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Biomedical subjects

C S Skinner

Publications and source records attributed to C S Skinner.

At least 19 recordsLinked to original sources
PubMed2004

Do benefits and barriers differ by stage of adoption for colorectal cancer screening?

In 2003, over 148,300 people were expected to be diagnosed and 56,000 to die from colorectal cancer (CRC). First-degree relatives (FDRs) of people with colon cancer have a two- to eight-fold increased risk for CRC. Despite evidence that screening is effective, adherence with screening recommendations in this at-risk population is low. This study's purposes were to (1) identify perceived benefits and barriers of fecal occult blood testing (FOBT), sigmoidoscopy and colonoscopy, and (2) compare demographic characteristics and perceived benefits and barriers by stage of adoption for CRC screening. Participating FDRs (n = 257) completed a 40-min structured telephone interview. Despite high rates of agreement with the benefits of screening, most FDRs were not contemplating being screened. Of those 50 and older, most were in precontemplation for FOBT, sigmoidoscopy and colonoscopy. Older age was related to stage for FOBT and sigmoidoscopy, but not colonoscopy. Lack of provider recommendation also was related to stage. Consistent with theoretical predictions, precontemplators had (1) higher rates of endorsement of specific barriers to screening and (2) lower rates of endorsement of benefits than contemplators or actors. For morbidity and mortality reduction, participation in routine, periodic screening is imperative. These findings can guide development of screening-promoting interventions.

Age Factors↗
PubMed2001

Women's interest in chemoprevention for breast cancer.

BACKGROUND: Chemoprevention is the use of pharmacologic or natural agents to inhibit the development of cancer. Tamoxifen citrate is the only approved chemopreventive agent for breast cancer. We sought to determine whether women are interested in taking a drug to prevent breast cancer and to assess the relationship between objective and subjective breast cancer risk and interest in chemoprevention. METHODS: We conducted telephone interviews (November 3, 1997, to May 6, 1998) among a community sample of women aged 40 to 45 and 50 to 55 years enrolled in a randomized controlled trial to evaluate the efficacy of a tailored mammography decision aid. Objective breast cancer risk was measured using the 5-year Gail score. Subjective breast cancer risk was measured using perceptions of absolute risk, perceptions of comparative risk, and worry about getting breast cancer. At 12-month follow-up (November 2, 1998, to July 20, 1999), we measured interest in taking a drug to prevent breast cancer. RESULTS: Among the 1273 women surveyed, 23% were interested in taking a drug to prevent breast cancer; 8% were potentially eligible for tamoxifen therapy (5-year Gail score > or = 1.66%). Eligibility for chemoprevention, based on the 5-year Gail score, was not associated with interest in taking a drug to prevent breast cancer. Women who were worried about breast cancer were 3 times more likely to be interested in taking a drug to prevent breast cancer than those who were not worried. CONCLUSION: Women's interest in chemoprevention might arise more from worries about getting breast cancer than from their objective risk factors.

Adult↗
PubMed2001

Perceptions of genetic risk assessment and education among first-degree relatives of colorectal cancer patients and implications for physicians.

BACKGROUND: Genetic risk assessment and education is a clinical service that provides an opportunity for individuals with a strong family history of cancer to understand their risk better, identify a screening regimen and discuss benefits and limitations of genetic testing. OBJECTIVES: The aim of this study was to assess knowledge of and attitudes to genetic risk assessment and education among first-degree relatives of patients with colorectal cancer. METHODS: We conducted focus groups among first-degree relatives of patients with colorectal cancer to assess perceptions of genetic risk assessment and education. In the groups, we elicited reactions using two definitions of genetic risk assessment and education-one brief and one more detailed-that might be used by a health practitioner during the referral process. RESULTS: Findings revealed a number of misconceptions and concerns including: (i) what is required to prepare for a session and a lack of desire to collect a family history; (ii) what is involved in a session (including assuming that genetic testing is always included in a session); (iii) distrust over accuracy and possible subjectivity of information provided; and (iv) fear of the effect that participation in a session might have on insurance status. CONCLUSIONS: The findings suggest that health practitioners should educate individuals about genetic risk assessment and education during the initial referral process. Further studies should explore how best to do this.

Adult↗
PubMed2001

Examining the boundaries of tailoring: the utility of tailoring versus targeting mammography interventions for two distinct populations.

Health messages can be generic, targeted to population subsets or tailored for individual recipients. There has been little examination of which populations need tailored interventions or whether tailored and targeted interventions differ in important ways. We used data from a mammography intervention study in two distinct populations to simulate a comparison of individually tailored versus targeted interventions. Tailored intervention content was based on individual recipients' interview responses. Targeted intervention content was based on composite group responses. For more than 60% in each population group, about two-thirds of tailored message content was a good match with content of the targeted intervention generated by composite group responses; roughly one-third of the content was 'not a good' fit for their intervention needs. Tailored interventions for more than 80% of subjects in each population differed in at least some way from those generated for all other population group members. This simulation is a first step in quantifying the contribution of individual tailoring over group targeting. Future research should examine whether a targeted intervention that is mostly a 'good' match results in behavioral outcomes similar to those of individually tailored interventions and whether particular differences in tailored versus targeted interventions yield significantly more favorable intervention outcomes.

Breast Neoplasms↗
PubMed2000

Outcomes of the Learn, Share & Live breast cancer education program for older urban women.

OBJECTIVES: This study assessed whether the Learn, Share & Live breast cancer education program resulted in favorable, replicable, and sustainable outcomes. METHODS: The program was implemented at index (year 1) and replication (year 2) sites. Baseline interviews (year 1; n = 240) and 2 follow-up telephone interviews (years 2 and 3; n = 337 and 323) were used to assess postintervention changes. RESULTS: From baseline to year 2, mammography adherence and stage of adoption improved at the index site relative to the replication site. Knowledge scores and percentages of respondents reporting that a friend had spoken with them about mammography improved significantly. Improvements were sustained through year 3 (2 years postintervention). In year 3, replication participants showed improvements in regard to knowledge and perceived mammography benefits, and there was a trend toward increased adherence. Site differences in postintervention adherence may have stemmed from respective choices of follow-up activities. CONCLUSIONS: The study outcomes affirm the impact of Learn, Share & Live, indicating a replicated and sustained program effect. Future studies should continue longer follow-up and explore the importance of providing mammography opportunities along with education.

Aged↗
PubMed2000

Factors associated with repeat mammography screening.

BACKGROUND: Even organizations with differing mammography recommendations agree that regular repeat screening is required for mortality reduction. However, most studies have focused on one-time screening rather than repeat adherence. We compare trends in beliefs and health-related behaviors among women screened and adherent to the National Cancer Institute's screening mammography recommendations (on schedule), those screened at least once and nonadherent (off schedule), and those never screened. METHODS: Our data are from a baseline telephone interview conducted among 1,287 female members of Blue Cross Blue Shield of North Carolina who were aged either 40 to 44 years or 50 to 54 years. RESULTS: The 3 groups differed significantly on beliefs and health-related behaviors, with the off-schedule group almost consistently falling between the on-schedule and never screened groups. Off-schedule women were more likely than on-schedule women, but less likely than those never screened, to not have a clinical breast examination within 12 months, to be ambivalent about screening mammography, to be confused about screening guidelines, and to not be advised by a physician to get a mammogram in the past 2 years. Off-schedule women perceived their breast cancer risk as lower and were less likely to be up to date with other cancer screening tests. CONCLUSIONS: Our findings suggest that women who are off schedule are in need of mammography-promoting interventions, including recommendations from and discussion with their health care providers. Because they are more positive and knowledgeable about mammography than women who have never been screened, they may benefit from brief interventions from health care providers that highlight the importance of repeat screening.

Adult↗
PubMed1999

Cost-effectiveness comparison of five interventions to increase mammography screening.

BACKGROUND: Mammography is the primary method used for breast cancer screening. However, compliance with recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography. METHODS: There were 808 participants who were randomly assigned to one of six groups. A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness. RESULTS: Three of the interventions (in-person, telephone plus letter, and in-person plus letter) had significantly better compliance rates compared with the control, physician letter, or telephone alone. However, when considering costs, only one emerged as the superior strategy. The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy, achieving a 35.6% mammography compliance at a marginal cost of $0.78 per 1% increase in women screened. CONCLUSIONS: A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography. Future research should confirm this finding and address its applicability to practice.

Aged↗
PubMed1999

How effective is tailored print communication?

This article reviews the "first generation" of tailored print communications studies in the published literature, describing the purpose, theoretical framework, sample, research design, message type and source, outcomes measured, and findings of each. Eight studies compared tailored versus similar nontailored print; one compared tailored print versus an alternate intervention, and three included tailored print as one of several intervention components. Although studies varied by behavioral topic, type of tailoring, and measurement of behavioral outcomes, several themes persist. Compared to their nontailored counterparts, tailored print communications have been consistently better remembered, read, and perceived as relevant and/or credible. There is also evidence that tailored print communications are more effective for influencing health behaviors. Six of the eight tailored/nontailored comparisons found more behavior change among tailored than nontailored recipients. Tailored print communications have also demonstrated effectiveness as an adjunct to other intervention components such as self-help smoking cessation manuals. However, studies comparing tailored print communications with tailoring via other media such as telephone counseling have shown mixed results. Additional research is needed to assess whether the behavioral topic itself may make a difference in whether tailoring is appropriate and effective.

Health Behavior↗
PubMed1999

Sociodemographic and health status characteristics with prostate cancer screening in a national cohort of middle-aged male veterans.

OBJECTIVES: To characterize variables associated with obtaining prostate cancer screening in a nonclinical, nationally distributed, middle-aged male population. METHODS: Telephone interviews were administered to 2652 individual members of the Vietnam Era Twin Registry in 1992 and 1995. Dependent variables were self-report measures of having had a digital rectal examination (DRE) and/or a prostate-specific antigen (PSA) test in the past 5 years. Independent variables were current measures of age, household income, education, race, insurance, source of care, and lifetime measures of physical condition, psychiatric illness, and alcohol and nicotine dependence. RESULTS: Thirty-five percent of the sample reported having had a PSA and DRE within the past 5 years. Prevalence of obtaining either a PSA or DRE varied with age, income, education, and race. Subjects with a regular source of care, a regular physician, and health insurance reported higher rates of having had a DRE or PSA and DRE. Persons with a physical or psychiatric illness reported more screening. A multiple regression model revealed that having a regular source of care, having a regular physician, physical illness, psychiatric illness, minority status, higher income, and age predicted having had some form of screening. CONCLUSIONS: A substantial portion of middle-aged men have had both a PSA and DRE performed at least once in the preceding 5 years. It may be possible to further improve prostate cancer screening participation by directing educational programs at men who are not in contact with the healthcare system. If the PSA and DRE screening guidelines that are finally adopted discourage screening among low-risk men younger than age 50, educational programs that emphasize age screening criteria may be warranted.

Health Status↗
PubMed1999

Risk beliefs and interest in counseling: focus-group interviews among first-degree relatives of breast cancer patients.

BACKGROUND: First-degree relatives (FDRs) of breast cancer patients are at potential genetic risk for developing breast cancer. Although FDRs are being targeted for screening and counseling, few studies have explored their beliefs about risk modification or preferences for risk counseling. METHODS: To learn more about these beliefs, the authors conducted four focus groups among FDRs (n = 29). RESULTS: Findings indicate misunderstanding about risk and interest in more information. For instance, the participants confused risk factors with causes, discounting scientific validity of risk-factor information if they knew a breast cancer victim without risk factors or with protective factors. Most FDRs thought lifestyle factors contributed to risk. The overwhelming majority thought they could reduce personal risk by lifestyle modifications. Most were not interested in genetic testing for breast cancer susceptibility, saying they would worry too much if they learned they had a mutated gene. According to the participants, lack of primary prevention techniques negates the value of genetic testing. CONCLUSION: If risk counseling for FDRs is to become more widespread, these exploratory findings should be addressed in research and program development.

Adult↗
PubMed1999

Psychological factors related to stage of mammography adoption.

This study examined the differences among women at different stages of mammography adoption on Health Belief Model variables, response efficacy, knowledge, and avoidance. A random sample of 361 women aged > or =40 years were grouped into six stages of mammography adoption (precontemplation, contemplation, action, maintenance, relapse precontemplation, relapse contemplation). A multivariate analysis of variance (ANOVA) revealed significant differences among women on all components of the Health Belief Model except perceived seriousness, as well as differences on response efficacy, knowledge, and avoidance. Results indicate that there are significant differences between women who have never had a mammogram (precontemplation and contemplation stages) and women who have had a mammogram in the past but are currently noncompliant (relapse stages). Further, significant differences were found between compliant women who have had one mammogram (action) and compliant women who have had multiple mammograms (maintenance) on barriers, motivation, confidence, and avoidance.

Adult↗
PubMed1999

Transrectal versus transvaginal abscess drainage: survey of patient tolerance and effect on activities of daily living.

PURPOSE: To evaluate patient perception of pain related to transrectal and transvaginal drainage and the catheter's effect on activities of daily living. MATERIALS AND METHODS: From July 1993 to August 1997, 22 male and 40 female patients (mean age, 41 years; age range, 4-80 years) underwent transrectal or transvaginal aspiration or drainage. Fifty-seven drainages were performed. In a follow-up survey, patients were asked to score pain experienced during the procedure and afterward on a scale of 1-10 and to rate the effect of the catheter on their activities of daily living. RESULTS: Twenty-two patients participated in the telephone survey. For those able to recall the insertion procedure, the mean pain score was 3.2 for transrectal and 5.9 for transvaginal drainage. Mean indwelling catheter pain was 1.6 for transrectal and 4.8 for transvaginal drainage. Pain after removal was 1.4 for transrectal and 2.3 for transvaginal drainage. Only one patient with a transrectal catheter reported severe limitation (bowel movement), with no reports of any serious effect on urinating, bathing, sitting, or walking. Transvaginally placed catheters caused marked limitation in all categories and were more painful than transrectal catheters (P < .05). CONCLUSION: Of the transrectal and transvaginal approaches, transrectal is better tolerated.

Abdominal Abscess↗
PubMed1998

Knowledge, perceptions, and mammography stage of adoption among older urban women.

INTRODUCTION: Mammography is under-used among older minority women. Identifying differences in their attitudes and beliefs by stage of mammography adoption will guide interventions for these under-studied and under-served women. METHODS: A total of 253 older urban women were interviewed, assessing breast cancer knowledge, perceived mammography benefits and barriers, stage of mammography adoption, personal experience with breast cancer, physical and cognitive functioning, smoking status, source and frequency of regular medical care, and demographics. Analyses compared scale scores and individual items by stage of mammography adoption. Multivariate analysis used linear and logistic regression with stepwise model selection. RESULTS: Sample mean age was 72.5 years; 88% were African American. About half (52%) had had a mammogram within the past 2 years (i.e., action stage of mammography adoption). Of the rest, 16% were thinking about having a mammogram in the next 6 months (contemplators) and 32% were not thinking about having a mammogram within 6 months (precontemplators). Knowledge and benefit scores were lowest for precontemplators. Overall barrier scores were highest for precontemplators (P < .001), but contemplators were most likely to worry about finding a lump (P < .05). Lower perceived barriers, provider recommendation, regular medical care somewhere other than a private physician's office, and age < 75 years were independently associated with more favorable mammography stage (R2 = .47). CONCLUSION: Mammography interventions for older urban women should combine provider recommendations with barrier-reducing interventions. Knowledge is associated with mammography contemplation, but barriers may affect whether contemplation leads to action. Precontemplators may need explanation of the rationale for screening; contemplators may need intervention to assuage fears.

Age Factors↗
PubMed1998

Learn, share, and live: breast cancer education for older, urban minority women.

Among older urban minority women, for whom breast cancer risk is high and the propensity to be screened is low, both social support and breast cancer knowledge have been linked to mammography use. The authors describe a theory-based breast cancer education program implemented via an existing informal network for low-income urban elderly coordinated by a social service agency. The program is both structured and flexible. Core education sessions include delineated content and methods and are led by health professionals. Participants choose from a variety of follow-up activities to promote screening within their community. Pre- and posttests administered among 80 program attendees in two sites indicate significant improvement in knowledge (p < .001). Program attendees in each site also planned and participated in follow-up activities to promote screening among their peers. Learn, Share, and Live seems to be an effective program for promoting breast cancer screening among older, urban, primarily minority women.

Black or African American↗
PubMed1997

Factors influencing effect of mammography screening in a university workplace.

The purpose of this study was to examine the relationship between theoretically identified variables and participation in mammography screening in a university workplace. A sample of 1093 women 50 and over returned a questionnaire following the offer of a free workplace breast cancer screening. Anderson's Behavioral Model of Health Services Use identified factors predisposing and enabling women to have mammograms. Predisposing variables included attitudes and experience related to mammography. Enabling variables included income, willingness to pay for mammography, health insurance coverage, and regular source of health care. Comparisons were made among: (i) those who were screened in the workplace, (ii) those who were screened elsewhere, and (iii) those who were not screened. Differences in perceived barriers, perceived benefits, practice of breast self-examination (BSE), and education surfaced. Results indicated, among other things, that women who were older, had no more than 12 years of education, had a family member with breast cancer, and were proficient with breast self-examination were more likely to have participated in the university work-site screening.

Breast Neoplasms↗
PubMed1995

Prenatal health behaviors as predictors of breast-feeding, injury, and vaccination.

OBJECTIVE: To identify maternal prenatal preventive health behaviors associated with breast-feeding, early childhood injuries, and vaccination. DESIGN: Secondary analysis of the 1988 National Maternal and Infant Health Survey. SETTING: Questionnaires were mailed to the mother's home. PATIENTS: The response rate to this nationally representative sample was 71%. These analyses include the 10,868 mothers whose infants had ever been at home. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Multivariable logistic regression was used to predict the following: (1) having "ever" breast-fed; (2) having breast-fed for at least 6 weeks; (3) "an accident or bad fall" during any of the first 6 months of the child's life ("early" injury) or (4) in the month prior to the interview ("recent" injury); (5) having received "any" vaccinations or (6) having received three diphtheria, pertussis, tetanus immunizations. RESULTS: Children of mothers who reduced alcohol consumption during the pregnancy, had higher incomes, and were white had the best preventive health outcomes. Adequacy of prenatal care was predictive of vaccination, but not of breast-feeding or injury. CONCLUSIONS: These data suggest that prenatal sociodemographic characteristics and maternal health behaviors have significant and continued effects on the preventive health outcomes of infants and children.

Adolescent↗
PubMed1995

Are patients of women physicians screened more aggressively? A prospective study of physician gender and screening.

OBJECTIVE: To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psychosocial, and other patient variables known to influence screening rates. DESIGN: A prospective design with baseline and six-month follow-up assessments of patients' screening status. SETTING: Twelve community-based group family practice medicine offices in North Carolina. PARTICIPANTS: 1,850 adult patients, aged 18-75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider. MAIN RESULTS: Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.05, 2.04] and 56% more likely to get a cholesterol test (OR = 1.56, 95% CI = 1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35-39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR = 2.69, 95% CI = 0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening. CONCLUSIONS: In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g., Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.

Adolescent↗