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Biomedical subjects

A C Marcus

Publications and source records attributed to A C Marcus.

At least 55 records · Page 3Linked to original sources
PubMed1981

Mode of payment as a predictor of health status, use of health services and preventive health behavior: a report from the Los Angeles Health Survey.

Several issues relevant to Health Maintenance Organizations (HMOs) were examined in this article using data collected from the Los Angeles Health Survey. No support was found for the hypothesis that HMOs disproportionately attract people in poorer health. In fact, HMO members actually reported lower rates of acute or occasional illness and disability than fee-for-service subscribers (FFS). HMO members also reported lower total family incomes and educational status than FFS subscribers and they were less likely to report having a regular doctor. Few differences were found between the two groups in reports of using health services and practicing preventive health behavior. However, HMO members were more likely to report a recent physical examination--but only after taking into account the fact that they were less likely to have a regular doctor. It has been shown that these findings are consistent with recent evidence, and serve to amplify serveral key findings reported in other studies.

Adolescent↗
PubMed1980

Monitoring health status, access to health care, and compliance behavior in a large urban community: a report from the Los Angeles health survey.

This article summarizes results from 2 health surveys conducted in Los Angeles County in 1974 and 1977. The original objective of this analysis was to identify aggregate changes in the health status of this population, in access as measured by the use/disability ratio, and in self-reported compliance with medical regimens. Additionally, we have suggested that this study illustrates the value of local population surveys for health policy--particularly in regard to recent Health Systems Agencies legislation. Substantial correspondence was found between the health status characteristics of both samples and national estimates, particularly for the prevalence of chronic illness. We also found a 3-year trend of increasing disability that is consisted with national data. However, unlike the national estimates, we found evidence of improved access relative to disability, and a corresponding reduction in the traditional income differential. Analysis of self-reported compliance showed little change over time, with Anglos and the middle and upper socioeconomic groups reporting less compliance with their doctors' recommendations.

Adolescent↗
PubMed1976

Satisfaction with health services: some policy implications.

Although consumer satisfaction with health services is a frequently measured variable in health services research, the relevance of this variable for health policy is not always clear. The present paper suggests two criteria for specifying the relevance of satisfaction with health services for policy at the organizational level. First, it should be shown that consumer satisfaction is the result of organizational behaviors that are manipulable by policy. second, where he has a choice, it should be shown that satisfaction affects the organizationally relevant behavior of the consumer. Data are presented that support both criteria. Several suggestions are made for maximizing the policy relevance of future studies of satisfaction.

Appointments and Schedules↗
PubMed1975

The effects of prepayment on access to medical care: the PACC experience.

The data reported herein are taken from a larger study in which a prepaid medical foundation was compared with a non-prepaid free-for-service system on a number of factors pertaining to how health care is perceived by both Medicaid recipients and physicians. The data to be presented are confined to the issue of the impact of prepayment on Medicaid recipients' perceptions of their access to health care. Two sets of questions are explored. The first set bears directly on the issue of gaining access to care. The second set addresses the issue of the acceptability of the services received. Few differences were observed between the systems in either accessibility or acceptability. Thus, the fears of some critics of the HMO concept with respect to prepayment creating incentives for the denial of services are not supported by the data. It is concluded that the organizational features of medical practice which affect access are actually quite similar in the two systems.

Appointments and Schedules↗
PubMedDate not supplied

Telephone counseling of breast cancer patients after treatment: a description of a randomized clinical trial.

The Telephone Counseling Trial for Breast Cancer Survivors is a randomized, controlled study designed to test the impact of a telephone-based counseling intervention on quality of life of early-stage breast cancer patients who have completed adjuvant treatment. A psychoeducational counseling model is utilized to promote adaptive coping to re-entry stressors and survivorship issues. Adaptation is fostered through the exploration of thematic materials, application of active coping strategies, encouragement of a personal expression of the breast cancer experience and the provision of psychological support. Patients are being recruited in collaboration with two NCI-designated clinical cooperative oncology groups: the Eastern Cooperative Oncology Group (ECOG) and the Southwest Cooperative Oncology Group (SWOG). The recruitment goal is 400 breast cancer survivors with Stage 1, Stage 2 and Stage 3 disease (with no greater than 10 positive lymph nodes involved). Patients are being enrolled by data managers on-site during their last treatment visit. The intervention is being delivered by the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. It includes 16 telephone outcalls which are delivered over a 12-month period. Primary outcome measures are quality of life, mood, social support, self-efficacy, and sexual functioning, assessed at baseline, 3, 6, 12 and 18 months follow-up. This article provides a description of the intervention protocol and study design. It is argued that this study could provide a model for developing and testing other psychosocial interventions within clinical cooperative groups nationwide.

Adaptation, Psychological↗
PubMedDate not supplied

AIDS-related attitudes and risk behaviors: a survey of a random sample of California heterosexuals.

BACKGROUND: This paper describes the results of an AIDS knowledge, attitudes, and behaviors survey of a random sample of heterosexual California adults. METHODS: The study was conducted from August 1990 until February 1991 and consisted of telephone interviews conducted in English and Spanish, with a household probability sample of 3,545 California adults, undersampling those age 44 and older. RESULTS: Approximately one-third of the sample believed that HIV/AIDS is contracted by donating blood, and 20% believed the infection could result from insect bites. Tolerance toward HIV-infected persons was highest among young, male, white, employed individuals with higher levels of education and income. Twenty-seven percent of males and 14% of females were categorized as high risk based on the presence of at least 1 of 7 risk factors. High-risk respondents tended to be male, young, employed, never married, U.S. born, and English speaking. Compared to low-risk respondents, they were less likely to use condoms and more likely to use alcohol and drugs in conjunction with sex. Most common sources of AIDS information were television, newspapers, and magazines. CONCLUSIONS: More strenuous efforts are needed to reach young adults, especially those beyond college age, with AIDS prevention messages. Creative messages via popular media venues should be explored.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A review of cervical cancer screening intervention research: implications for public health programs and future research.

In this paper we review the published literature with respect to cervical cancer screening intervention research. Mass media campaigns appear to work best in promoting cervical cancer screening when multiple media are used, when they promote specific screening programs that eliminate or reduce access barriers, or when they are used in combination with other strategies. Many positive examples of using outreach staff to promote cervical cancer screening, as well as using mobile examination rooms in the community, were found. Substantial evidence that letters mailed to patient populations are efficacious was found, especially in promoting interval screening; however, bulk mailings to nonpatient populations have generally not been successful. Both physician and patient prompts have shown promise as well as opportunistic screenings in both the outpatient and the inpatient settings. In addition, several strategies for reducing loss to follow-up among women with abnormal test results were identified, including telephone follow-up, educational mailouts, audiovisual programs, clinic-based educational presentations and workshops, transportation incentives, and economic vouchers. Of special note is the success of other countries in establishing centralized recall systems to promote interval screening for cervical cancer. Ultimately, such systems could replace the need for opportunistic screening in underserved populations and perhaps many community outreach efforts. It is argued that health departments represent a logical starting point for developing a network of recall systems in the United States for underserved women.

Female↗
PubMedDate not supplied

The cancer information service research consortium: an emerging laboratory for cancer control research.

The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to provide accurate, up-to-date information about cancer to the nation. Although the CIS has in the past served as a venue for cancer communications research, up until very recently the research capacity of the CIS was underutilized. In 1993, this situation changed dramatically with funding from the NCI to form the Cancer Information Service Research Consortium (CISRC). In this article the CISRC is described for the first time, including its research agenda and administrative structure. Early indications from the CISRC suggest that the CIS can serve as one of the premiere laboratories in the country for cancer communications and cancer control research. Several factors are suggested for the early success of the CISRC in sustaining this collaborative effort with the CIS. The progress that has been made by the CISRC could provide a useful model for other large health information programs to maximize their contributions to behavioral science and health promotion research, as well as to establish their own program of policy-relevant research.

Community-Institutional Relations↗
PubMedDate not supplied

A feasibility test of a brief educational intervention to increase fruit and vegetable consumption among callers to the Cancer Information Service.

BACKGROUND: In this paper, results are reported from a pilot study designed to test the feasibility of a proactive educational intervention delivered to callers of the Cancer Information Service (CIS). METHODS: The study used a randomized two-group design (intervention vs control). Callers assigned to the intervention condition received a brief educational intervention at the end of usual service to increase fruit and vegetable consumption. As part of the intervention, key education messages and materials drawn from the 5 A Day for Better Health program of the National Cancer Institute were provided to CIS callers over the telephone and then reinforced with two follow-up mailings. RESULTS: Results from this pilot study indicated high levels of adherence to protocol by CIS Information Specialists who delivered the intervention to eligible CIS callers. Results obtained from the 4-week telephone follow-up interviews indicated that intervention subjects (n = 142) reported higher consumption of fruits and vegetables, averaging approximately 0.75 servings more per day (P < 0.01) than control subjects (n = 134). CONCLUSION: Nearly 80% of CIS callers endorsed the strategy of providing 5 A Day information at the end of usual service, even if such information was not specifically requested by the caller (i.e., the information was provided to CIS callers proactively.

Adult↗
PubMedDate not supplied

Increasing fruit and vegetable consumption among callers to the CIS: results from a randomized trial.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the Cancer Information Service (CIS). METHODS: CIS callers assigned to the intervention group received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention subjects. Subjects were interviewed by telephone at both 4-week (n = 1,672) and 4-month (n = 1,286) follow-up. RESULTS: A single-item measure of fruit and vegetable consumption revealed a significant intervention effect of approximately 0.65 servings per day at 4-week follow-up (P < 0.001) and 0.41 servings per day at 4-month follow-up (P < 0.001). Using a seven-item food frequency measure that was also included in the 4-month interviews, a similar intervention effect of 0.34 servings per day was obtained (P = 0.006). The vast majority of CIS callers (88%) endorsed the strategy of providing 5 A Day information proactively. CONCLUSIONS: A brief educational intervention delivered to CIS callers at the end of usual service was associated with an increase in self-reported fruit and vegetable intake.

Adult↗
PubMedDate not supplied

The cancer information service research consortium: a brief retrospective and a preview of the future.

The Cancer Information Service Research Consortium (CISRC) was initially funded by the National Cancer Institute (NCI) in 1993 to examine seven key research questions. In this paper, the final results pertaining to these seven research questions are briefly reviewed, as well as several key lessons that have been learned from this unique research collaboration. Also described is the second generation of CISRC research that was recently funded by the NCI and is now in its first year of development. The results obtained from the first generation of research should provide the Cancer Information Service, as well as other organizations and agencies, with several viable programmatic options for the future.

Humans↗
PubMedDate not supplied

Cancer prevention counseling on telephone helplines.

Since 1983, the National Cancer Institute (NCI) has collected data by means of its Cancer Information Service (CIS), a toll-free telephone helpline for health care professionals and members of the public who have questions about cancer treatment, diagnosis, and prevention. These data reveal information about the characteristics of callers and their questions and about how inquiries reflect mass media promotions and secular trends. A request for a publication is the most common type of inquiry, followed by information about specific cancer sites, smoking prevention and cessation, other types of prevention, cancer treatment, cancer symptoms, referrals to physicians, NCI clinical trials, hospital and clinic-based screening programs, and general counseling or coping. Breast cancer is the most common cancer of interest, followed by respiratory system cancers, colon and prostate cancers, leukemia, melanoma, nonHodgkin's lymphoma, cervical cancer, general or unspecified skin cancer, and ovarian cancer. Responding to these other caller inquiries, CIS counselors may proactively guide callers to a desirable goal, such as screening mammography. Protocols have been developed to assist counselors' proactive efforts, and preliminary results are beginning to support this approach. The findings gathered in this study underscore the health education potential of telephone helplines and point to the need for controlled evaluation research on the effectiveness of proactive counselor advice.

Adult↗