a mammogram within the last 2 years (OR = 1.70; 95% CI = 1.14–2.53) or to have had one within the last year (OR = 2.30; 95% CI = 1.54–3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.     

Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania

PURPOSE/OBJECTIVES: To assess relationships among breast cancer detection behaviors and selected variables in healthy women. DESIGN: Correlational study. SETTING/SAMPLE: A sample of 1,000 women was selected randomly from the 16,500 members of the General Federation of Women's Clubs of Pennsylvania. Respondents (N = 538; 54% response rate) were predominately white, well educated, lived in urban areas, and had an average age of 60 years. METHODS: Mailed packets with a professionally designed, scannable survey instrument that included questions related to detection behaviors, a risk index, health behaviors, attitudes, and knowledge. MAIN RESEARCH VARIABLES: Breast cancer detection behaviors: mammography, clinical breast examination (CBE), breast self-examination (BSE). Structural/demographic variables: age, education, residence, knowledge of breast cancer and detection methods, teaching history, encouragement, and risk index (family/medical history). Predisposing variables: susceptibility, benefits/barriers, confidence, social norms and influence, and general health motivation. FINDINGS: Women reported moderate/high adherence to recommendations for early detection of breast cancer. Mammography behavior was predicted by older age, being encouraged by a doctor or nurse, and greater risk. CBE predictors were greater knowledge and risk along with greater benefits, social norms, and health motivation. BSE behavior was predicted by having had BSE technique checked, greater knowledge, greater risk, decreased barriers to BSE, and higher health motivation. CONCLUSIONS: Common predictors of breast screening behaviors include risk (family/medical history), knowledge, and general health motivation. IMPLICATIONS FOR NURSING PRACTICE: Educational efforts can be designed specifically to influence variables related to compliance with early breast cancer detection behaviors.     

Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States

Objective To critically evaluate recent studies that examined determinants of CRC screening behaviors among average-risk older adults (≥50 years) in the United States. Methods A PUBMED (1996–2006) search was conducted to identify recent articles that focused on predictors of CRC initiation and adherence to screening guidelines among average-risk older adults in the United States. Results Frequently reported predictors of CRC screening behaviors include older age, male gender, marriage, higher education, higher income, White race, non-Hispanic ethnicity, smoking history, presence of chronic diseases, family history of CRC, usual source of care, physician recommendation, utilization of other preventive health services, and health insurance coverage. Psychosocial predictors of CRC screening adherence are mostly constructs from the Health Belief Model, the most prominent of which are perceived barriers to CRC screening. Conclusions Evidence suggests that CRC screening is a complex behavior with multiple influences including personal characteristics, health insurance coverage, and physician–patient communication. Health promotion activities should target both patients and physicians, while focusing on increasing awareness of and accessibility to CRC screening tests among average-risk older adults in the United States.     

Differences in predictors of cervical and breast cancer screening by screening need in uninsured Latino women

BACKGROUND: Latino women experience higher mortality for cervical cancer and lower 5-year survival for breast cancer than non-Latino White women. Adherence with screening recommendations can increase chances of survival, yet the factors that influence screening behaviors in uninsured women are not well documented. METHODS: Uninsured Latino women (N = 467) recruited in four US cities participated in the study. Logistic regression was used to model adherence to recommendations by screening type (cervical or breast cancer) and screening need (needs to obtain initial screening, overdue for rescreening, up-to-date with rescreening). RESULTS: Predictors differed by type of screening and screening need. Women who reported exposure to cancer education were more likely to have had a mammogram and to be up-to-date with Pap smear screening than women without such exposure. Women who were younger, had more than a sixth grade education, and/or had children were more likely to have had a Pap smear. Older women who had been in the US the longest were more likely to be overdue for a Pap smear. Women with incomes 5000 to 7000 were more likely to have obtained a mammogram. Regional differences were found with respect to mammography screening and maintenance behaviors. CONCLUSIONS: Exposure to cancer education is an important predictor of screenings among uninsured urban Latino women. The potential of creating educational interventions that can increase screening rates among women who evidence health disparities is encouraging. Recruitment strategies to reach women in need of screenings are provided.     

Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy?

Background: Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. Methods: A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen’s Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. Results: Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on “most people with genital HPV have no visible signs/symptoms” and less than 18% answered correctly on “I can transmit HPV to my partner(s) even if I have no HPV symptoms.” Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy. Conclusions: Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.     

Factors associated with perceived risk of breast cancer among women attending a screening program

Summary A person's perception of the risk of, or susceptibility to, developing a disease is believed to be an important determinant of health-related behavior, yet little is known about the determinants of perceived risk. Knowledge of these correlates may be useful in identifying and addressing barriers to performance of health behaviors such as mammography screening. Data collected from over 36,000 women participating in a breast cancer screening program in Texas were used to examine the associations between perceived risk of ever getting breast cancer and a number of demographic factors, health-related behaviors, and risk factors for breast cancer. There was a strong positive association between family history of breast cancer and risk perception (OR=11.3, CI=10.34–12.35). Women who reported other risk factors for breast cancer also reported higher perceived risk, but those associations were of lesser magnitude. Age was inversely associated with perceived risk, and black, but not Hispanic, women were more likely to perceive their risk as high compared with white women. Of the health-related behaviors for the early detection of breast cancer, only having had a prior mammogram was associated with perceived risk. Educational interventions to heighten women's awareness of breast cancer risk factors may increase perceived risk in high risk women and influence their decision to undergo screening mammography.     

Estimation of individualized probabilities of developing breast cancer for Japanese women

BACKGROUND: Projecting individualized probabilities of developing breast cancer is needed for counseling and chemoprevention for Japanese women, in whom breast cancer incidence has been rapidly increasing. METHODS: We calculated individualized probabilities of developing breast cancer within 10-20 years and until life expectancy for Japanese women by multiplying the relative risk for each risk factor combination by the cumulative risk for the reference group. The risk factors used were age at menarche, age at first delivery, family history of breast cancer, and body mass index (BMI) (in post-menopausal women). The relative risk by menopausal status for each risk factor combination was estimated from a case control study conducted at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), Japan. The cumulative risk of breast cancer for the reference group within 10-20 years and until life expectancy was estimated to divide the corresponding cumulative risk for Japanese women by the weighted average of the relative risk. The weight is an expected proportion of those who have each risk factor combination among the general population. The cumulative risk for Japanese women was estimated using a data file from the Osaka Cancer Registry (OCR). RESULTS: We obtained cumulative risks for any age women within a certain range according to various risk factor combinations by menopausal state. For example, the highest risk group had about a 5 times higher risk probability of developing breast cancer than the general population at initial age 40, within 10-20 years, and until life expectancy. CONCLUSION: The cumulative risk of breast cancer varied according to individuals' risk factors among Japanese women. The availability of concrete individualized risk estimation figures will be of use to health care providers in encouraging Japanese women to seek counseling and to adopt self-control of body weight as a primary preventive measure, as well as to have breast cancer screening.     

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry

Summary Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified – European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.     

Application of Health Behavior Theories to Breast Cancer Screening among Asian Women

Background: Although breast cancer is a major public health worry among Asian women, adherence toscreening for the disease remains an obstacle to its prevention. A variety of psycho-social and cultural factorspredispose women to delay or avoidance of screening for breast cancer symptoms at the early stages when cureis most likely to be successful. Yet few interventions implemented to date to address this condition in this regionhave drawn on health behavior theory. Materials and Methods: This paper reviews the existing literature onseveral cognitive theories and models associated with breast cancer screening, with an emphasis on the workthat has been done in relation to Asian women. To conduct this review, a number of electronic databases weresearched with context-appropriate inclusion criteria. Results: Little empirical work was found that specificallyaddressed the applicability of health theories in promoting adherence to the current breast cancer preventionprograms Among Asian women. However, a few studies were found that addressed individual cognitive factorsthat are likely to encourage women’s motivation to protect themselves against breast cancer in this region ofthe world. The findings suggest that multi-level, socio-cultural interventions that focus on cognitive factors havemuch promise with this issue. Conclusions: Interventions are needed that effectively and efficiently target thepersonal motivation of at-risk Asian women to seek out and engage in breast cancer prevention. Concerningimplications, personal motivation to seek out and engage in individual preventive actions for breast cancerprevention among Asian women is a timely, high priority target with practical implications for communitydevelopment and health promotion. Further studies using qualitative, anthropologic approaches shaped forimplementation in multi-ethnic Asian settings are needed to inform and guide these interventions.     

The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study

Objectives: Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States. Methods: One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross‐section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods. Results: There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence. Discussion: This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence. Copyright © 2010 John Wiley & Sons, Ltd.     

Assessing the Influence of Health Literacy on HIV-Positive Women’s Cervical Cancer Prevention Knowledge and Behaviors

Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥2 Pap tests during the year after HIV diagnosis (p?=?0.02), and less likely to have had a Pap test <1 year previously (p?=?0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.     

Personal cancer prevention and screening practices among Asian Indian physicians in the United States

This study examines personal cancer prevention and screening practices of Asian Indian physicians. Asian Indians are the third largest group of Asian Pacific Islanders (APIs) residing in the United States. Using a cross-sectional study approach, we investigated cancer prevention and screening practices of 254 randomly selected Asian Indian physicians in the United States. Results showed that prevalence of conventional risk factors were low, e.g., smoking, alcohol consumption. Nutrition-related behaviors indicated 31-48% met the Food Guide Pyramid's recommendations for daily intake of fruits, vegetables, low fat/cholesterol diet, and grains. Certain cancer prevention and screening practices failed to meet age appropriate recommendations of leading health agencies. For men age 50 and over, only 27% ever had a flexible sigmoidoscopy and 25% ever had a fecal occult blood test (FOBT); 84% of women age 40 and over ever had a mammogram and 87% of women ever had a Papanicalou (Pap) smear. With respect to cancer screening behaviors, the respondents were less likely to engage in these preventive screenings (with the exception of mammography) than the general US population and the APIs (except Pap smears). Additionally, our respondents were less likely than other physicians to practice cancer screening behaviors. Results support the need to promote regular cancer prevention and screening among Asian Indian physicians.