Correlates of unrealistic risk beliefs in a nationally representative sample

Unrealistically optimistic or pessimistic risk perceptions may be associated with maladaptive health behaviors. This study characterized factors associated with unrealistic optimism (UO) and unrealistic pessimism (UP) about breast cancer. Data from the 2005 National Health Interview Survey were analyzed (N = 14,426 women). After accounting for objective risk status, many (43.8%) women displayed UO, 12.3% displayed UP, 34.5% had accurate risk perceptions (their perceived risk matched their calculated risk), and 9.5% indicated “don’t know/no response.” Multivariate multinomial logistic regression indicated that UO was associated with higher education and never smoking. UP was associated with lower education, lower income, being non-Hispanic Black, having ≥3 comorbidities, current smoking, and being overweight. UO was more likely to emerge in younger and older than in middle-aged individuals. UO and UP are associated with different demographic, health, and behavioral characteristics. Population segments that are already vulnerable to negative health outcomes displayed more UP than less vulnerable populations.     

Association of cancer worry and perceived risk with doctor avoidance: an analysis of information avoidance in a nationally representative US sample

Fear of receiving bad news about one’s health can lead people to avoid seeking out health information that, ironically, may be crucial for health maintenance. Using a nationally representative US sample, the present study examined whether perceived likelihood of developing cancer and worry about cancer were associated with reports of avoiding visits to one’s doctor, in respondents under and over age 50. Cancer worry, but not perceived risk of cancer, predicted doctor avoidance in respondents aged 50 and older, whereas the opposite pattern held for respondents under age 50. Moreover, in respondents aged 50 and older, cancer worry and perceived cancer risk interacted such that cancer worry was linked to doctor avoidance only when respondents also perceived a high likelihood of cancer. The latter result is consistent with the notion that worry may motivate information seeking when people expect information to dispel worry and information avoidance when the information is seen as highly likely to confirm one’s fears. Findings suggest a need for communication strategies that can influence worry and perceived risk differentially. Research should also assess the effectiveness of other behavioral strategies (e.g., automatic scheduling of appointments) as a means for reducing doctor avoidance.     

Osteoporosis risk perceptions among patients who have sustained a fragility fracture

Objective

To explore the perceptions of patients who have sustained a fragility fracture regarding their future fracture risk and the beliefs underlying their perceptions.

Methods

Patients with fragility fracture participated in a telephone interview. Quantitative and qualitative methods were used to characterize patient characteristics and perspectives of future fracture risk. Content analysis of qualitative statements was independently performed by three investigators to identify common themes and contrasting statements, and the findings were discussed to ensure consensus.

Results

Consistent themes were identified among participant responses irrespective of whether they responded “yes”, “no” or “unsure” when asked whether they were at increased fracture risk: (1) patients’ perception of risk was influenced by whether or not they believed they had osteoporosis, which may be altered by interaction with health care providers; (2) patients’ had their own perceptions of their bone health; (3) patients’ attributed their risk to their own actions or “carefulness”; and (4) patients’ had specific beliefs about their fracture and determinants of fracture risk.

Conclusion

Patients who experience fragility fractures develop perceptions about future fracture risk that are influenced by interactions with health care providers, as well as beliefs about their fracture and beliefs that they can modify their risk.

Practice implications

Health care providers should discuss strategies for fracture prevention with all patients after fragility fracture to ensure that patients understand that participation in preventative behaviours can modify their risk.     

Asthma and cigarette smoking in a representative sample of adults

The current study examined the association between asthma and both smoking and nicotine dependence in the National Comorbidity Survey-Replication (NCS-R) as well as the temporal patterning between smoking and asthma onset (N = 5692; 53% female; M (age) = 45.01, SD = 17.9). Results indicated lifetime history of daily smoking and nicotine dependence were both significantly associated with asthma diagnosis and half of individuals with asthma reported that their asthma diagnosis preceded smoking onset. These data suggest that nicotine dependence may maintain a stronger relation with asthma than smoking and that there may be distinct developmental trajectories for asthma-smoking relations.     

The association between pubertal status and sleep duration and quality among a nationally representative sample of U. S. adolescents.

Many hormones play important roles in both pubertal development and sleep regulation. Because of the possible consequences of impaired sleep, including impaired health and cognition, it is important to examine whether an association between pubertal stage and sleep exists. The aim of this analysis is to examine the association between sleep and adolescent growth and developmental stage in a large sample of adolescents ages 12-16 years from a nationally representative longitudinal study. This analysis used the public-use data set of the National Longitudinal Study of Adolescent Health, an extensive survey of health and behavior among adolescents in the United States. The study included two interviews approximately 1 year apart. Pubertal development, sleep variables, and height are self-reported. Pubertal development scores were calculated by summing responses to three questions for each sex. The sleep variables include sleep duration, frequent insomnia (once/week or more), frequently waking tired (once/week or more), and insufficient sleep. The results indicate a sex difference in the association between sleep problems and pubertal development. Among females, there was a significant increase in sleep problems with increasing pubertal development score, but not among males. The negative association between sleep duration and pubertal development score, however, was significant in both males and females. There is no association between sleep duration and height velocity (inches/year) in this sample. The results, which are based on a large sample size, warrant further examination with more objective measures into the association between sleep and growth and development among adolescents.     

Factors associated with outcome in unaided smoking cessation, and a comparison of those who have never tried to stop with those who have.

AIM. This survey set out to determine the factors associated with outcome of unaided smoking cessation attempts and to compare the characteristics of smokers who had tried to stop with those who had never tried. METHOD. A postal questionnaire was sent to a random sample of 2000 adults in Aberdeen, Scotland. Those respondents who smoked or who were ex-smokers were sent a second questionnaire. The outcome measure for success in trying to stop smoking was abstinence for more than four months. RESULTS. Light and heavy smokers were more successful at smoking cessation than moderate smokers. Those who succeeded perceived that they had more social support than failures, and were more likely to have 'simply just stopped'. They were less likely to have used nicotine gum or to believe that smoking was harmful. Those who failed experienced more withdrawal symptoms, and were more likely to be tempted by the presence of others smoking. Eleven per cent of smokers had never tried to stop. These smokers were older and more dependent than those who had tried to stop. They were less likely to acknowledge the health risks of smoking or to conform to social pressures, but were more likely to consider stopping for financial reasons alone. CONCLUSION. Heavily dependent smokers may fare better in unaided cessation than the results of clinic-based research suggest. For those who have tried to stop, increasing motivation and social support, and minimizing withdrawal symptoms, may be more productive than further emphasis on health risks. Motivating smokers who have not previously tried to stop may involve more emphasis on the health risks of smoking and the health benefits of stopping, as well as on other non-financial benefits of stopping such as social acceptability. Fiscal measures may be particularly effective in motivating this group of smokers to try to stop.     

Cervical cancer screening attitudes and beliefs of malaysian women who have never had a pap smear: A qualitative study

Background: Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.Purpose: This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women.Method: In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear.Results: Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.Conclusion: Women need tobe educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia. This study was funded by the Ministry of Science, Technology and Environment Malaysia, Intensification of Research in Priority Areas (IRPA) 06-02-1032 PR0024/09-06.     

Sexual risk behavior among HIV-positive men who have sex with men: a literature review

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.     

Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men

OBJECTIVE: To examine the prevalence of negotiated safety (NS) in a diverse sample of HIV-negative men who have sex with men (MSM), characteristics of MSM practicing NS, and adherence to NS. METHODS: This was a cross-sectional survey of San Francisco MSM recruited from venues and community organizations. NS relationships were defined as those in which HIV-negative men were in seroconcordant primary relationships for >/=6 months, had unprotected anal intercourse (UA) together, and had rules prohibiting UA with others. Adherence to NS was determined from self-reported sexual behavior in the prior 3 months. Presence of an agreement with NS partners to disclose rule breaking was also determined. RESULTS: Of 340 HIV-negative participants, 76 (22%) reported a current seroconcordant primary relationship for >/=6 months. Of these 76 men, 38 (50%) had NS relationships, 30 (39%) had no UA with primary partners, and 8 (11%) had UA with primary partners without rules prohibiting UA with others. In multivariate analysis, NS was more common than no UA with primary partners in younger men. Among 38 NS men, 29% violated their NS-defining rule in the prior 3 months, including 18% who reported UA with others, and 18% reported a sexually transmitted infection (STI) in the prior year. Only 61% of NS men adhered fully to rules and agreed to disclose rule breaking. CONCLUSIONS: Although NS was commonly practiced among HIV-negative men in seroconcordant relationships, some men violated NS-defining rules, placing themselves and potentially their primary partners at risk for HIV infection. Prevention efforts regarding NS should emphasize the importance of agreement adherence, disclosure of rule breaking, and routine STI testing.     

The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample

BACKGROUND: The present study examined health-related quality of life (HRQOL) and the prevalence of mental disorders in pregnant and past-year pregnant women compared to non-pregnant women. METHOD: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions. Three groups of women (ages 18-44) were compared: currently pregnant (n=451), past-year pregnant (n=1061), and not pregnant (n=10,544). Past-year mood, anxiety and substance use disorders were assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. HRQOL was measured by the Medical Outcomes Study Short Form (SF-12). All analyses included sociodemographics as covariates. RESULTS: Multiple logistic regression analyses showed that pregnant women were less likely than non-pregnant women to have depression and alcohol abuse or dependence; and less likely than past-year pregnant women to have depression and mania. Past-year pregnant women were less likely than non-pregnant women to have social phobia and alcohol dependence or abuse. Multiple linear regression analyses demonstrated that pregnant and non-pregnant women had higher mental component scores than past-year pregnant women. Physical component scores were lower in pregnant women than in non-pregnant and past-year pregnant groups. LIMITATIONS: This was a cross-sectional survey and the causality of relationships cannot be inferred. CONCLUSIONS: Results suggest that pregnant women have a lower likelihood of mental disorder than both non-pregnant and past-year pregnant women.