Biomedical subjects
H L Howe
Publications and source records attributed to H L Howe.
Repeat mammography among women over 50 years of age.
Mammography decreases mortality among women 50 years of age and older. Although recent surveys show that mammography use has increased since 1983, it continues to be underused by women at risk for breast cancer. The frequency of repeat screening at recommended intervals remains an important unanswered question. This record audit study included all visits from 1986 to 1988 for active female patients, 51-64 years of age, in a family medicine practice. The practice has a disproportionately black patient population, many of whom are on public assistance, characteristics associated with lower compliance with cancer screening guidelines. I reviewed medical records for a physician's recommendation for mammography and also for a radiology report documenting receipt of the mammogram. I also abstracted from the medical record the reason for mammography, a history of breast cancer risk factors, and sociodemographic information. In addition, I noted documentation of a clinical breast examination (CBE) and CBE results. Records for 150 patients were included in the analysis. The results indicate that repeat screening mammography is not common: 3% had three mammograms during the study period; 19% had two; 33% had one; and 44% had none. Physician recommendation for first-time mammography and clinical examination occurred with low frequency. As others report, mammography use is strongly associated with physician recommendation for a mammogram.
Public concern about chemicals in the environment: regional differences based on threat potential.
While the hazards of chronic environmental pollution remain unclear, people are making decisions about their exposure to pollution and its possible effects on their health. To compare people's concerns about environmental problems, a systematic, stratified sample was surveyed. The sample was made up of residents, ages 25 through 74 years, of three areas of New York State. The three areas were western New York, with a high density of toxic dump sites; Long Island, with a major shallow ground water aquifer; and the remainder of the State, excluding New York City, as a comparison area. The sampling list was obtained from records of licensed drivers of the New York State Department of Motor Vehicles. A 66 percent response rate was obtained to the mailed survey. As expected, most concerns were greater for western New York and Long Island, the two areas with highest threat potential for exposure or contamination, than for the comparison area. The single exception was that no regional differences were noted for concerns about environmental pollution and contamination. All concerns were associated with perceived distance between one's residence and a source of potential exposure. Regardless of region, women were more concerned than men about exposures, pollution, and related health effects. No sex differences, however, were noted for economic concerns.
Cancer incidence following exposure to drinking water with asbestos leachate.
In November 1985, the New York State Department of Health was altered to extraordinary concentrations of asbestos leachate in the drinking water in the Town of Woodstock. Concentrations of 3.2 million fibers per liter (MFL) to 304.5 MFL were found, depending on location. An investigation of cancer incidence in the area was conducted for the period 1973-83 using the State Cancer Registry to compute standardized incidence ratios. No evidence was found of elevated cancer incidence at sites associated with asbestos exposure. A statistically non-significant excess of kidney cancer was seen among men, but not women. Colon cancer among men was significantly low, but incidence among women was similar to that expected. Lung cancer incidence was lower than expected for both sexes. Ovarian cancer rates were not different from expected rates. At sites not previously related to asbestos exposure, cancer of the oral cavity was significantly high, with most affected persons having a history of cigarette smoking. Surveillance of the community is continuing because of an insufficient latent period for some exposed groups.
Recency of Pap smear screening: a multivariate model.
Most descriptive reports of women who have not received recent Pap smear screening have been limited to bivariate descriptions. The purpose of this study was to develop a multivariate model to predict the recency of Pap smear screening. A systematic sample of women residents, aged 25 to 74 years, in upstate New York was selected. The women were asked to report use of Pap smear screening during several time periods, their congruence with recommended medical practice, general use of medical services, and a variety of sociodemographic indicators. A log linear weighted least squares regression model was developed, and it explained 30 percent of the variance in recency of Pap smear screening behavior. While the sociodemographic variables were important predictors in the model, the medical care variables were the strongest predictors of recent Pap smear use. A significant relationship between race and recency of Pap smear testing was not supported by these data.
Characteristics of skillful breast self-examiners.
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Enhancing the effectiveness of media messages promoting regular breast self-examination: messages based on innovation adoption principles.
As public health departments have come to rely more and more on the mass media for the promotion of healthful behavior, it has become increasingly desirable to determine the motivating capability of the messages used in this promotion. A fact that is well understood is that many times any message at all is better than none. However, the effectiveness of various media health messages has not been well researched.A study was therefore undertaken of the comparative effectiveness of two different messages describing how to do a breast self-examination. An "experimental message" for the study was designed by applying the principles that facilitate innovation adoption to the message's format and presentation. This message's impact was then compared with that of the American Cancer Society's pamphlet "How To Examine Your Breasts." This pamphlet had been mailed to a sample of women similar to those receiving the experimental message, but who lived in a different geographic area. The use in each area of control groups who had received no messages afforded an opportunity to study maturation effects (other factors than the mailings that might have influenced study results).The experimental message proved more successful in persuading women to adopt breast self-examination than the comparison message. The women who reported a change in breast self-examination practice following the mailing could be characterized as having a more extensive social support system to promote breast examinations and as having a pre-experiment perception that breast self-examination was a complex practice to perform repeatedly at regular intervals.
Education of rural physicians about breast cancer through an oncology outreach program.
In 1990, the Rural Illinois Cancer Consortium initiated an intervention in the management of breast cancer for all rural hospitals. Regional data from a 12-county area were used to identify issues and develop an intervention emphasis. The data suggested two management issues: eliminate unilateral diagnostic mammography and increase the number of patients that have their tumor staged. The intervention involved seminars to provide feedback to physicians on management of breast cancer patients in the region. A series of personalized mailings emphasizing the intervention message were also deployed. Although data are not yet available to measure the intervention impact, immediate feedback on the interventions was sought through a physician survey and several process measures. The immediate feedback measures were assessed. These measures were the penetration of the rural hospital seminars, physician behavior self-reported by mail survey, and number of inquiries to the Physician Data Query. Each of the nine hospitals held a seminar, and 39 percent of the rural physicians treating breast cancer patients attended. Survey data showed physician behavior change in the desired direction, compared with data from the baseline medical record audit conducted in 1986-87. Intervention feedback was useful in defining the implementation success of the interventions. The outcome evaluation, based on medical record audits, is in progress.