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Biomedical subjects

A C Marcus

Publications and source records attributed to A C Marcus.

At least 37 records · Page 2Linked to original sources
PubMed1991

Screening mammography rates and barriers to use: a Los Angeles County survey.

The use of screening mammography among women 40 years of age and older in Los Angeles County was assessed through a random digit dial telephone interview. The sample of 802 women represents a large urban population with substantial proportions of blacks, Hispanics, and Asians. The survey obtained information regarding adherence to the ACS/NCI screening mammography guidelines, perceived benefits of early detection and mammography, perceived threat of developing breast cancer, and barriers to utilization. The results showed that 71% of the women had had at least one mammogram, with 49% having received a screening mammogram according to the guidelines for their age. Less than half the respondents knew the screening guidelines for their age, with women ages 40-49 years being less knowledgeable than women greater than or equal to 50 years old (29 vs 58% answering correctly). A logistic regression analysis predicting the likelihood of having obtained a screening mammogram according to the guidelines found the following to be predictive: concern over radiation (negative association), age (negative association), family history, knowledge of guidelines, and cost of a mammogram (negative association). Other demographic factors and beliefs were not significantly related to this dependent variable.

Adult↗
PubMed1991

The tobacco withdrawal syndrome in unaided quitters.

Tobacco withdrawal was assessed over a one year follow-up period in a prospective study of 554 persons stopping smoking on their own on a target quit date, the Great American Smokeout or New Year's Day. Tobacco dependence was related to smoking status as well as to the tobacco withdrawal syndrome through the one month follow-up. During the first week of follow-up at least 87% of subjects reported withdrawal symptoms, and craving was reported by at least two-thirds. There was consistency in the rankings of the four most prevalent short- and long-term symptoms: restless, eating more than usual, anxious/tense and impatient. During the first week, levels of symptom severity and frequency fo craving dropped from days 1 and 2 to week 1. Across long-term follow-ups the withdrawal syndrome peaked at 1 month and leveled off at 6 and 12 months. Results are discussed in terms of clinical and treatment implications.

Adult↗
PubMed1990

Screening for cervical cancer in emergency centers and sexually transmitted disease clinics.

Low-income women are at increased risk of developing cervical cancer compared with middle- and upper-income women. How can poor women be reached for screening and early diagnosis of cervical cancer and its precursor stages? One answer to this question is based on the observation that a high percentage of the unscreened population has received some form of medical care within the previous 5 years. Emergency centers and sexually transmitted disease (STD) clinics often provide such care to patients who lack a regular source of health care. Thus, they represent potential resources for cervical cancer screening. However, in a survey of 19 hospitals whose patient populations include a high proportion of low-income patients, only five reported a protocol for cervical cancer screening in their emergency centers. Similarly, all 11 STD clinics included in this survey reported that fewer than 5% of their female patients had a Papanicolaou smear taken even though virtually all of them received a pelvic examination. Based on these findings, it appears that health care administrators and policymakers could intensify their cancer prevention programs by mobilizing these resources for cancer control.

Community Health Centers↗
PubMed1989

Prevalence of cigarette smoking in the United States: estimates from the 1985 current population survey.

In September 1985, the Census Bureau collected health information on 114,342 individuals as part of its Current Population Survey (CPS). A special supplement that included questions on smoking practices was sponsored by the Office on Smoking and Health. The CPS, with its large sample size, provides a unique opportunity to examine region, division, and state estimates of smoking prevalence. The overall prevalence rate for males in the 1985 CPS was estimated at 31.3%, compared with 25.0% for females. For males, smoking rates were highest in the South (34.5%) and lowest in the West (28.0%). For females, smoking rates were highest in the North Central region (26.3%) and lowest in the West (22.7%). Among males, blacks reported higher smoking rates (37.2%) than whites (30.7%) or Hispanics (30.9%). In contrast, white females (25.8%) and black females (26.0%) reported virtually identical smoking rates, while Hispanic females reported a considerably lower rate (16.5%). White-collar workers (both males and females) also reported substantially lower smoking rates than service or blue-collar workers. For both males and females, peak smoking prevalence occurred in the 40-49-year age group (males = 38.1%, females = 30.6%).

Adolescent↗
PubMed1989

Ethnic variations in the prevalence of smoking among registered nurses.

A survey of smoking behavior was conducted on 1,569 registered nurses in six unrelated acute care hospitals in Los Angeles in 1984-1985. Smoking prevalence, higher than for other health professionals but lower than for women in the United States or in other recently surveyed samples of nurses, was closely linked to the ethnicity and the age distribution of the nurses surveyed. Patterns for black and white nurses, who account for the majority of nurses nationally, were similar to those found in other recent studies of registered nurses. Among Asian nurses, however, prevalence was lower, age of initiation was higher, and the mean number of cigarettes smoked daily was lower than for other nurses. Smoking prevalence for younger nurses was lower than for other nurses, and these nurses were more likely to report themselves as never having smoked. Smoking patterns among nurses remain a significant public health concern.

Adult↗
PubMed1989

Use of smokeless tobacco in the United States: recent estimates from the current population survey.

Chewing tobacco, snuff, and total smokeless tobacco use from the 1985 Current Population Survey (CPS) are reported. The CPS is the only survey capable of providing national, regional, and individual state tobacco use estimates for all 50 states and the District of Columbia. The prevalence of smokeless tobacco use varies considerably among and within regions of the country, by division and state. Smokeless tobacco use is highest in the South and lowest in the Northeast. Individual states with the highest smokeless tobacco use among males are West Virginia (23.1%), Mississippi (16.5%), Wyoming (15.8%), Arkansas (14.7%), and Kentucky (13.6%). In all regions of the country, use of smokeless tobacco among women is considerably less than men. Nationally, male use of such products was 5.5%; less than 1% of women use them. Snuff consumption is predominantly a behavior characteristic of white males; less than 1% of black or Hispanic males consume this product. Higher percentages of blue-collar and service workers use it compared with white-collar workers. Snuff and chewing tobacco use among teenage boys in the United States increased dramatically between 1970 and 1985, a time when their use of cigarettes was declining. The significance of individual state level estimates is discussed.

Adolescent↗
PubMed1988

Evaluation of a worksite self-help smoking cessation program for registered nurses.

Cigarette smoking among nurses remains a public health concern despite a recent decline in current smoking prevalence. We recruited 149 registered nurses into a no-cost, targeted, self-help smoking cessation program supplemented by a supportive worksite environmental module. The study was designed to expand understanding of nurses' smoking and to measure program effectiveness. Follow-ups were conducted at one, six and 12 months post-intervention to assess self-reported smoking status (92% objectively validated) and predictors of cessation. Point prevalence abstinence at these time points (22.5%, 21.5% and 19.5%), continuous abstinence (12.7%), and an ever-quit rate of 57% (i.e., quit for at least 48 hours), compare favorably to population quit rates and to rates reported for other self-help programs. Logistic regression analyses were utilized to identify predictors of short-term cessation [time before needing a cigarette, concern regarding the health hazards of smoking, working in a critical care setting, use of targeted weight manual] and long-term cessation [dosage (inverse relationship), use of standard American Lung Association maintenance manual, working with dying patients, and M.D.s' opposition to upgrading nursing service (inverse relationship)].

Attitude of Health Personnel↗
PubMed1987

Quasi-experimental evaluation of the Los Angeles Know Your Body program: knowledge, beliefs, and self-reported behaviors.

In 1981-1982 the Division of Cancer Control (Jonsson Comprehensive Cancer Center, University of California, Los Angeles) implemented a Know Your Body program in the Los Angeles and Santa Monica Unified School Districts. The results from this evaluation are based on analyses of over 1,400 elementary school children (ages 9-11 years) from 18 schools who were assigned to one of four comparison groups: (a) Know Your Body curriculum and health screening (N = 688 students/seven schools), (b) Know Your Body health screening only (N = 333 students/three schools), (c) Know Your Body curriculum only (N = 253 students/five schools), and (d) the control group (N = 234 students/three schools). Standardized questionnaires concerning health knowledge, beliefs, and (self-reported) behaviors were group-administered by teachers in January 1981 (pretest) and then again in March 1982 (post-test). The group receiving both the Know Your Body curriculum and the clinical screening scored higher than the control group on four out of six post-test knowledge measures, one out of three belief scales, and one out of four behavioral measures. The curriculum-only group scored higher than the control group on five out of six post-test knowledge measures and on two of three belief scales. The screening-only group did not score significantly higher than the control group on any of the outcome measures. Among children identified during the clinical screening (at pretest) as being at higher risk of developing chronic disease (N = 543), students receiving both the screening and the curriculum (N = 401) scored higher on four out of six knowledge measures and reported significantly lower consumption of both dairy products and high-cholesterol foods than "high-risk" students receiving only the clinical screening (N = 142).

Attitude to Health↗
PubMed1986

Telephone surveys in public health research.

The last 10 years have seen increasing use of telephone surveys in public health research. This paper reviews issues of sampling, data quality, questionnaire development, scheduling of interviewers, respondent burden, interviewer effects, and the use of the computer in telephone interviewing. Throughout, the authors focus on findings from recent research, with particular emphasis on those studies suggesting new advances or protocols for conducting telephone health surveys. The findings of this review suggest four conclusions. First, telephone interviews can be highly recommended for follow-up interviews in panel surveys that use an initial face-to-face interview. Second, telephone surveys can be recommended as a viable alternative to costly face-to-face surveys in cross-sectional studies of the general population. Third, when the focus of the survey is on subgroups of the population that have both low telephone coverage and higher rates of nonresponse (e.g., low income and low education respondents), telephone interviews should be used more cautiously. In these situations, a dual sampling frame approach (using a combination of face-to-face and telephone interviewing) may be considered. Finally, computer-assisted telephone interviewing (CATI) represents one of the most important and innovative technologic advances in health survey research in recent years. The advantages of CATI in improving survey management are noteworthy and ideally suited for moderate- to large-sample surveys. CATI also provides an attractive (and largely untapped) resource for testing and refining other methodologic protocols in survey research.

Computers↗
PubMed1986

ICWU cancer control education and evaluation program: research design and needs assessment.

The International Chemical Workers Union is implementing a 3-year nationwide field experiment in cancer prevention education. The educational program includes three stages: generalized cancer control education, education tailored to each local union, and an interactive monitoring system designed to provide ongoing communication and reinforcement for desired cancer control behaviors among local unions and their members. These alternative educational approaches will be systematically evaluated using a randomized factorial study design involving more than 120 local unions. The need for such a program is demonstrated by the results of a needs assessment survey of 690 union members. Respondents expressed strong concern regarding possible carcinogen exposures at the work site, combined with generally low ratings of co-worker knowledge of and adherence to appropriate cancer control behaviors. Engineering controls and personal protective equipment were reported to be inadequate in many work sites.

Attitude to Health↗
PubMed1985

Smoking behavior among US Latinos: an emerging challenge for public health.

In this paper we review evidence on smoking and lung cancer among Latinos, including findings from several unpublished studies and technical reports. Recent surveys of smoking behavior in California, Texas, and New Mexico indicate a notable sex difference in smoking among Latinos, with Latino males smoking at least as frequently as White males, while Latino females report smoking rates considerably lower than White females. Our analysis of the 1979 and 1980 National Health Interview Surveys corroborates this finding and also indicates that this pattern holds true for subgroups of the Latino population, including country of origin. Taken together, these findings suggest that among Latino males rates of lung cancer and other cigarette-linked diseases may increase in the near future.

Adolescent↗
PubMed1984

Mode of payment and identification with a regular doctor. A prospective look at reported use of services.

Despite the apparent success of health maintenance organizations (HMOs) in lowering the costs of health care, they have been criticized for other reasons, including the lack of doctor-patient continuity in the patient's having a regular doctor. Consistent with previous research, HMO members sampled from Los Angeles County (N = 190) were less likely to identify with a regular doctor than comparable fee-for-service (FFS) subscribers (N = 653) (P less than 0.001). When differences in this variable were not controlled statistically, HMO members reported higher rates of physician visits, but only for acute respiratory problems (P less than 0.05). It was not until differences in having a regular doctor were taken into account that HMO members were found to report higher rates of use for all symptoms (P less than 0.05) as well as for digestive problems (P less than 0.10). These findings suggest the importance of taking physician-patient continuity into account when comparing utilization rates across health plans. Additionally, few differences were found in reports of morbidity, although HMO members were less likely to report cold symptoms during this 1-year survey than comparable FFS subscribers (P less than 0.05).

Adolescent↗
PubMed1983

Baseline chronic disease risk factors in a racially heterogeneous elementary school population: The "Know Your Body" program, Los Angeles.

The Los Angeles "Know Your Body" (KYB) program is an organized health education activity for children designed to encourage positive health behavior and discourage or interrupt behavioral patterns that are linked to illness, injury, disability, or death. Components of KYB include a 20-week curriculum; a survey of health knowledge, attitudes, and behaviors; in-service training for elementary school teachers; and a clinical screening that provides feedback to students on selected indices. As part of a KYB field demonstration in Los Angeles conducted by the UCLA Division of Cancer Control, Jonsson Comprehensive Cancer Center, 1,503 Los Angeles and Santa Monica-Malibu children ages 9-11 in grades 4 and 5 underwent baseline health screening evaluations in March 1981, measuring height, weight, triceps skinfold thickness, serum cholesterol, pulse rate recovery following exercise, and blood pressure. The population mean for serum cholesterol was 182.6 mg/dl, with no significant racial/ethnic, sex, or age differences. Significant racial/ethnic differences were found in obesity, with Hispanics having the highest prevalence, Asians the lowest. Black students scored significantly higher in pulse rate recovery following exercise, suggesting better relative cardiovascular fitness, and Asians scored lowest. Blacks were more likely to exceed the 95th percentile in diastolic and systolic blood pressure. Overall, 48% of the children had one or more chronic disease risk factors.

Age Factors↗
PubMed1983

Sex differences in reports of illness and disability: a further test of the fixed role hypothesis.

Data from a longitudinal study of adult health behavior (N = 1088) were used to test the 'fixed role' hypothesis as an explanation for sex differences in reports of illness and disability. According to this hypothesis, the traditional female excess in reported morbidity is due to females having more flexible role obligations than men--thus making it easier for women to adopt the sick role. In this analysis, regression techniques were used to examine sex differentials in reports of both 'symptom episodes' and bed days, while controlling statistically for fixed roles such as employment status, head of household and % contribution to the total family income. Our findings showed that the three fixed role measures did not explain sex differences in reports of symptom episodes or total bed days (N = 1088). However, among people reporting at least one bed day (N = 503), such obligations did explain the female excess in reported bed days. These findings suggest that fixed role obligations may play a larger role in determining when to relinquish the sick role as opposed to its adoption. These analyses also suggest that role obligations associated with employment status have the major influence on such sick role behavior.

Adult↗
PubMed1983

Non-participation in telephone follow-up interviews.

The present analysis examined sample attrition in a one-year longitudinal health survey that made use of telephone follow-up interviews (N = 1210). Overall, respondent attrition had little impact on the sociodemographic and health status characteristics of the sample at the final interview. However, certain subgroups were statistically less likely to participate in the follow-up interviews, including younger respondents, the non-employed, people from the lower socioeconomic groups, and those who initially rated their health as fair or poor. Reports of physical illness and disability obtained at the initial interview were unrelated to rates of sample attrition.

Adolescent↗
PubMed1982

Racial/ethnic differences in access to health care: further comments on the use-disability ratio.

Indicators of access to health care generally fall into one of two broad groups. The first group of indicators focuses on factors responsible for differential rates of use and often are assessed through reports of patient satisfaction. The second group of indicators focuses more specifically on actual rates of use, and therefore represents a more objective measure of access. One of the most widely used objective indicators of access is the use-disability ratio. This article illustrates some problems in using this ratio in health services research and some strategies one might adopt to minimize these problems. The data reported below were obtained from an analysis of racial/ethnic differences in use of services that was conducted as part of the 1979 Los Angeles Health Survey (N = 1003). Our findings suggest that 1) blacks had greater access to health care than either white/Anglos or Hispanics, particularly for respiratory and musculo-skeletal problems, and 2) the use-disability ratio should be used cautiously, since it is sensitive to subgroup differences in the chronicity and cause of the disability

California↗
PubMed1982

Memory aids in longitudinal health surveys: results from a field experiment.

The use of memory aids to improve respondent recall is becoming increasingly popular in health surveys. In a one-year field experiment involving over 1,200 respondents, people assigned memory aids reported over 50 per cent more symptom episodes than those not assigned memory aids. Differences in reporting levels were particularly striking during the first six to 12 weeks of the survey, for symptoms related to acute, transitory illness, and among minorities and the lower socioeconomic groups. Respondents assigned memory aids were also more likely to report a doctor contact--especially during the fall/winter months. Among respondent who used their memory aids at least once (N = 252), nearly 35 per cent said they were influenced by the information recorded in their memory aids, and most of those who were influenced said that they became more aware of their health. Ten of these people said that they became more worried or depressed because of the information recorded in their memory aids. This constitutes about a four per cent risk among those people who reported using their memory aids at least once. There was no evidence to suggest that the memory aids influenced perceptions of health status.

Adolescent↗