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Biomedical subjects

R B Warnecke

Publications and source records attributed to R B Warnecke.

At least 19 recordsLinked to original sources
PubMed2003

Improving the self reporting of tobacco use: results of a factorial experiment.

OBJECTIVES: To examine divergent estimates of smoking prevalence in two random digit dial surveys for the same population. Based upon internal and external reviews of survey procedures, differences in survey introductions (general health versus tobacco specific introduction) and/or differences in the use of filter questions were identified as the most likely explanations. This prompted an experiment designed to investigate these potential sources of measurement error. DESIGN: A randomised 2 x 2 factorial experiment. SETTING: A random digit dial telephone survey from July to September 2000. SUBJECTS: 3996 adult Californian respondents. MAIN OUTCOME MEASURES: A series of smoking prevalence questions in the context of a tobacco or general health survey. RESULTS: Logistic regression analyses suggest that, among females, prior knowledge (from the survey introduction) that a survey is concerned with tobacco use may decrease self reported smoking prevalence (approximately 4% absolute prevalence difference). Differences in the use of filter questions resulted in almost no misclassification of respondents. CONCLUSIONS: The tobacco specific survey introduction is causing some smokers to deny their tobacco use. The data suggest that these smokers tend to be women that smoked occasionally. A desire by the participants to minimise their personal time costs or a growing social disapproval of tobacco use in the USA may be contributing to the creation of previously undetected survey artefacts in the measurement of tobacco related behaviours.

Adolescent↗
PubMed2001

Examining the effectiveness of a community-based self-help program to increase women's readiness for smoking cessation.

This study investigated the effectiveness of two components of a smoking cessation intervention: a reading manual and a series of televised programs. Female smokers in the Chicago metropolitan area with a high school education or less were interviewed at 4 different times: baseline, immediate postintervention, and 6 and 12 months. We examined the effects of several baseline measures (race, age, number of cigarettes smoked, and stage of readiness to change) and exposure to the intervention components on subsequent stage of change. Race, baseline smoking rate, baseline stage, and exposure to both intervention components had direct effects on stage at immediate postintervention, with both intervention components increasing readiness to quit. Furthermore, exposure to the manual interacted with baseline stage, such that the manual benefited women at earlier stages more than women at later stages. Effects of both components were sustained at 6 months, and the effects of the manual were sustained at 12 months.

Adolescent↗
PubMed2001

Changes in self-efficacy and readiness for smoking cessation among women with high school or less education.

The most common theory of smoking cessation postulates that readiness to quit begins with changes in attitudes that move the smoker toward behavioral change and eventual cessation. However, trends in smoking indicate that many who currently smoke are not ready to quit. Hence, strategies that both enhance readiness and focus on quitting are likely to be most effective. We hypothesize that an intervention addressed to motivating behavior change will enhance readiness to change, which will in turn increase the smokers self-efficacy regarding further change. A smoking cessation intervention that combined a self-help booklet and televised segments was developed to address these issues in a population of women smokers with high school or less education. Readiness to quit was measured prior to the intervention, immediately following the intervention, and again at six and 12 months after intervention. The results indicate that the intervention had its effects on readiness to quit, which in turn affected self-efficacy, which further enhanced readiness to quit. These findings indicate that interventions aimed at this group of smokers may need to provide achievable objectives that focus on preparing the smoker to quit as well as promote cessation.

Adult↗
PubMed2000

Effectiveness and cost-effectiveness of multiple outcalls to promote mammography among low-income women.

A multiple outcall approach based on the Transtheoretical Model was used to encourage mammography behavior in low-income women in the state of Colorado. Women (n = 983) were recruited in person at grocery and discount stores and were then called over the telephone to receive the multiple outcall intervention. These women were compared with 3,080 women who were recruited by telephone and randomly assigned to three study groups: health survey only (control); single outcall; or advance card + single outcall. Subsequent mammography behavior was assessed through a telephone interview conducted 6 months after initiation of the protocol. After controlling for baseline differences between groups in age, education, income, health status, and previous mammography behavior, the multiple outcall intervention was significantly related to mammography behavior among women nonadherent at baseline (odds ratio, 2.58; 95% confidence interval, 1.45-4.60). Furthermore, women who received the multiple outcall intervention had higher "stage of change" at follow-up and more positive attitudes toward mammography. Cost-effectiveness analysis indicated that although the multiple outcall intervention was more costly to deliver ($14.84 per subject compared with about $7.00 for the single outcall interventions), it cost considerably less per subject converted from nonadherent to adherent. Despite study design limitations, the multiple outcall intervention appears to be an effective method of promoting mammography among previously nonadherent women. The results suggest that a combined approach, in which nonadherent women receive multiple calls promoting screening behavior, followed by single calls at the appropriate intervals to promote repeat screening, may be a useful strategy in defined populations.

Aged↗
PubMed1999

Characteristics associated with exposure to and participation in a televised smoking cessation intervention program for women with high school or less education.

OBJECTIVES: This paper estimates the prevalence of exposure to and participation in a televised smoking cessation intervention targeting women with high school or less education and describes characteristics related to exposure and participation. METHODS: A random sample of the population of female smokers with high school or less education in the Chicago metropolitan area was used to estimate the prevalence of exposure to a targeted smoking cessation intervention with television and booklet components (n = 722). Multiple logistic regression analysis was used to examine characteristics related to exposure to each component and participation, defined as simultaneous use of both components, in a sample of population and registrants combined (n = 1,727). RESULTS: About one of every four women in the target population either saw the television series or called for the booklet (24.5%); 17.5% saw the television series, 9.4% called for the booklet, and 2.4% both saw the television series and called for the booklet. Independent predictors of booklet exposure were black, older age, annual income $40,000 or less, heavier smoking, and higher stage of readiness to quit. Adjusting for booklet exposure, independent predictors of television exposure were older age and nonblack. Independent predictors of participation were black, older age, and higher stage of readiness to quit. CONCLUSIONS: The intervention reached a substantial portion of low-educated female smokers. Women who were older, black, or at higher stages of readiness to quit were most likely to be exposed and to participate. Heavier smokers or lower income women were most likely to be exposed but not necessarily to participate.

Adult↗
PubMed1998

Psychosocial factors and smoking cessation behaviors among smokers who have and have not ever tried to quit.

Relationships between smoking cessation behaviors and demographic characteristics and attitudes were analyzed among two groups of smokers, those who had and had not ever tried to quit. Telephone interviews were completed with 1501 smokers at baseline and at a 3 month follow-up. Multiple logistic regression analyses were used to identify factors that were associated with planning to quit, attempting to quit and quitting smoking within the two groups of smokers. Different patterns of correlates were found across groups and within the three outcome measures, indicating the potential importance of targeting interventions according to whether or not smokers have made a prior quit attempt. These findings also support the value of using multiple outcome measures in the smoking cessation process.

Adult↗
PubMed1997

Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms.

This paper reports an examination of cognitive processes used by 178 women aged 50 years and older in retrieving information about the frequency with which they received Papanicolaou smears, mammograms, and clinical breast examinations. Women were selected from a health maintenance organization in which they had been enrolled for at least 5 1/2 years. The literature suggested that reporting of regular events such as these kinds of tests is likely to be based on schemas, which is an estimation technique in which events are reported in a format with generic content. Thus, if the procedure is believed to occur annually, the respondent will report receiving five tests in 5 years. The study attempted to evaluate whether use of episodic recall, in which respondents are forced to report individual events, would be more accurate than reports based on estimation using a schema format. The results indicated that most of the errors occurred in Papanicolaou smear reporting, which is consistent with the literature, and that the fewest errors occurred with mammograms. Regardless of the questionnaire format, respondents persisted in using schemas based on the date of annual physical examination. Most reporting errors occurred because the interval between examinations was estimated incorrectly.

Aged↗
PubMed1997

Improving question wording in surveys of culturally diverse populations.

PURPOSE: The purpose of this paper is to briefly describe a theoretical model articulating cognitive theory and sources of potential response bias resulting from racial or ethnic cultural experience to survey questions that deal with health behavior. The theory components are then evaluated using questions obtained from national health surveys conducted by the National Center for Health Statistics and Centers for Disease Control and Prevention. The analysis explores the effects of four cognitive tasks involved in responding to questions as specified by the model: question interpretation, information retrieval from memory, judgment formation, and response editing. Implications for epidemiological research are considered. METHODS: Data were collected from a purposive sample of 423 adults aged 18 through 50 who were recruited to ensure equal numbers of African American, Puerto Rican, Mexican American, and non-Hispanic white respondents, stratified by age, gender, and education. Individual questions were selected for evaluation to ensure variation by topic and question format. Probes related to each of the cognitive tasks were designed to obtain insight into the underlying cognitive processes used by respondents to answer survey questions. All statistical analyses used logistic regression or ordinary least squares multiple regression as appropriate. RESULTS: Variation by race/ethnicity was found in the way respondents defined physical activity in a series of questions used in the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS). Gender and race/ethnicity appeared to influence interpretation in the absence of specific cues in the question format about how to respond. Strategies used to retrieve information from memory did not appear to be influenced by respondent culture; however, frequency of the event was associated with the recall strategy in that more frequent or regular events were more likely to result in estimates about frequency, whereas unusual or seldom occurring events were counted. Effects of race/ethnicity on judgment formation seem to be reflected in the propensity of respondents' willingness to use extreme response categories. Most effects due to race/ethnicity were found in respondent editing of answers. Race/ethnicity was found to be associated with a social desirability trait; with willingness to disclose socially undesirable behavior, particularly to interviews from racial or ethnic groups that differed from the respondent; and with the tendency to overreport socially desirable behavior. CONCLUSIONS: Overall, the results of this research suggest several ways in which the validity of questions about risk behavior can be improved. In designing such questions, the investigator should envision the interview as a structured conversation in which ordinary conversational norms apply. Thus, questions that might request redundant information or that are threatening to the respondent need to be asked in ways that minimize these effects. Using interviewers of the same racial or ethnic group is important. Attending to the order of questions to ensure that redundant information is not requested is important. Writing questions to ensure that where response cues occur they lead the respondent to answer in unbiased ways is also important. Testing questions for potential racial or ethnic bias before using them is also important, even if the questions have been used successfully with population groups other than that or those included in a study.

Adolescent↗
PubMed1996

Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

OBJECTIVE: This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS: Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. METHODS OF ANALYSIS: Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. RESULTS: Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. CONCLUSION: Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment.

Clinical Protocols↗
PubMed1995

Age and smoking cessation behaviors.

BACKGROUND: Predictors of smoking cessation behaviors during a 3-month period were examined among smokers in three age groups: 18 to 29, 30 to 49, and 50 years or older. METHODS: Using random-digit dialing, telephone interviews were completed with 1,644 smokers in the Chicago metropolitan area at baseline and at a 3-month follow-up. Multiple logistic regression was used to identify factors that predicted trying to quit smoking and quitting smoking within each age group and by stage of readiness to quit smoking. RESULTS: There were no significant differences by age in trying to quit smoking or in quitting smoking among smokers in the contemplation or preparation stages. However, there were important age differences in the factors that predicted those behaviors. In general, different factors predicted smoking cessation behaviors in each age group at each of three stages of the smoking cessation process (contemplation, preparation, and action). Also, within each age group, different factors predicted the behavior at each stage. CONCLUSIONS: The findings suggest that smokers of all ages are equally appropriate targets for smoking cessation interventions. Moreover, there are important age-related differences among smokers over the course of their smoking careers that should be considered when planning and implementing smoking cessation interventions.

Adolescent↗
PubMed1995

Readiness of older adults to stop smoking in a televised intervention.

Smokers aged 60 and older who enrolled in a televised smoking cessation program were compared with older smokers in the target population, using data from telephone interviews. Multiple logistic regressions identified factors that differentiated older smokers at various stages of readiness to quit. Within the target population, smokers planning to quit someday (N = 238) were more likely to have had greater concern about health effects of smoking and perceived a stronger desire by others for them to quit than smokers with no such plan (N = 127). Compared with older smokers in the target population who were planning to quit someday, program registrants (N = 95) perceived greater severity of lung cancer, had greater concern about the health effects of smoking, perceived greater reduction of lung cancer risk from quitting, and had more determination to quit. These findings indicate important factors according to the stage in the smoking cessation process that must be considered when intervening with older smokers.

Aged↗
PubMed1994

Preferences of community physicians for cancer screening guidelines.

OBJECTIVE: To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published. DESIGN: Interviews were conducted with a national random sample of 3436 physicians in family practice, internal medicine, general surgery, and gynecology by mail or telephone or both. The overall response rate was 67%. MEASUREMENTS: Consensus by specialization and by physician and practice characteristics on the appropriate screening intervals for early detection of cancers of the breast, cervix, colon and rectum, and lung for asymptomatic adults at normal risk. RESULTS: More than 60% of the physicians surveyed agreed on the length of the screening intervals for six of eight procedures. Consensus most closely followed American Cancer Society- and National Cancer Institute-recommended screening intervals for all procedures except chest roentgenogram. Acceptance of screening intervals was not related to the extent of agreement among published guidelines. Surgeons tended to favor more aggressive screening than family physicians and internists; gynecologists most consistently favored aggressive screening for cancers occurring in women. Older physicians and those in solo practice tended to favor outmoded procedures such as routine chest roentgenograms and to be more conservative about screening intervals. CONCLUSIONS: Physicians stated that they follow the American Cancer Society and National Cancer Institute guidelines for cancer screening more than the guidelines published by their own specialty societies, but they also reported procedures not recommended in any guidelines. These findings suggest that changing physician screening practices will be difficult.

American Cancer Society↗
PubMed1994

Age and readiness to quit smoking.

The relationship between planning to quit smoking within the next 3 months and demographic characteristics, smoking history, attitudes and beliefs about smoking cessation, and motivation was analyzed among smokers in three age groups: 18 to 29, 30 to 49, and 50 years or older. Using random-digit dialing, telephone interviews were completed with 2,353 smokers before initiating a self-help, minimal-contact intervention in the Chicago metropolitan area. Multiple logistic regression was used to identify factors that predicted planning to quit within the next 3 months. The two youngest age groups were most likely to have attitudes favorable to being ready to try to quit smoking (they were more concerned about health effects of smoking, perceived a greater reduction in the likelihood of getting lung cancer, were more determined to quit, and were more confident in their ability to quit). Among all three age groups, one-fourth or less planned to quit within the next 3 months, and desire to quit was the strongest predictor in each group. Among smokers who planned to quit someday, the oldest were most likely to plan to quit within the next 3 months. The findings show that there are important age-related differences in readiness to quit smoking that should be considered when planning and evaluating smoking cessation interventions.

Adult↗
PubMed1994

Physician and practice characteristics associated with judgments about breast cancer treatment.

Since most cancer is treated in the local community, the judgments of primary care physicians about treatment of breast cancer are important. This study examined physician and practice characteristics associated with physician judgments about the treatment of Stage I and Stage II breast cancer. Data are combined from samples of 3,436 physicians: physicians affiliated with hospitals participating in the Community Clinical Oncology Program (CCOP) and a national sample of non-CCOP physicians. This study focused on 1,460 physicians who had seen breast cancer patients and participated in treatment decision-making. Judgments were elicited using brief vignettes. Judgments were more variable for Stage I than for Stage II treatments. Judgments consistent with the NIH Consensus Conferences on breast cancer were more likely from surgeons, physicians who participated in information networks focused on cancer, and those with more breast cancer patients. Concurrence with the consensus conference positions was less likely in older physicians and those in solo practice. These findings point to structures that reinforce quality of care, particularly those that enhance communication, such as group practice or the activities of hospital staffs, information networks, and organized continuing education.

Breast Neoplasms↗
PubMed1994

Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns.

PURPOSE: This study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients. PATIENTS AND METHODS: Data analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989. RESULTS: Analyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among several subgroups of node-negative patients. CONCLUSION: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community. However, the Alert mechanism is controversial and should be used judiciously to ensure its credibility.

Adult↗