Biomedical subjects

Rachel T Fouladi

Publications and source records attributed to Rachel T Fouladi.

At least 19 recordsLinked to original sources

PubMed2007

Reaching and treating Spanish-speaking smokers through the National Cancer Institute's Cancer Information Service. A randomized controlled trial.

Although the prevalence of smoking is lower among Hispanics than among the general population, smoking still levies a heavy public health burden on this underserved group. The current study, Adiós al Fumar (Goodbye to Smoking), was designed to increase the reach of the Spanish-language smoking cessation counseling service provided by the National Cancer Institute's Cancer Information Service (CIS) and to evaluate the efficacy of a culturally sensitive, proactive, behavioral treatment program among Spanish-speaking smokers. Adiós was a 2-group randomized clinical trial evaluating a telephone-based smoking cessation intervention. Spanish-speaking smokers (N = 297) were randomized to receive either standard counseling or enhanced counseling (EC). Paid media was used to increase the reach of the Spanish-language smoking cessation services offered by the CIS. The Adiós sample was of very low socioeconomic status (SES), and more than 90% were immigrants. Calls to the CIS requesting smoking cessation help in Spanish increased from 0.39 calls to 17.8 calls per month. The unadjusted effect of EC only approached significance (OR = 2.4, P = .077), but became significant after controlling for demographic and tobacco-related variables (OR = 3.8, P = .048). Adiós al Fumar demonstrated that it is possible to reach, retain, and deliver an adequate dose of treatment to a very low SES population that has traditionally been viewed as difficult to reach and hard to follow. Moreover, the findings suggest that a proactive, telephone-counseling program, based on the Treating Tobacco Use and Dependence Clinical Practice Guideline and adapted to be culturally appropriate for Hispanics, is effective. Cancer 2007. (c) 2006 American Cancer Society.

Adult↗

PubMed2007

Attachment and sexual health behaviors in homeless youth.

PURPOSE: To explore relationships and group differences in attachment-related constructs (social connectedness and social support) and sexual health behaviors in a sample of homeless youth. DESIGN AND METHODS: An exploratory design, this study analyzed baseline data from an ongoing intervention study. Survey data were collected by audio, computer-assisted self-interview (A-CASI) from a nonprobability sample of homeless youth (n = 176). RESULTS: Social connectedness was positively correlated with period of time homeless, while social support was positively related to sexual self-concept and to self-efficacy and intention to use condoms. PRACTICE IMPLICATIONS: The street group that homeless youth identify with may be a potential resource for peer-mentoring and skill-building regarding healthy sexual behavior.

Adolescent↗

PubMed2006

Measuring asthma severity: instrument refinement.

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors.

Absenteeism↗

PubMed2006

Racial and ethnic differences in predictors of smoking cessation.

Racial/ethnic differences in the determinants of smoking cessation could have important treatment implications. The current study examined racial/ethnic differences in smoking cessation, prospective predictors of cessation, and whether the predictive ability of these factors differed by race/ethnicity. Participants were 709 employed adults recruited through the National Rural Electric Co-op Association or through natural gas pipeline corporations. Data were collected in 1990 and 1994. Although race/ethnicity was not predictive of abstinence, Hispanic, African American, and White smokers displayed differential on tobacco-, alcohol-, and work-related variables. These racial/ethnic differences highlight the specific factors that should be considered when providing smoking cessation treatment to specific populations. Limitations are noted.

Adult↗

PubMed2006

At-risk drinking in employed men and women.

BACKGROUND: "At-risk" drinking is associated with a variety of negative health and social consequences. However, little is known about the characteristics of at-risk drinkers or of changes in at-risk status over time. PURPOSE: The objective was to examine the correlates of at-risk drinking and the prospective predictors of maintenance or change in at-risk status. METHOD: Participants were 4,322 employed individuals assessed at baseline and 4 years later. At-risk drinking was defined as 2 or more drinks per day for men and 1 or more drinks per day for women. RESULTS: The baseline prevalence of at-risk drinking was 11%. Four percent of baseline not-at-risk individuals transitioned to at-risk drinking at follow-up, and 54% of the baseline at-risk individuals remained at-risk at follow-up. Several demographic-, work-, and tobacco-related variables differentiated at-risk groups and were prospective predictors of change in at-risk drinking status among those individuals who were not at risk at baseline. However, none of the constructs predicted change among at-risk drinkers. CONCLUSION: The data suggest that at-risk drinking is of public health concern. Eleven percent of the participants met criteria for at-risk drinking. Further, at-risk and not-at-risk drinkers differed on numerous characteristics, and their drinking may be influenced by different factors.

Adult↗

PubMed2006

Comparison of three modes of measuring stress, coping, and humor in school-age children.

Computer-assisted administration of surveys is gaining popularity among many researchers, but the equivalence of this method to more traditional approaches such as using paper and pencil has not been determined for many commonly used questionnaires, particularly among school-age children. This study examined systematic differences in the responses of 4th, 5th, and 6th graders to measures of stress, coping, and humor among three modes of assessment: paper-and-pencil questionnaires, computer-assisted self-interviewing (CASI), or a combination of paper-and-pencil and CASI. Participants were 1,245 ethnically diverse children enrolled in public schools in the central region of the United States. Psychometric and score distribution characteristics were examined using item analyses and analyses of mean and covariance structure as a function of mode of assessment. Differences in response patterns, primarily at the scale score level, were documented on some of the key measures. In general, CASI medians and means were higher and correlations among CASI measures tended to be lower than those obtained with paper-and-pencil and mixed mode assessment, and CASI variances were lower. This study suggests the importance of the continued examination of the impact of mode of questionnaire administration when assessing these and other domains of well-being in school-age children.

Adaptation, Psychological↗

PubMed2005

Depression in pregnant women seeking smoking cessation treatment.

The proportion of DSM-IV-based threshold and subthreshold depressive disorders was assessed, using the Primary Care Evaluation of Mental Disorders and a DSM-IV based assessment of depression history, in a sample of 139 pregnant smokers seeking smoking cessation treatment. Sixty-three percent of the sample met criteria for a current or past depressive disorder. Forty-six percent had a current threshold or subthreshold depressive disorder. Twenty percent met criteria for current major depression, with half of those having major depression with dysthymia. Twenty-one percent of the sample was chronically depressed (i.e., dysthymia or major depression with dysthymia). Women with current depression were less likely to tell their doctors that they smoked. Our results suggest that investigation of the prevalence of depression in community samples of pregnant smokers is warranted, as depression may present a major obstacle in pregnant women's efforts to quit smoking.

Adult↗

PubMed2005

Understanding the associations among education, employment characteristics, and smoking.

The current study examined the association between education level and smoking status in a community-based sample of working adults. Participants were enrolled at the University of Texas M.D. Anderson Cancer Center site of a cancer risk behavior reduction intervention delivered at the worksite. There was a strong educational gradient in smoking status. The prevalence of current smoking was almost threefold higher among individuals with <HS degree than among individuals with at least a college degree (37% versus 14%), while the percentage of never smokers among individuals with <HS degree was less than half that of individuals with at least a college degree (29% versus 60%). The educational gradient in smoking status was extremely robust and education uniquely contributed to the prediction of smoking status over and above the effects of demographics, job status, and job related characteristics. Identifying the mechanisms underlying this association as well as high risk subgroups of individuals with low education could contribute to reducing the educational gradient in smoking status and warrants further research attention.

Adult↗

PubMed2005

Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery.

OBJECTIVES: The aim of the present study was to predict postoperative pain and morphine consumption based on preoperative psychosocial factors. METHODS: One hundred and twenty-two women completed measures of distress and coping 1 week before major abdominal gynecological surgery by laparotomy. Forty-eight hours after surgery, measures of pain and negative affect (NA) were completed, and morphine consumption was recorded from a patient-controlled analgesia pump. Four weeks after surgery, measures of pain and NA were completed. RESULTS: Multivariate analyses revealed that preoperative self-distraction coping (P=.039) positively predicted postoperative pain levels in the hospital, after accounting for the effects of age, concurrent NA, and morphine consumption. Emotional support (P=.031) and religious-based coping (P=.036) positively predicted morphine consumption in the hospital, after accounting for the effects of age, concurrent NA, and pain levels. Preoperative distress (P<.04 to .008) and behavioral disengagement (P=.034), emotional support (P=.049), and religious-based coping (P=.001) positively predicted pain levels 4 weeks after surgery, after accounting for the effects of age and concurrent NA. CONCLUSION: The results suggest that preoperative psychosocial factors are associated with postoperative pain and morphine consumption.

Adaptation, Psychological↗

PubMed2005

What accounts for the association of education and smoking cessation?

BACKGROUND: Education has been identified as a potent sociodemographic predictor of smoking cessation and the Healthy People 2010 goals include the elimination of health disparities attributable to education. METHOD: The current study prospectively examined the association of education with smoking cessation as well variables that might account for that association among employed adults residing in the southeastern United States. RESULTS: A strong educational gradient in cessation was evident. Only 6% of smokers with less than a high school (HS) degree quit smoking during the 4-year study period, whereas 17% of smokers with a HS degree but no college degree and 28% of smokers with at least a college degree quit smoking. CONCLUSIONS: Education appeared to uniquely contribute to the prediction of smoking abstinence over and above the effects of demographic, environmental, tobacco dependence, transtheoretical model, and job-related variables. Obtaining a better understanding of how or why education influences smoking cessation could contribute to reducing the educational gradient in abstinence and warrants further research attention.

Adult↗

PubMed2004

Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma.

BACKGROUND: Research suggests that stress-reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life. Yoga, an ancient Eastern science, incorporates stress-reduction techniques that include regulated breathing, visual imagery, and meditation as well as various postures. The authors examined the effects of the Tibetan yoga (TY) practices of Tsa lung and Trul khor, which incorporate controlled breathing and visualization, mindfulness techniques, and low-impact postures in patients with lymphoma. METHODS: Thirty-nine patients with lymphoma who were undergoing treatment or who had concluded treatment within the past 12 months were assigned to a TY group or to a wait-list control group. Patients in the TY group participated in 7 weekly yoga sessions, and patients in the wait-list control group were free to participate in the TY program after the 3-month follow-up assessment. RESULTS: Eighty nine percent of TY participants completed at least 2-3 three yoga sessions, and 58% completed at least 5 sessions. Patients in the TY group reported significantly lower sleep disturbance scores during follow-up compared with patients in the wait-list control group (5.8 vs. 8.1; P < 0.004). This included better subjective sleep quality (P < 0.02), faster sleep latency (P < 0.01), longer sleep duration (P < 0.03), and less use of sleep medications (P < 0.02). There were no significant differences between groups in terms of intrusion or avoidance, state anxiety, depression, or fatigue. CONCLUSIONS: The participation rates suggested that a TY program is feasible for patients with cancer and that such a program significantly improves sleep-related outcomes. However, there were no significant differences between groups for the other outcomes.

Adaptation, Psychological↗

PubMed2004

Late relapse/sustained abstinence among former smokers: a longitudinal study.

BACKGROUND: Relapse remains the most refractory aspect of nicotine dependence, but little is known about relapse that occurs after a period of prolonged abstinence (i.e., "late relapse"). METHOD: The current study examined the prevalence and predictors of late relapse/sustained abstinence in a community-based, longitudinal cohort of former smokers surveyed at baseline and again 4 years later (n = 1143). RESULTS: Late relapse rates declined precipitously and sustained abstinence increased as the duration of abstinence at baseline increased. Although the risk for late relapse appeared to be small when using a point prevalence definition of smoking, that risk increased substantially if fluctuations in smoking behavior over time were considered (i.e., many former smokers relapsed and then regained abstinence during the 4-year study period). Although there were a number of significant prospective predictors of late relapse/sustained abstinence, they did not retain their predictive ability after controlling for baseline duration of abstinence. CONCLUSION: Although late relapse rates in the general population of former smokers appear low, and particularly so for individuals who have been abstinent for long periods of time, fluctuations between abstinence and smoking over time are not uncommon. How these fluctuations influence health or sustained abstinence over time is unclear. Because late relapse rates are generally low, interventions are likely to require careful targeting of at-risk individuals if they are to be efficacious and cost-effective.

Adult↗

PubMed2004

Seeking help for erectile dysfunction after treatment for prostate cancer.

Prostate cancer survivors appear to have higher rates of seeking medical help for erectile dysfunction (ED) than other cohorts of sexually dysfunctional men; however, factors associated with help-seeking for ED after prostate cancer have not been investigated. A group of 1,188 men with ED after prostate cancer responded to a postal survey about their sexuality, including a new questionnaire developed to measure traditional masculine attitudes about sex that could inhibit help-seeking. Respondents had a mean age of 68 years and were an average of 4.3 years postdiagnosis of cancer. At the time of the survey, 46% had sought medical help for ED since their cancer treatment and 44% intended to seek help in the next year. A hierarchical backward selection logistic regression analysis was performed to determine factors correlated with seeking help for ED after prostate cancer. Blocks of factors were entered in to the analysis in order. Factors significant within each step were retained when calculating a final model. Out of 37 factors entered into the model, three retained significance: Men who sought help for ED were more likely to have had a prostate cancer treatment designed to spare sexual function and reported higher distress about postcancer ED. Even with all other factors taken into account, men who had more positive attitudes on the Help-Seeking Questionnaire were significantly more likely to have sought help for ED. A second logistic regression analysis examined correlates of intent to seek help for ED within the next year. Out of 38 factors entered into the analysis, six retained significance in the final model: Men intending to seek help had been treated more recently for their prostate cancer, were more dissatisfied with their sexual function, had higher levels of distress about postcancer ED and loss of sexual desire, and were more likely to have sought help for ED even before their prostate cancer was diagnosed. Even with these factors taken into account, positive attitudes on the Help-Seeking Questionnaire were significantly associated with help-seeking intentions. These results suggest that cognitive-behavioral interventions designed to challenge men's negative beliefs about seeking help for ED could potentially increase help-seeking behavior.

Adult↗

PubMed2004

Prevalence and predictors of transitions in smoking behavior among college students.

The prevalence of smoking among college students is surprisingly high and represents a significant public health issue. However, there are few longitudinal studies of smoking in this population. This study examined the prevalence and predictors of transitions in smoking behavior among a cohort of 548 college students. Over the course of 4 years, 87% of daily smokers and almost 50% of occasional smokers continued to smoke. Among nonsmokers, 11.5% began smoking occasionally and none became daily smokers. In general, predictors of smoking behavior change were significant only among baseline occasional smokers and included gender, smoking outcome expectancies, and affect regulation expectations. Peer and parental smoking, demographics, affect, stress, and alcohol use were generally not predictive of change. Tobacco control interventions targeted at college students are clearly warranted.

Adolescent↗

PubMed2003

The effects of depressed mood on smoking cessation: mediation by postcessation self-efficacy.

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively.

Adaptation, Psychological↗

PubMed2003

Cancer worry is associated with abnormal prostate-specific antigen levels in men participating in a community screening program.

An accumulating body of research suggests that psychological factors can affect physiological parameters. We assessed the association between the perceived risk of prostate cancer, prostate cancer-specific worry, and cancer-related symptoms and prostate-specific antigen (PSA) levels or the findings from digital rectal examination (DRE) in a large sample of men undergoing a free prostate cancer screening. Participants (n = 1635) completed a background questionnaire and a questionnaire that assessed their prostate cancer history, screening behavior, perceived risk of prostate cancer, and prostate cancer worry. PSA levels were then determined, and a DRE was conducted. A PSA level of >or=4.0 ng/ml was considered abnormal. The sample size for the multivariate analyses was reduced because of missing data on certain items. Participants who had an abnormal PSA level reported a significantly higher perceived cancer risk (P = 0.02), cancer worry (P = 0.004), and a greater percentage indicated the reason for the current screening was cancer-related symptoms (P = 0.014) than did participants who had normal PSA levels. Multivariate logistic regression analyses controlling for age, past screening behavior, past screening results, and reason for current screening revealed that perceived cancer risk [P = 0.01; odds ratio (OR), 1.5; 95% confidence interval (CI), 1.1-2.1], cancer worry (P = 0.001; OR, 3.3; 95% CI, 1.7-6.5), and cancer-related symptoms (P = 0.05; OR, 3.4; 95% CI, 1.1-10.3) remained significantly associated with an abnormal PSA level. When perceived cancer risk, cancer worry, and cancer-related symptoms were entered in the same multivariate analysis, only cancer worry remained in the model. The present findings suggest that prostate cancer-specific worry was associated significantly with an abnormal PSA level.

Adult↗

PubMed2002

The use of treatments for erectile dysfunction among survivors of prostate carcinoma.

BACKGROUND: The objectives of this survey were to describe the prevalence of using a treatment for erectile dysfunction (ED) among men after therapy for localized prostate carcinoma and to construct models explaining the variance in trying a treatment, treatment success, and adherence to treatment. METHODS: A postal survey was sent to 2636 men in The Cleveland Clinic Foundation's Prostate Cancer Registry who were treated initially with either definitive radiotherapy or prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, and the partner's sexual function. Men were asked about their current and intended use of medical treatments for ED. Standardized questionnaires included the Sexual Self-Schema Scale-Male Version, the International Index of Erectile Function, urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index), and the Short-Form Health Survey. RESULTS: The return rate was 49%. Differences between men who returned the questionnaire and men who did not respond suggest that the sample was weighted toward men who were more interested in staying active sexually. ED was a problem for 85% of men, and 59% of this group used at least 1 treatment for ED. Only 38% of men found that a medical treatment was at least somewhat helpful in improving their sex lives, however, and 30% of respondents still were using at least 1 treatment at the time of the survey. Factors that were associated with the efficacy of treatments for ED and with their continued use included having a sexual partner, younger age, choosing a treatment for prostate carcinoma that was more likely to spare some sexual function, and not having had neoadjuvant or current antiandrogen therapy. Men who tried a greater number of treatments for ED were more likely to find one that worked. Men were more likely to continue using treatments for ED that produced greater improvements in sexual function. CONCLUSIONS: The success of medical treatments for men with ED among long-term survivors of prostate carcinoma is limited. Men prefer noninvasive treatments, although invasive treatments are more effective. Sexual counseling for men and their partners is recommended, because it may increase the use of medical therapies for ED. Creating more realistic expectations in both partners also may enhance treatment adherence.

Adult↗

PubMed2002

Defining sexual outcomes after treatment for localized prostate carcinoma.

BACKGROUND: The objective of this survey was to identify factors associated with good sexual outcomes in a large group of survivors of localized prostate carcinoma. METHODS: A postal survey was sent to 2636 men in the Cleveland Clinic Foundation's Prostate Cancer Registry who either were treated with definitive radiotherapy or underwent prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, partner's sexual function and health, and a number of factors hypothesized to affect sexual satisfaction. Standardized questionnaires included the Sexual Self-Schema Scale-Male Version, the International Index of Erectile Function (IIEF), urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index, and the Short Form Health Survey (SF-36). RESULTS: The return rate was 49%, yielding a sample of 1236 men at an average of 4.3 years post-treatment. Comparing responders with nonresponders suggested that the sample may have been somewhat biased toward men who were more interested in maintaining sexual function. At the time they were diagnosed with prostate carcinoma, 36% of men had erectile dysfunction (ED). Within the past 6 months, however, 85% of men reported having ED. Only 13% of men were having reliable, firm erections spontaneously, and another 8% of men were having erections with the aid of a medical treatment. Men were as distressed about loss of desire and trouble having satisfying orgasms as they were about ED. Of the 84% of men who reported having a current sexual partner, 66% indicated that she had a sexual problem. Younger age was associated strongly with better sexual outcome (global IIEF score). With demographic factors taken into account, better sexual outcome was related significantly to medical factors, including not having neoadjuvant or current antiandrogen therapy, undergoing bilateral nerve-sparing prostatectomy or brachytherapy, and having better mental and physical health composite scores on the SF-36. Sexual factors that were associated with a better outcome included having normal erections before treatment for prostate carcinoma, choosing a treatment based on the hope that it would preserve sexual function, having more sexual partners in the past year, and having a sexually functional partner. CONCLUSIONS: The great majority of men who survive prostate carcinoma do not achieve a return to functional sexual activity in the years after treatment. The priorities a man places on sexuality and on having a sexually functional partner are important factors in sexual satisfaction at follow-up, over and above the influence of age and medical factors.

Adult↗