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Biomedical subjects

R C Brownson

Publications and source records attributed to R C Brownson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Prostate cancer screening--a physician survey in Missouri.

This study investigated prostate cancer screening practices using prostate specific antigen testing (PSA), digital rectal examination (DRE), and transrectal ultrasonography (TRUS) by primary care physicians in Missouri. In 1993, a mail survey was sent to a stratified random sample of 750 physicians whose primary specialty was general practice, family practice, or internal medicine. Three separate mailings resulted in an overall adjusted response rate of 60 percent. Ninety-five percent of physicians were more inclined to use PSA compared with three years previously, with only 45 percent of physicians more inclined to use DRE. An increase in the use of PSA following a negative DRE was reported by 85 percent and a greater inclination to use TRUS following a positive PSA was reported by 90 percent Eighty-six percent agreed with the American Cancer Society (ACS) guidelines on prostate cancer screening. Using logistic regression adjusted across levels of demographic and practice factors, prevalence odds ratios were derived with results indicating that agreement with ACS guidelines and being in private practice are strong predictors of a physician's inclination to routinely screen asymptomatic patients for prostate cancer. Our findings have provided baseline information on prostate cancer screening in Missouri and suggest that primary care physicians view PSA testing as a useful procedure and appear to be using it in a manner similar to the general pattern seen across the country.

Adult↗
PubMed1998

Demonstration projects in community-based prevention.

Community-based demonstration projects represent the translation of research findings into practice. This article discusses the scientific basis for demonstration projects and illustrates various principles through two large-scale programs: the Health Promotion and Disease Prevention Research Centers and the Community-Based Public Health initiative. These programs have shown several key components for success, including: building effective partnerships, using existing data effectively, adopting a causal model in intervention design, employing appropriate evaluation techniques, using policy change as an intervention, and utilizing the potential of community groups to foster change among professional partners.

Health Promotion↗
PubMed1998

Predictors of mammography utilization in Missouri, 1993-1994.

Mammography utilization data were studied for 915 women from a combined sample of 1994 Missouri Behavioral Risk Factor Surveillance System and a Special Breast and Cervical Cancer Control Project Evaluation Survey, as well as similar data from 6,784 new participants in Missouri's Breast and Cervical Cancer Control Project during 1993-1994. Among women aged 40 and over, having some college education and having health insurance coverage were associated with a higher likelihood of ever having a mammogram. Education, age, health care, Pap testing, and smoking were identified as important predictors of compliance with recommended schedule of yearly mammography among women aged 50 and over.

Adult↗
PubMed1998

Implementing smoking bans in American hospitals: results of a national survey.

OBJECTIVES: To determine how well hospitals complied with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tobacco control standards, which required banning smoking in hospital buildings; to explore issues involved in developing and implementing smoking bans; and to ascertain the perceived success of the policies. DESIGN: Postal survey conducted January through June 1994. PARTICIPANTS: Stratified random sample of American hospitals surveyed by JCAHO (n = 1055). MAIN OUTCOME MEASURES: Enacting smoking policies more restrictive than the JCAHO standard; the respondent's judgment of the relative success of the hospital's smoking policy. RESULTS: More than 96% of hospitals complied with the smoking ban standard; 41.4% enacted policies that were more restrictive than required by JCAHO. Several characteristics were associated with exceeding JCAHO requirements: location in a "non-tobacco state"; having fewer than 100 beds; location in a metropolitan statistical area; having unionsed employees; and having no psychiatric or substance abuse unit, favour having the same tobacco policy in psychiatry and substance abuse units as the rest of the hospital. More than 95% of respondents viewed their hospital's policy as successful. The JCAHO requirements and concern for employees' health were the major forces influencing hospitals to go smoke-free. Negative employee morale and lack of acceptance by visitors and patients were the most commonly cited barriers to overcome when implementing smoke-free policies. CONCLUSIONS: Smoking bans were successfully implemented in American hospitals, with many restricting smoking beyond the JCAHO standard. Other industries wishing to follow hospitals' lead would be most likely to succeed in the context of a social norm favouring a smoking ban and regulation by an outside agency.

Health Policy↗
PubMed1998

State laws on youth access to tobacco in the United States: measuring their extensiveness with a new rating system.

OBJECTIVE: To develop and implement a rating system evaluating the extensiveness of state laws restricting youth access to tobacco. DESIGN: State laws on youth access to tobacco were analysed and assigned ratings on nine items. Six items addressed specific tobacco-control provisions, and three related to enforcement provisions. For each item, a target was specified reflecting public health objectives. Achieving the target resulted in a rating of +4 points; for three items, a rating of +5 was possible if the target was exceeded. Criteria for lower ratings were established for situations when the target was not met. SETTING: United States. RESULTS: State scores (sum of the ratings across all nine items) ranged from 0-18 in 1993, 2-21 in 1994, and 1-21 in 1995 and 1996, out of a possible total of 39. The average score across states was 7.2 in 1993, 7.9 in 1994, 8.2 in 1995, and 9.0 in 1996. The overall mean rating (per item) was 0.80 in 1993, 0.88 in 1994, 0.91 in 1995, and 1.00 in 1996, on a scale where 4.0 indicates that the target goals (per item) were met. From 1993 to 1996, scores increased for 20 states, decreased for one state, and remained unchanged for the others. The number of states for which state preemption of local tobacco regulation was a factor doubled from 10 states in 1993 to 20 states in 1996. CONCLUSIONS: Although all states have laws addressing youth access to tobacco, this analysis reveals that, as of the end of 1996, the progress towards meeting health policy targets is slow, and state legislation that preempts local tobacco regulation is becoming more common.

Adolescent↗
PubMed1998

Physical activity and minority women: a qualitative study.

Few physical activity research studies have been conducted with minority women. The purpose of this study was to explore patterns of physical activity among minority women. Focus groups were conducted with volunteers older than age 40. Each group was led by a trained moderator familiar with the ethnic community targeted. The sessions were audiotaped and professionally transcribed. Constructs were researched and codes were developed. Data were analyzed using NUD*IST qualitative analysis program. While participants did not identify themselves as "exercisers," they indicated they got enough physical activity from caregiving, housekeeping, and workday activities. The most common environmental barriers to becoming more physically active included safety, availability, and cost. Personal barriers included lack of time, health concerns, and lack of motivation. Results indicate the importance of terminology and assessment when conducting physical activity research in these populations. Also, results suggest many barriers are changeable with policies and interventions.

Adult↗
PubMed1998

Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans.

OBJECTIVES: This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. METHODS: The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. RESULTS: The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. CONCLUSIONS: A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods.

Adolescent↗
PubMed1998

Trends in cancer incidence and mortality in Missouri.

BACKGROUND: Cancer is the second leading cause of death in Missouri. Several factors influence public health planning and policy-making decisions, including assessment of the trends in disease and in related risk factors, of overall disease burden on the population, and of the effectiveness of intervention programs. To assess the influence of statewide cancer screening, education, and intervention programs on Missouri's cancer burden, recent trends in cancer incidence and mortality rates among Missourians were analyzed. METHODS: Age-standardized cancer incidence rates from 1985-1992 and cancer mortality rates from 1985-1994 and 1990-1996 were calculated by race, age group, and sex using data collected by the Missouri Cancer Registry and the Missouri Center for Health Statistics. Rates for each year examined were logged and regressed onto year. RESULTS: Between 1985 and 1992, the rate of cancer incidence increased by 16.1% (p < .05). From 1985-1994, cancer mortality rate increased by 3.5% (p < .05). Mortality among males, however, decreased between 1990 and 1996. This decrease was particularly pronounced among African-American males. Missouri males endured greater incidence of and mortality from cancer than Missouri females. Elderly males (both African American and white) exhibited the greatest increase in cancer incidence over the periods examined (+27.3% and +31.8% increase respectively, p < .05). Racial differences were nonexistent for cancer incidence rates, but the cancer mortality rate for African Americans was 45% greater than that for whites. CONCLUSIONS: Although Missouri cancer incidence and mortality rates are higher now compared to 16 years ago, data are presented that indicate a slight decline in mortality rates over the past six years. The recent decline (1990-96) in mortality was present only among men, particularly African-American men. The incidence increase was particularly important for women. Despite the implementation of some programs designed to target minorities and undeserved populations at greater risk, these data indicate that large demographic differences in cancer incidence and mortality still persist. A greater commitment to cancer screening, access to treatment, and cancer prevention programs are necessary to meet Missouri's year 2000 goals for cancer incidence and mortality.

Adolescent↗
PubMed1998

Trends in breast cancer screening in Missouri from 1987 to 1995, and predictions for the years 2000 and 2010.

BACKGROUND: Breast cancer is a major cause of morbidity and mortality in the United States (U.S.) and Missouri. In 1992, 3,915 new breast cancer cases were diagnosed and in 1995, 1,006 deaths from breast cancer were reported in Missouri. Although breast cancer incidence has increased in Missouri in the past 20 years, there are indications that early detection has also increased during the same period. Knowledge about which segments of the population have experienced the greatest increase in mammography screening rates helps in planning and implementation of breast cancer control programs at the state level. OBJECTIVES: Examine the prevalence and trends of lifetime mammography and 2-year mammography compliance in Missouri by age, race, and education from 1987 to 1995 and make predictions for the years 2000 and 2010. METHODS: We used data from the Missouri Behavioral Risk Factor Surveillance System (BRFSS), 1987 to 1995, to estimate the prevalence of ever having had a mammogram and compliance with mammography screening guidelines within two years by race, age, and education status among Missouri women over age 18. Using linear models, we regressed breast cancer screening prevalence estimates on time to obtain trends and predictions. RESULTS: Overall, African-American women were more likely to have had a lifetime mammogram than white women. However, we found a steady increase in the prevalence of ever having had a mammogram for all groups of women defined by age and education status, except among African Americans. Increase in the prevalence of ever having had a mammogram was much higher in women age 50 and older and slightly higher among women with a high school education or less. The average prevalence of 2-year mammography screening compliance was about 60% for all groups, a rate which did not significantly change between 1987 and 1995. By the year 2000, white women will have mammography rates equal to or higher than African-American women, and the majority of all women age 50 and older (98.3% to 100%) will have had a lifetime mammogram. CONCLUSION: Missouri target populations are predicted to attain Year 2000 National Health Objectives concerning lifetime mammography. Current efforts should be continued in order to maintain levels of mammography, particularly among African-American women.

Adolescent↗
PubMed1997

Dietary fats and lung cancer risk among women: the Missouri Women's Health Study (United States)

In a population-based case-control study of women in Missouri (United States), most of whom were smokers, we obtained information on adult diet to evaluate the effects of dietary fats in relation to lung cancer risk. All newly diagnosed, primary lung cancer cases among women 35 to 84 years of age reported to the Missouri Cancer Registry from 1 January 1993 to 31 January 1994 were invited to participate, as were population-based controls. The analysis focused on interviews obtained from 624 controls and 587 cases. In-person interviews were obtained from 99.0 percent of controls and 60.6 percent of cases. Age and energy-adjusted relative risks suggested a direct relation between risk of lung cancer and intake of dietary fats (e.g., total fat, saturated fat) and frequency of meat consumption. After adjusting for confounders, dietary fats were no longer associated with risk, but the adverse effect of frequent consumption of meat persisted. Risk was elevated about 90 percent (95 percent confidence interval = 1.2-3.0) among women in the highest quintile of red meat intake compared with those in the lowest quintile. Risk estimates associated with red meat consumption, however, were dependent on interview status; the effect was restricted to cases whose dietary information was provided by proxy. In summary, after adjusting for potential confounders and removing data obtained from proxy respondents, dietary fats and consumption of red meat were not associated with lung cancer risk among women in Missouri.

Adult↗
PubMed1997

Health care coverage: traditional and preventive measures and associations with chronic disease risk factors.

Physician counseling of patients on health related activities is an essential component of chronic disease prevention, however this requires patients to have ready access to health care providers. Previous studies have explored access to health care in terms of health plans and cost without accounting for the lack of preventive coverage inherent in many insurance policies. This study compares two measures of health care access, one using an assessment of cost and health plan availability, and a new coverage measure including preventive services. Data was collected from 2574 adult respondents to the 1991-92 Missouri Behavioral Risk Factor Surveillance System Surveys. Odds ratios were generated for demographic variables, health related behaviors and preventive screening and the two coverage measures. Using health plan and cost 22% lacked full coverage, however including availability of preventive coverage almost 60% lacked full coverage for preventive care. For both coverage measures significant associations were found with age, exercise, marital status, routine checkup and mammography screening. Using the measure of coverage of preventive services, rural residents and those who had never had cholesterol screening were more likely to lack coverage. Inclusion of preventive care in measures of health care coverage may alter previously reported associations with socio-demographic and health related factors. Policy makers should realize that including preventive services in health care coverage greatly increases the number of individuals lacking adequate coverage, and that those lacking adequate coverage are the least likely to undergo preventive screening.

Adolescent↗
PubMed1997

Family history of cancer and risk of lung cancer in lifetime non-smokers and long-term ex-smokers.

BACKGROUND: Genetic factors appear to play a role in the aetiology of lung cancer. METHODS: To examine the association between family history of cancer (all types) and risk of lung cancer among non-smokers, we conducted a case-control study. Cases (n = 618) were identified through the Missouri Cancer Registry for the period 1986 through 1991, and included 432 lifetime non-smokers and 186 ex-smokers who had stopped at least 15 years prior to diagnosis or had smoked for less than one pack-year. Controls (n = 1402) were selected through drivers licence and Medicare files. RESULTS: The risk of lung cancer increased directly in relation to the number of family members affected with cancer. The odds ratio (OR) associated with five or more first-degree relatives with cancer was 2.7 (95% confidence interval [CI] 1.2-6.1), with a significant linear trend in risk according to the number of relatives affected (P = 0.03). Increased lung cancer risk was associated with two or more affected siblings (OR = 1.4; 95% CI: 1.0-1.9) and with two or more affected offspring (OR = 3.2: 95% CI: 1.3-8.1). Risk was slightly elevated for family history of lung cancer (OR = 1.3; 95% CI: 1.0-1.8). CONCLUSIONS: Our study identified a slight increase in risk of lung cancer in relation to five or more relatives with cancer. Preventive implications of this increased risk are unclear because the attributable fraction is low in comparison to a variety of other factors.

Adult↗
PubMed1997

Future trends affecting public health: challenges and opportunities.

Many accomplishments of public health can be cited, yet public health professionals face unprecedented challenges and opportunities in the coming decades. To assist public health practitioners, researchers, and educators in preparing for current and future changes affecting the population's health, the authors describe several important "macrolevel" trends. These trends include: the aging of the population, changing patterns in the U.S. racial/ethnic composition, changes in health care delivery systems, the explosion of information technologies, changing needs in the public health work force, the growth in health-related partnerships, and anti-government sentiment and polarization. A series of implications for each of the major trends is provided. It may be important for public health leaders and policy makers to take these trends and implications into account as they plan and prioritize future approaches to disease prevention and health promotion.

Aged↗
PubMed1997

Cardiovascular disease control efforts among local health departments in Missouri: four-year trends and policy implications.

Knowledge, attitudes, and activities in cardiovascular disease (CVD) control among local health departments in Missouri were surveyed in 1990 and in 1994, following four years of a community-based CVD risk-reduction project. Hypertension screening was rated as the most frequently performed CVD-related activity in 1990 and in 1994. Differences in mean scores between baseline and follow-up surveys showed no significant changes except for cholesterol screening. Respondents preferred individual patient education rather than community-wide approaches to risk reduction. Our findings highlight the need for more emphasis on coalition building and community-based programs for preventing and controlling CVD at the local health department level.

Cardiovascular Diseases↗