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Ann C Klassen

Publications and source records attributed to Ann C Klassen.

15 recordsLinked to original sources
PubMed2007

A spatial scan statistic for ordinal data.

Spatial scan statistics are widely used for count data to detect geographical disease clusters of high or low incidence, mortality or prevalence and to evaluate their statistical significance. Some data are ordinal or continuous in nature, however, so that it is necessary to dichotomize the data to use a traditional scan statistic for count data. There is then a loss of information and the choice of cut-off point is often arbitrary. In this paper, we propose a spatial scan statistic for ordinal data, which allows us to analyse such data incorporating the ordinal structure without making any further assumptions. The test statistic is based on a likelihood ratio test and evaluated using Monte Carlo hypothesis testing. The proposed method is illustrated using prostate cancer grade and stage data from the Maryland Cancer Registry. The statistical power, sensitivity and positive predicted value of the test are examined through a simulation study.

Cluster Analysis↗
PubMed2006

Evaluation of a nutrition education intervention for women residents of Washington, DC, public housing communities.

We designed, implemented and evaluated an educational intervention to increase fruit and vegetable consumption among urban African-American women. Women aged 20-50 years (n=212) from 11 public housing communities participated in seven 90-min classes with a professional nutritionist. Our prospective pre- and post-test design, with 4-month follow-up, assessed the relationship between attendance and dietary change, using three 24-hour recalls per time point. Mean change in average daily dietary values for fruits and vegetables, calories and percent calories from fat (post-test versus pre-test, follow-up versus pre-test) was compared by class attendance, to evaluate the impact of class attendance on dietary change. Attendance varied from zero (35%) to five to seven classes (42%). Baseline dietary recalls showed average daily consumption of 3.05 servings of fruits and vegetables, 2416 calories and 35.8% calories from fat. No improvements in fruit and vegetable consumption, but statistically significant decreases in total calories and percent calories from fat, were seen at both endpoints. Women attending five to seven classes had the greatest dietary improvements, averaging, at post-test and follow-up, respectively, 246.2 and 324.5 fewer calories and 3.08 and 2.97% fewer calories from fat. Results suggest that, for some residents of low-resource communities, small group interventions are popular, effective vehicles for nutrition education.

Adult↗
PubMed2006

What can geography tell us about prostate cancer?

One of the most striking characteristics of prostate cancer is the degree of geographic variation in its patterns of occurrence and progression; this variation is apparent at local, national, and international levels. Although geographic theory, methods, and data are increasingly utilized for public health research, epidemiologic research in prostate cancer etiology and progression has not taken full advantage of the spatial sciences as partner disciplines. This article reviews the known factors influencing the biology and epidemiology of prostate cancer and some of the ways in which findings to date have benefited from geography. A model is presented for geographically integrated research in prostate cancer, with discussion of how spatially referenced data and methods could enhance approaches to answering remaining questions in prostate cancer.

Demography↗
PubMed2006

Missing stage and grade in Maryland prostate cancer surveillance data, 1992-1997.

BACKGROUND: Missing data in cancer surveillance records are common; however, little information exists on the types of cases most likely to have missing data, or how missing data influence research or policy. Two clinical elements often missing in surveillance data are histologic grade and stage of disease. Missing data are either not clinically ascertained or not successfully abstracted. METHODS: Prostate cancer cases (N=22,217) reported to the Maryland Cancer Registry during 1992-1997 were geocoded by residence and analyzed. Multi-level logistic regression was used to examine case attributes and area-level demographic, economic, and health services characteristics predictive of either missing stage or grade. A scanning statistic was used to explore geographic clustering of high and low rates of missing stage and grade within the state, before and after adjustment for significant variables from multi-level models. RESULTS: Older age, black race, missing grade, and higher county-level median income increased the likelihood of missing stage, whereas more recent year of diagnosis, higher blockgroup-level median income, and county-level rurality decreased the likelihood. Older age, missing or later stage, higher blockgroup-level median income, and more urologists per case in one's county of residence increased the likelihood of missing tumor grade, and more recent year of diagnosis, higher county-level median income, and rurality decreased the likelihood. Adjustment reduced statistically significant clusters of missing stage from six to two, and clusters of missing grade from three to zero. CONCLUSIONS: Results suggest systematic influences on missing stage and grade, which could be investigated with case-control follow-back studies.

Adolescent↗
PubMed2005

Measuring sustained mammography use by urban African-American women.

Although the numbers of African-American women who are 'ever' screened for breast cancer has increased, sustaining regular screening over a lifetime remains a problem. Face-to-face interviews about breast cancer screening were conducted with 576 African-American women from an east coast city. The well-screened index measuring adherence to breast cancer screening guidelines was developed and tested. This index incorporated a woman's past and present use of mammography plus her future intent to be screened. Respondents were dichotomized into well-screened and not well-screened groups. Social and psychological factors associated with sustained screening as measured by this index were then explored. In bivariate analyses, education, health insurance, usual source of care, chronicity and preference for provider ethnicity and gender were significantly different for the two groups. In the multivariate model, women who were well-screened were significantly more likely to report recent physician contact, Pap smear, dental visit, history of breast problems, and beliefs that screening should be done annually and that early detection improves outcomes. Women reporting poor health were less likely to be well-screened. The well-screened index can potentially be used for assessment by clinicians and for program evaluation; however further validation studies need to be conducted. Despite limited resources, the majority of these urban African-American women are building lifetime patterns of regular breast cancer screening. Focused efforts are needed to achieve sustained screening patterns in the 25% who are not regularly screened.

Black or African American↗
PubMed2005

Pain and discomfort associated with mammography among urban low-income African-American women.

African-American women have lower rates of breast cancer screening than Caucasian women. Discomfort during mammography may deter women from rescreening. Research to date has focused primarily on Caucasian women. This study examined mammography-associated discomfort among urban, low-income African-American women, and how discomfort influenced rescreening intentions. Using survey data from 530 urban African-American women aged 45 years and older, we assessed sociodemographic, psychological, and health-related predictors of pain or discomfort, and associations between pain or discomfort and intention for rescreening. Seventy-six percent of women reported discomfort; reasons included machine compression (96%), breast size (36%), stature (30%), and roughness by technicians (18%). Intention to rescreen within 2 years was significantly reduced with reporting any discomfort (OR 0.61; 95% CI: 0.38, 0.98), reporting two specific reasons-stature (OR 0.47; 95% CI: 0.31, 0.72) and technician roughness (OR 0.43; 95% CI: 0.26, 0.72), and attributing more sources for pain or discomfort (p for trend = 0.02). Most women reported discomfort; for some, this influenced intended adherence. Offering women the opportunity to control the amount of compression may reduce the pain associated with mammography and subsequently increase compliance.

Black or African American↗
PubMed2004

The role of area-level influences on prostate cancer grade and stage at diagnosis.

BACKGROUND: This research explores area-level social influences on prostate cancer, to test whether area-level influences explain disparities in U.S. prostate cancer burden. METHODS: The authors geocoded 23,993 1992-1997 Maryland prostate cancer cases, and linked cases to 1990 census data. The authors examined the effect of 17 area-level social variables, measured at block group, tract, and county, modeling individual and multilevel predictors of later stage and higher tumor grade. RESULTS: Younger age, black race, higher grade or ungraded tumors, and earlier year of diagnosis were associated with later stage. Block group percentage of white-collar workers (O.R. = 0.93, 95% C.I. = 0.89, 0.98), and county resources (O.R. = 0.94, 95% C.I. = 0.89, 0.98), were protective of later stage. Older age, black race, and earlier year of diagnosis were associated with higher grade. Block group income was protective for white men (O.R. = 0.92, 95% C.I. = 0.87, 0.96), but for all men, county resources increased risk of higher grade (O.R. = 1.23, 95% C.I. = 1.16, 1.31). CONCLUSIONS: Social resources did not significantly reduce racial differences. Results suggest tumor biology is related to relative resources, with better outcomes associated with greater small-area wealth in low-resource counties, but stage at diagnosis is associated with absolute resources, with better outcomes associated with higher small-area social class in high-resource counties.

Adolescent↗
PubMed2003

Predictors of regular Pap smears among Korean-American women.

BACKGROUND: Many Korean-American women (KAW) are unaware of the importance of regular cancer screening. This research estimates rates and examines predictors of regular cervical cancer screening among KAW. METHODS: Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing. RESULTS: Thirty-nine percent of women had regular Pap smears. Regular Pap smear rates varied with age, with women 65 years and older least likely to have regular Pap smears. In multiple logistic regression, the strongest correlate of regular Pap smear was knowledge of guidelines. Physician recommendation, having health insurance, and having friends or family members receiving Pap smears were also important facilitators. Spoken English proficiency interacted with education for an outcome; women with a low level of education and low English proficiency had lower rates of Pap smears than those who had a high level of education and high proficiency. The most frequently given reason for lack of a regular Pap smear was a belief that screening was unnecessary if a woman had no symptoms of cervical cancer. CONCLUSIONS: Strategies for education on screening guidelines, along with physician referrals, should be implemented. Culturally appropriate educational programs about cervical cancer screening should be developed for less educated and less acculturated immigrant women.

Adult↗
PubMed2003

Opportunities for oral cancer screening among older African-American women.

BACKGROUND: Older persons with smoking histories are important targets for oral cancer screening. Although older persons in low-income communities often lack regular dental care, little is known about the characteristics of groups at greatest risk for poor screening. METHODS: Survey data from 576 African-American women aged 45-93 were used to identify predictors of smoking and recency and type of dental care. RESULTS: Fifty-nine percent of respondents were current or former smokers, and 62% reported dental care within the past 3 years. Among smokers, no recent dental care was associated with older age, worse health, not working, no regular medical provider, and no recent mammography. CONCLUSIONS: These results suggest that episodic visits to non dentist providers offer opportunities for oral screening in high-risk populations.

Black or African American↗
PubMed2002

If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program.

BACKGROUND: Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues. METHODS: We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 1(1/2) h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community. RESULTS: Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have <10,000 dollars annual income (OR = 2.34, 95% CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95% CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95% CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95% CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95% CI 1.52,8.60). CONCLUSIONS: Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.

Black or African American↗
PubMed2002

A comparison of three comorbidity indexes in a head and neck cancer population.

We explored differences in prognostic ability for mortality of the established and validated Charlson comorbidity index with two other comorbidity indexes developed for this study. Our study was limited to persons diagnosed with HNCA between 1985 and 1993 in a database formed by a linkage of files from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program with Health Care Finance Administration Medicare files (n=9386). Adjusted relative risks (RR) and 95% confidence intervals (95%CI) for comorbidity index scores of 1 or more compared to 0 were (RR=1.50, 95% CI 1.43-1.68) Charlson index, (RR=1.53 95% CI 1.42-1.66) HNCA index, and (RR=1.49, 95% CI 1.32-1.68) ATC index, respectively. The Charlson and HNCA indexes displayed dose-response patterns (P-value for trend <0.0001). Although the ATC index appears promising, the HNCA and Charlson indexes had similar adjusted RR's, dose-response patterns, P-values, and chi-square scores and appear particularly well-suited to the measurement of comorbidity.

Aged↗
PubMed2002

Reducing disparities in breast cancer survival: a Columbia University and Avon Breast Cancer Research and Care Network Symposium.

On November 8th, 2001, faculty from Universities, government and non-profit community organizations met to determine how, separately and together, they could address disparities in survival of women with breast cancer in the diverse patient populations served by their institutions. Studies and initiatives directed at increasing access had to date met modest success. The day was divided into three sections, defining the issues, model programs, government initiatives and finally potential collaborations. By publishing these proceedings, interested readers will be aware of the ongoing programs and studies and can contact the investigators for more information. The Avon Foundation funded this symposium to bring together interested investigators to share programmatic experiences, data and innovative approaches to the problem.

Breast Neoplasms↗
PubMed2002

Relationship between patients' perceptions of disadvantage and discrimination and listing for kidney transplantation.

OBJECTIVES: This study explored wait-listing decisions among African American and White men and women eligible for kidney transplants, focusing on lifetime experiences of race and sex discrimination as a possible influence. METHODS: Patient records from 3 Baltimore-area hemodialysis units were reviewed, and semistructured face-to-face interviews were conducted with transplant-eligible patients and with unit staff members. RESULTS: African American patients reported more racial discrimination, and women reported more sex discrimination. Women and older patients were less likely to be placed on the waiting list, as were patients with previous experiences of racial discrimination. Discrimination measures predicted list access more strongly than patient race. CONCLUSIONS: Lifetime experience of and response to discrimination may contribute to race and sex differences in access to care and should be included in research on health care disparities.

Adult↗
PubMedDate not supplied

A problem solving approach to nutrition education and counseling.

This report applies problem-solving principles to the design and implementation of nutrition education and counseling programs. A framework is proposed that builds on an extensive body of research in mental health and health education that has demonstrated the efficacy of a problem-solving approach to helping people cope with stressful life events. Our framework uses problem-solving principles in helping participants in nutrition education or counseling programs to overcome obstacles they experience in changing their nutrition behaviors. Both research and clinical experience suggest that incorporating problem-solving techniques in nutrition education and counseling will increase long term change in nutrition behaviors.

Attitude to Health↗