Factors affecting breast cancer risk reduction practices among California physicians

BACKGROUND: Little is known about the incorporation of breast cancer risk reduction therapies into clinical practice. METHODS: We assessed factors related to physicians' performance of breast cancer risk reduction practices through a self-administered survey. Subjects were California physicians in family medicine, internal medicine, or obstetrics/gynecology, identified through the AMA Masterfile. Physicians reported their breast cancer risk reduction practices (initiating patient counseling, referring patients for genetic evaluation, and prescribing tamoxifen or raloxifene) as well as barriers to counseling. RESULTS: Of 1647 eligible physicians, 822 responded. Eighty-six percent reported initiating counseling, 45% referred a patient for genetic evaluation, 31% prescribed raloxifene, and 11% prescribed tamoxifen for breast cancer prevention in the past year. The leading frequent barriers to counseling were "not enough time" (40.3%) and "insufficiently informed about risk reduction options" (19.1%). Multivariate analysis showed that a training and role factors scale was negatively associated with all risk reduction practices, and number of breast cancer diagnoses per year was positively associated with referring for genetic evaluation and prescribing chemoprevention. CONCLUSIONS: Physicians in primary care specialties report participation in several breast cancer risk reduction activities. Issues related to physician training and role in risk reduction affect the implementation of these practices.     

The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups

BACKGROUND: This study was designed to determine which of several emotional propensities were associated with the frequency of mammograms and clinical breast exams among six groups of minority women. Three emotion-related variables that have been identified in the previous literature as influencing screening were examined: Repression, cancer worry, and embarrassment. However, these variables have never been examined within the same study, nor where relevant background variables are controlled. METHODS: 1364 African American, US-born white, English-speaking Caribbean, Haitian, Dominican, and Eastern European women were recruited via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. RESULTS: As expected, self-regulation and cancer worry were both positively associated with mammogram and clinical breast exam frequency, while embarrassment regarding having a mammogram was negatively associated with screening. These results held even after controlling for demographic variables and the presence or absence of physician recommendation. Screening rates for African American women equaled or exceeded the rates for European Americans. Other minority subpopulations had even lower screening rates, including women from the English-speaking Caribbean and Haitians. CONCLUSIONS: Results are discussed in terms of their implications for screening intervention, models of health behavior, and the need for more precise operationalizations of ethnicity in screening research.     

Barriers to care among racial/ethnic groups under managed care

We describe barriers to care reported by racial/ethnic groups and explore the extent to which barriers vary between persons enrolled in managed care and those in non-managed care plans, using data from the 1996 Medical Expenditure Panel Survey (MEPS). Most respondents expressed satisfaction with their care; however, a substantial percentage reported experiencing barriers. Minorities, particularly Hispanics and Asian Americans, were more likely than non-Hispanic whites were to report barriers. Managed care enrollees across racial/ethnic groups faced different types of barriers than non-managed care enrollees did. Although managed care enrollees were more likely to report having a usual source of care and greater continuity of care, they also reported more difficulties obtaining care and less satisfaction with their care.     

Factors associated with racial/ethnic differences in colorectal cancer screening

Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening. METHODS: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted. RESULTS: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n = 194), Hispanic (n = 162), and non-Hispanic white (n = 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than $25,000. Overall 62.5% were current with CRC screening: 67.5% of non-Hispanic whites, 54.3% of African-Americans, and 48.6% of Hispanics (P < .001). A doctor's recommendation (odds ratio, 3.86); awareness of screening (odds ratio, 3.32); older age (odds ratio, 2.88); greater education (odds ratio, 2.02); and perceived susceptibility (odds ratio, 1.74) contributed to racial/ethnic differences in CRC screening. CONCLUSIONS: Interventions to address CRC screening disparities among racial/ethnic groups should focus on the health care setting and patient education about CRC screening; differences in attitudes and beliefs seem to be less important.     

Infant mortality among racial/ethnic minority groups, 1983-1984

Infant mortality varies considerably among racial/ethnic groups in the United States. For groups other than whites and blacks, previously published rates based on the vital statistics system have been underestimated because of inconsistencies in the classification of race and Hispanic status on birth and death certificates. For this report, infant mortality rates (IMRs) are based on the 1983 and 1984 linked birth and infant-death files, and mother's race and Hispanic origin are reported in accordance with information shown on the birth certificates. Overall, Asians have somewhat lower infant mortality rates than whites, but the rates vary from 6.0/1,000 among Japanese mothers to 9.0/1,000 among "other Asian" mothers. Hispanic mothers show even wider variation: from 7.8/1,000 among Cubans to 12.9/1,000 among Puerto Ricans. Blacks have an IMR twice as high as that for whites, and the rate for American Indians is nearly 60% above the rate for whites. Mexicans are the third largest minority group in the United States, accounting for one-quarter million births per year. Despite a high rate of poverty and low use of prenatal care, Mexicans have approximately the same IMR (9.0/1,000) as non-Hispanic whites. Further study of this group could assist in the development of prevention strategies.     

Factors influencing participation in weekly support groups among women completing an HIV/STD intervention program

Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.     

Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups

OBJECTIVES: We examined associations between obesity, diabetes, and 3 adverse pregnancy outcomes--primary cesarean delivery, preterm birth, and low birth-weight (LBW)--by racial/ethnic group. Our goal was to better understand how these associations differentially impact birth outcomes by group in order to develop more focused interventions. METHODS: Data were collected from the 1999, 2000, and 2001 New York City birth files for 329,988 singleton births containing information on prepregnancy weight and prenatal weight gain. Separate logistic regressions for 4 racial/ethnic groups predicted the adverse pregnancy outcomes associated with diabetes. Other variables in the regressions included obesity, excess weight gain, hypertension, preeclampsia, and substance use during pregnancy (e.g., smoking). RESULTS: Chronic and gestational diabetes were significant risks for a primary cesarean and for preterm birth in all women. Diabetes as a risk for LBW varied by group. For example, whereas chronic diabetes increased the risk for LBW among Asians, Hispanics, and Whites (adjusted odds ratios=2.28, 1.69, and 1.59), respectively, it was not a significant predictor of LBW among Blacks. CONCLUSIONS: In this large, population-based study, obesity and diabetes were independently associated with adverse pregnancy outcomes, highlighting the need for women to undergo lifestyle changes to help them control their weight during the childbearing years and beyond.     

Factors affecting participation in health checkups: Evidence from Japanese survey data

Multiple factors influence individuals to get health checkups. This study investigates key determinants of the health checkup decision by using 2696 Japanese respondents’ data from a questionnaire survey entitled “Preference Parameters Study” that was conducted in four countries by the Global Centers of Excellence program at Osaka University. In the Probit and OLS regressions, other than relevant personal attributes being identified, the hyperbolic discounter dummy and its interaction terms with respondents’ health behaviors were also included as independent variables. The results suggest that some socio-demographic variables such as gender, age, income, household size, occupational status, educational level are significant. In addition, hyperbolic discounters are found to be more likely than non-hyperbolic discounters to seek health checkups, which indicates that the effect of time preference on health checkup behavior differs significantly among the different types of time discount structures.     

Feeding practices of mothers from varied income and racial/ethnic groups

Objective: Relatively few investigators have explored the role of maternal control in describing the feeding behaviour of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviours (i.e. restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the body mass index (BMI) of their four-year-old offspring. Methods: Responses to the ‘restriction’ and ‘pressure to eat’ variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers. Results: Mothers from both groups gave predominantly ‘neutral’ ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic. Conclusions: The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.     

A population-based cohort study of the relation between maternal birthweight and risk of gestational diabetes mellitus in four racial/ethnic groups

Intrauterine growth retardation and low birthweight have been associated with an increased risk of insulin resistance and type II diabetes later in life. We hypothesised that maternal low birthweight is associated with an increased risk of gestational diabetes mellitus (GDM). Study subjects comprised women giving birth in Washington State between 1987 and 1995. Information for 21,528 births to non-Hispanic white women, 6359 to African-American women, 7456 to Native American women and 6496 to Hispanic women was available for analysis. All information was derived from statewide computerised vital records and hospital discharge summaries of obstetric and neonatal admissions with linkage to birth certificates of mothers. Maternal birthweight was collected from subjects' birth certificates. Information from both the birth certificates and the obstetric and neonatal admissions database was used to determine whether subjects developed GDM. Poisson regression models were estimated to calculate unadjusted and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for GDM by categories of maternal birthweight. The cumulative incidence of GDM among non-Hispanic white, African-American, Native American and Hispanic women was 2.8, 2.6, 2.7 and 3.0% respectively. After adjusting for maternal age, parity, cigarette smoking, history of chronic hypertension and participation in the Medicaid programme, non-Hispanic white women with a birthweight < 2000 g were 1.7 times more likely to have had their pregnancy complicated by GDM (RR = 1.7; 95% CI 0.8, 3.3) than those with a birthweight 3000-3999 g. The corresponding adjusted RRs for African-American, Native American, and Hispanic women were 2.8 [95% CI 1.2, 6.1], 3.1 [95% CI 1.2, 8.2] and 2.4 [95% CI 0.9, 6.0] respectively. Among African-American women, those with a birthweight > or = 4000 g also experienced a twofold increased risk of GDM (RR = 2.1; 95% CI 1.0, 4.1). This association of high birthweight and increased GDM risk was not found among women in the other three racial/ethnic groups. These findings suggest that individuals with low birthweight constitute a group at increased risk for GDM.     

Evaluating the disparity of female breast cancer mortality among racial groups - a spatiotemporal analysis

Background  

The literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade.     

Risk factors for early adolescent drug use in four ethnic and racial groups.

OBJECTIVES. It is widely believed that risk factors identified in previous epidemiologic studies accurately predict adolescent drug use. Comparative studies are needed to determine how risk factors vary in prevalence, distribution, sensitivity, and pattern across the major US ethnic/racial groups. METHODS. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. Respondents (n = 6760) were sixth- and seventh-grade Cuban, other Hispanic, Black, and White non-Hispanic boys in the 48 middle schools of the greater Miami (Dade County) area. RESULTS. Findings indicate 5% lifetime illicit drug use, 4% lifetime inhalant use, 37% lifetime alcohol use, and 21% lifetime tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. CONCLUSIONS. While the cumulative prevalence of risk factors bears a monotonic relationship to drug use, ethnic/racial differences in risk factor profiles, especially for Blacks, suggest differential predictive value based on cultural differences.