Measuring adherence to mammography screening recommendations among low-income women

OBJECTIVES: (1) To describe the accuracy of self-report and administrative claims for measuring mammography adherence among low-income women; (2) to determine whether the accuracy of self-report differed between telephone interview and mailed questionnaire; and (3) to explore whether the method of measuring adherence affected associations between mammography adherence and participant sociodemographic characteristics. DESIGN: Retrospective cohort study of women receiving care from a Philadelphia Medicaid Managed Care Organization (MCO). PARTICIPANTS: Three hundred and ninety-nine low-income women eligible for screening mammography of whom 64% were African American, 14% Caucasian, 13% Hispanic, and 8% Asian American. MEASURES: Self-reported use of mammography screening, administrative mammography claims data, and dates of mammograms from radiology facility records. The "gold standard" categorized women as having undergone screening if they had either a billing claim or facility record for a mammogram in the past 12 months. MAIN RESULTS: Two hundred and eighty-three of the 399 women reported having had a mammogram in the past 12 months. The sensitivity of self-report was 0.93, specificity was 0.54, positive predictive value was 0.70, and negative predictive value was 0.86. One hundred and seventy-nine of the 399 women had a claim for a mammogram in the past 12 months. The sensitivity of claims data was 0.83 with a negative predictive value of 0.84. The sensitivity of self-report was higher with telephone data collection (0.98) than with mailed data collection (0.82), while the specificity was higher with mail (0.64) than telephone (0.50). African American race was associated with adherence to screening recommendations when mammography use was measured by self-report (RR 1.31, P = 0.002) but not when it was measured by claims or facility validation (RR 1.03, P = 0.56, and RR 1.12, P = 0.15, respectively). CONCLUSIONS: Accurate measurement of adherence to mammography screening among low-income women is difficult. Self-report substantially overestimates adherence (particularly when collected through telephone interviews), while also misclassifying some women who underwent screening as not having been screened (particularly when collected through mailed questionnaires). In contrast, administrative claims data substantially underestimates adherence. Inaccurate measurement of mammography adherence can lead to a biased understanding of the factors associated with adherence.     

Breast cancer screening among African American women: adherence to current recommendations

Breast cancer remains one of the leading causes of cancer death among African American women, and rates of mammography screening for African American women remain lower than rates for their Caucasian counterparts. The purpose of the current study was to explore the reasons for nonadherence to American Cancer Society breast screening guidelines among African American women who had not received a mammogram within the past year. Participants included 91 African American women between 40 and 84 years of age recruited from churches, housing projects, and a health fair at a historically African American university who had not received a mammogram within the past 12 months. Findings revealed that 36% of participants had never received a mammogram, 43% did not have their breasts examined by their doctor once a year, 55% did not perform monthly self-examination, and 23% did not know how to examine their breasts for breast cancer. The most frequently reported reason for not getting a mammogram was because the participant's doctor had not suggested it.     

Association of body mass index to meeting physical activity recommendations

OBJECTIVE: To investigate the association between BMI and physical activity based on the CDC-ACSM recommendation and a more demanding standard consistent with the IOM recommendation. METHODS: A random-digit-dialed survey (n=1810) used 2001 BRFSS questions to measure physical activity. RESULTS: Data revealed a monotonic association between BMI and physical activity level. Lower odds of meeting both recommendations were associated with higher BMI. The proportion meeting the CDC-ACSM recommendation was at least 3 times that of persons meeting the IOM-based recommendation. CONCLUSIONS: Meeting either recommendation was associated with BMI; however, a larger proportion of persons were meeting the less demanding CDC-ACSM recommendation.     

Association between body composition and body mass index in young Japanese women

The National Nutrition Survey of Japan indicated a trend toward a decreasing body mass index (BMI; kg/m2) among young Japanese women. Current studies suggest that not-high BMI often does not correlate with not-high body fat percentage. Recently, the classification of BMI in adult Asians was proposed by the International Obesity Task Force. The addition of an "at risk of overweight" category, BMI as 23.0-24.9, was intended to prevent chronic diseases. We investigated the association between body fat percentage (BF%) and BMI to evaluate the screening performance of BMI focused on individual preventive medicine. The subjects consisted of 605 female college students. The subjects' ages (y), heights (cm), body weights (kg), BMIs, and BF percents with underwater weighing expressed as the means +/- SD were 19.6 +/- 0.5, 158.7 +/- 5.6, 53.8 +/- 7.2, 21.3 +/- 2.4, and 24.9 +/- 4.9, respectively. We defined high BF% as +/- 85th percentile of BF% (29.8%). High-BF% individuals are often not classified into BMI > or = 23.0 because their BMI readings are very broad (18.4-31.7). In comparison to the screening performances (specificity and sensitivity), BMI > or = 23.0 (85.3% and 52.1%, respectively), rather than BMI > or = 25.0 (96.7% and 29.8%, respectively), is recommended for the mass evaluation of fatness. For this reason, the BMI "at risk of overweight" category is characterized as the threshold of increasing the appearance ratio of high-BF% individuals. In conclusion, the BMI > or = 25.0 kg/m2 category is determined as high BF%, regardless of body composition measurement for mass evaluation as a result of quite high specificity. Even so, body composition measurement is necessitated by the individual evaluation of fatness focused on preventive medicine because BMI performed a poor representation of body composition, especially BMI < 25.0 kg/m2 individuals.     

Vascular structure and function in women: relationship with body mass index

BACKGROUND: The purpose of the present study was to compare endothelial function in lean (body mass index [BMI]=18.0-24.9 kg/m2); overweight (BMI=25-29.9 kg/m2); and obese (BMI>30 kg/m2), healthy, eumenorrheic women. METHODS: Eighteen lean, 22 overweight, and 19 obese eumenorrheic middle-aged women were studied. Vascular structure and function were assessed via non-invasive ultrasound imaging of the carotid and brachial arteries. Body composition, blood pressure, fasting blood lipids, glucose, and insulin also were measured. RESULTS: The groups demonstrated significantly (p<0.001) different mean values for total body, lean body, and fat masses. The obese group demonstrated significantly (p<0.05) elevated fasting glucose and insulin levels and lower high-density lipoprotein levels as compared to the lean group. The overweight group also demonstrated elevated fasting glucose levels as compared to the lean group (p<0.05) with no significant difference from the obese group. Only systolic blood pressure differed among the three groups, being elevated in the obese group compared to the lean group (p<0.05). The obese group demonstrated significantly (p<0.05) elevated carotid artery lumen diameter, carotid artery wall cross-sectional area, and brachial artery lumen diameter with significantly (p<0.05) lower flow-mediated dilation as compared to the lean group. The overweight group demonstrated elevated carotid artery wall cross-sectional area and brachial artery lumen diameter as well as lower flow-mediated dilation as compared to the lean group (p<0.05). CONCLUSIONS: The results of this study support the hypothesis that carotid artery wall cross-sectional area is elevated and flow-mediated dilation reduced in overweight and obese eumennorheic women as compared to lean counterparts in relation to BMI classification.     

Relation of body mass index to depression and weighing frequency in overweight women

OBJECTIVE: Research suggests that overweight and obesity are associated with depressive symptoms, particularly among women. Evidence from weight control trials suggests that higher weighing frequency is associated with greater weight loss or less weight gain. As limited data exist on the effects of self-weighing on body mass index (BMI) among overweight adults with or without depression, this study seeks to examine this issue using data from a population-based epidemiologic survey. METHODS: Data from a large population-based survey of 4655 women ages 40-65 in the greater Seattle area, surveyed from November 2003 to February 2005, were used to examine associations of depression and weight self-monitoring with BMI. Sample-weighted regression models were used to examine associations of depression, self-weighing frequency, and BMI, with demographic factors (race/ethnicity, employment status, smoking status, age, martial status, educational attainment) entered as covariates. RESULTS: Regression models indicated that higher self-weighing frequency and negative depression status were independently associated with lower BMI, with no interaction observed between depression and self-weighing. CONCLUSION: Frequent self-weighing appears to be associated with lower BMI in both depressed and non-depressed overweight women.     

Reproductive history and body mass index in black and white women

The relationships of timing, spacing, number of births, and demographic variables to body mass index were examined in 844 white and 289 black women. Subjects were interviewed in 1978-1979 as mothers or female guardians of a stratified random sample of all Minneapolis children in grades 1-3. Results indicate that among black and white women, number of births, age at last birth, and years between first and last births were positively associated with body mass index. However, when age, education, and income were included in the regression equation for black women, none of the reproductive variables predicted body mass index. When number of births, age at last birth, and years between first and last birth were included in the same regression for white women, only number of births was independently associated with body mass index.     

Built environment and change in body mass index in older women

We examined the association between neighborhood walkability and changes in body mass index (BMI) and obesity during a 14-year follow-up among community-dwelling women 71 years of age on average (n=1008 representing 253 census tracts). Multilevel models predicted change in BMI or incidence of obesity controlling for age, marital status, number of incident comorbidities, self rated health, and death, over a follow-up of 14 years. Among non-sedentary older women, average BMI remained stable (β=0.007, p=0.291); risk of becoming obese increased 3% per year (odds ratio=1.03, 95% CI 1.01, 1.05). Walkability was not associated with BMI or risk of obesity. Future research should consider additional neighborhood characteristics relevant to older adults, such as proximity to retail, public transit, or parks.     

Soy intake is related to a lower body mass index in adult women

BACKGROUND: Experimental and epidemiologic studies suggest that soy may promote weight loss. AIM OF THE STUDY: The goal of this study was to examine the relation of soy intake with body weight over the lifespan of women with Caucasian, Japanese, and Native Hawaiian ancestry. METHODS: We assessed the relation between lifetime soy consumption and body mass index (BMI) among 1,418 women in Hawaii. All subjects reported anthropometric measures, regular diet, and soy intake throughout life. The lifetime soy questionnaire was completed again by a subset of 356 women 5 years after study entry and the kappa values indicated moderate agreement. We regressed soy intake on BMI at study entry and at age 21 while controlling for confounding variables, computed least square means, and performed trend tests. RESULTS: Higher soy consumption in adulthood was related to a lower BMI (P=0.02). This association was only significant for Caucasian women and for postmenopausal subjects. The women in the highest category also experienced a smaller annual weight change since age 21 (by 0.05 kg/year) than the low soy intake group (P=0.02). We observed no association between early life soy intake and BMI. High vegetable consumption was significantly associated with a higher soy intake among Caucasian women. CONCLUSIONS: In this study, women consuming more soy during adulthood had a lower BMI, but the relation was primarily observed for Caucasian and postmenopausal subjects. This indicates that the association may be due to other nutritional factors and behaviors common in women with high soy intake.     

Reported food choices in older women in relation to body mass index and depressive symptoms

This paper examines the relationships among reports of depressive symptoms, BMI and frequency of consumption of 30 foods in 4655 middle-aged women. Food was grouped into three categories: high-calorie sweet, high-calorie nonsweet, and low-calorie. Controlling for total energy intake, BMI and depressive symptoms were both inversely associated with a higher frequency of consumption of low-calorie foods. BMI was positively associated with consumption of high-calorie nonsweet foods and negatively related to consumption of high-calorie sweet foods. Depressive symptoms were positively associated with sweet foods consumption and negatively associated with nonsweet foods consumption. These findings suggest that the positive association between BMI and depression in women may be mediated by sweets consumption. This is consistent with the hypothesis that eating sweet foods reduces negative affect.     

Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings

There is increasing evidence that in utero effects of excessive gestational weight gain may result in increased weight in children; however, studies have not controlled for shared genetic or environmental factors between mothers and children. Using 2,758 family groups from the Collaborative Perinatal Project, the authors examined the association of maternal prepregnancy body mass index (BMI) and gestational weight gain on child BMI at age 4 years using both conventional generalized estimating equations and fixed-effects models that account for shared familial factors. With generalized estimating equations, prepregnancy BMI and gestational weight gain had similar associations with the child BMI z score (β = 0.09 units, 95% confidence interval (CI): 0.08, 0.11; and β = 0.07 units, 95% CI: 0.04, 0.11, respectively. However, fixed effects resulted in null associations for both prepregnancy BMI (β = 0.03 units, 95% CI: -0.01, 0.07) and gestational weight gain (β = 0.03 units, 95% CI: -0.02, 0.08) with child BMI z score at age 4 years. The positive association between gestational weight gain and child BMI at age 4 years may be explained by shared family characteristics (e.g., genetic, behavioral, and environmental factors) rather than in utero programming. Future studies should continue to evaluate the relative roles of important familial and environmental factors that may influence BMI and obesity in children.     

Associations of serum minerals with body mass index in adult women

OBJECTIVE: This cross-sectional study evaluated the association between serum minerals and body mass index in adult women. METHODS: One hundred and eighteen adult women were recruited by written advertisement from outpatient clinics or a health promotion center at a university hospital. Serum calcium, magnesium, copper and zinc were measured by an automatic analytical instrument and body mass index was calculated from height and weight. RESULTS: Serum magnesium was inversely associated with body mass index (beta=-0.283, P=0.001) whereas serum copper had a positive association with body mass index (beta=0.197, P=0.025) after adjusting for age, physical activity, energy intake, dietary fat, alcohol consumption, supplements and menopause status. No associations were found with serum calcium and zinc. CONCLUSION: Serum magnesium and copper may be involved in the regulation of body size in adult women.     

Dietary patterns are associated with body mass index in multiethnic women

This cross-sectional study investigated the relationship between dietary patterns and body mass index among 514 women with different ethnic backgrounds who completed a validated food-frequency questionnaire. An exploratory factor analysis with orthogonal rotation started with 23 food items and resulted in four factors that accounted for 93% of the total variance. Confirmatory factor analysis with the 16 items that had factor loadings of at least 0.60 validated the four dietary patterns. The most significant dietary pattern, "meat," was characterized by high intake of processed and red meats, fish, poultry, eggs, fats and oils, and condiments. The "vegetable" pattern loaded high on different vegetables, whereas the third pattern named "bean" was high in legumes, tofu and soy protein. The major components of the "cold foods" pattern were fruit, fruit juice and cold breakfast cereals. Although the "meat" pattern was predominant among Hawaiians and the "bean" pattern very common among Chinese and Japanese women, factors two and four were not related to ethnicity. After adjustment for daily energy intake, the "meat" pattern was positively associated with body mass index (r = 0.17, P: = 0.0001), whereas the other three patterns showed negative relationships to body mass index (r = -0.076, P: = 0.084, r = -0.13, P: = 0.003, and r = -0.13, P: = 0.003) for vegetables, beans and cold foods, respectively. The associations were similar in direction and magnitude for all ethnic groups. The study results support the ideas that choosing the right foods may be important in weight control and that food-based dietary patterns may be useful in dietary counseling.     

不同体重指数的年轻患者行IVF-D助孕结局分析

目的 分析在供精体外受精-胚胎移植(IVF-D)新鲜周期中,不同体重指数的年轻女性助孕的结局.方法 回顾性分析2014年1月至2015年10月在西北妇女儿童医院接受常规长方案IVF-D助孕的576例患者资料.排除可能影响结局的因素,纳入年龄≤35岁第1周期IVF-D助孕的269例患者.根据我国体重指数(BMI)参考标准,分为三组,即BMI<18.5kg/m2(n=38)、BMI 18.5~23.9(n=188)和BMI≥24(n=43).结果 BMI≥24kg/m2者不孕年限显著增加(χ2=10.399,P=0.006).BMI≥24kg/m2的hCG日雌二醇水平明显低于其他两组(P=0.020).不同BMI组,Gn时间(P=0.421)、Gn总量(P=0.252)、获卵数(P=0.287)、受精率(P=0.777)、2PN率(P=0.249)、可用胚胎率(P=0.602)、优胚率(P=0.209)和周期取消率(P=0.795)无明显差异.不同BMI组,临床妊娠率无差异(P=0.629).与其他两组相比,BMI≥24,流产率有增高趋势(P=0.167),活产率有下降趋势(P=0.197),但没有统计学差异.结论 体重指数增加不影响年轻女性IVF助孕结局.     

身体质量指数作为肥胖筛查标准的判别准确性评价

摘要：目的　以ＷＨＯ 体脂率肥胖判定标准作为“金标准”,对中国成年人身体质量指数（简称体质指数,
ＢＭＩ）肥胖判定标准的真实性、可靠性、收益等进行评价,并探讨ＢＭＩ作为体脂率是否超标的指征的诊断
性能及适宜的截断值。方法　研究对象为１８～７９ 岁成年人６８９ 名,测试身高、体重,计算ＢＭＩ。采用
ＤＥＸＡ 法对研究对象进行全身身体成分测定。以世界卫生组织推荐的体脂率判定标准（男性Ｆ％ ≥２５％,
女性Ｆ％≥３５％）作为肥胖判定的“金标准”,以中国肥胖问题工作组研制的中国成年人肥胖判定的ＢＭＩ
标准（ＢＭＩ≥２８ｋｇ／ｍ２） 作为筛检阳性标准。对ＢＭＩ标准的真实性、可靠性、收益等进行评价,并采用
ＲＯＣ 曲线分析进行截断值判定。结果　ＢＭＩ作为肥胖筛查标准的真实性评价主要表现为特异度高,灵敏度
过低,假阴性率过高;尤其是女性,灵敏度只有０．１８,假阴性率高达８２％。与体脂率“金标准”判断一致
性男性尚好（Ｋａｐｐａ值为０．３２）,女性则较差（Ｋａｐｐａ值为０．１３）。ＢＭＩ作为肥胖筛查标准约登指数较低,
尤其女性（０．１３）;阳性预测值和阳性似然比较高;阴性预测值较低,阴性似然比较高。以体脂率判定的肥
胖作为效标时,ＢＭＩ的诊断性能中等（ＡＵＣ＝０．８２２,犘＝０．０００）,男女分组诊断性能提高（ＡＵＣ 分别为
０．８４４和０．８６８,犘＝０．０００）;ＢＭＩ切点男女分别为２５．２４和２３．９８。结论　国内现有成年人ＢＭＩ肥胖判定
界值可能偏高,尤其对于女性;在较小样本研究中不宜以ＢＭＩ作为肥胖分组的依据;应建立以健康指标为
参照的、考虑身体脂肪成分和不同性别年龄的各人群肥胖判定标准;以健康干预为目标的ＢＭＩ筛查截断值
确定时应以提高灵敏度、适当降低特异度为原则。
关键词：身体质量指数;体脂率;肥胖;筛检试验评价;ＲＯＣ 分析
中图分类号：Ｒ５８９　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０６ ０５７１ ０５