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Biomedical subjects

Sally W Vernon

Publications and source records attributed to Sally W Vernon.

At least 19 recordsLinked to original sources
PubMed2007

Which women aren't getting mammograms and why? (United States).

OBJECTIVE: This study investigates why women who reported no recent mammogram did not get the test. METHODS: Using data from the 2000 National Health Interview Survey (NHIS), we examine correlates of mammography use among women 40 years and older (n = 10,212), with particular focus on the 30% (n = 3,188) who reported no recent mammogram. Non-screening is examined in the context of two important correlates of mammography use-access to health care and a physician's recommendation to get a mammogram. RESULTS: In total, 80% of non-screeners who reported having access to healthcare did not receive a recommendation for a mammogram. Women age 65 years and older were more likely than younger women to report not receiving a recommendation (OR 1.77, 95% CI 1.25-2.50). For women who reported having access, non-screening was significantly more likely among younger women (40-49), those with less education, incomes less than 20,000 dollars, residence outside Metropolitan Statistical Areas (MSAs) and no family history of breast cancer. Among women with access problems, those who had not visited a primary care provider in the past year were much more likely to be non-screeners (80%) compared with those who had seen a provider (46%). Among women with access, those who reported put it off as the main reason for non-screening were significantly more likely to be younger and to be born in the U.S. than women who said that they didn't know they needed a mammogram. CONCLUSIONS: Most non-screeners report not receiving a physician recommendation for mammography. Although a minority reported access problems, the effect of lacking access on utilization was strong and is accentuated when women without access do not see a doctor. These findings confirm the importance of a mammography recommendation and raise questions concerning whether this information is being conveyed by physicians or heard by patients.

Adult↗
PubMed2006

Lessons learned from developing a tailored print intervention: a guide for practitioners and researchers new to tailoring.

Although some "how-to" guides have been written on tailored messaging, we found no reports on lessons learned from the process of developing a tailored intervention. Such lessons may be useful for practitioners and researchers who are new to tailored intervention development. The authors describe lessons gleaned from the process of developing a repeat mammography tailored print intervention. Lessons learned include the following: Selection of determinants appropriate for tailoring should be based on a theoretic framework and refined through assessment of the target population; researchers should anticipate threats to fidelity of intervention delivery because of incomplete or illogical survey data; fingerprinting enables assessment of intervention dose and how it relates to effectiveness of the tailored intervention; and a systematic process for conducting a systems test is needed to check for inconsistencies and errors before final tailored letter production. These lessons are discussed in the context of challenges and possible solutions for tailored health communication.

Female↗
PubMed2006

Estimating development cost for a tailored interactive computer program to enhance colorectal cancer screening compliance.

The authors used an actual-work estimate method to estimate the cost of developing a tailored interactive computer education program to improve compliance with colorectal cancer screening guidelines in a large multi-specialty group medical practice. Resource use was prospectively collected from time logs, administrative records, and a design and computing subcontract. Sensitivity analysis was performed to examine the uncertainty of the overhead cost rate and other parameters. The cost of developing the system was Dollars 328,866. The development cost was Dollars 52.79 per patient when amortized over a 7-year period with a cohort of 1,000 persons. About 20% of the cost was incurred in defining the theoretic framework and supporting literature, constructing the variables and survey, and conducting focus groups. About 41% of the cost was for developing the messages, algorithms, and constructing program elements, and the remaining cost was to create and test the computer education program. About 69% of the cost was attributable to personnel expenses. Development cost is rarely estimated but is important for feasibility studies and ex-ante economic evaluations of alternative interventions. The findings from this study may aid decision makers in planning, assessing, budgeting, and pricing development of tailored interactive computer-based interventions.

Colorectal Neoplasms↗
PubMed2006

Primary care patients' understanding of colorectal cancer screening.

PURPOSE: To determine the current level of awareness and understanding about colorectal cancer (CRC) and colorectal cancer screening (CRCS) among primary care patients in order to develop interventions to educate patients about options for CRCS, help them identify CRCS preferences and make informed choices about CRCS options. METHODS: During the spring of 2001 and 2003, two sets of focus groups with primary care patients were conducted at a large multi-specialty group practice in Houston, Texas. RESULTS: Participants (n = 42) in both sets of focus groups had low knowledge about CRC and expressed fear and embarrassment about CRC and CRCS. Attitudes towards the fecal occult blood test (FOBT) were mixed, with some participants considering it difficult to finish and others preferring the privacy it afforded. Some participants initially failed to recognize the difference between sigmoidoscopy (SIG) and colonoscopy (COL), and several endoscopy-specific barriers were identified such as fear of pain, embarrassment/humiliation, and dislike or fear of test preparation. Some participants felt that endoscopy was likely to be more effective than FOBT, and others clearly preferred COL to SIG. System-specific barriers to endoscopy (e.g. difficulty scheduling appointments and insurance coverage) were also identified. We found little change in the barriers reported by primary care patients, despite a two-year difference between focus groups. Participants also provided suggestions for improving CRCS including telephone, letters and/or email reminders from the clinic, videotapes and websites. CONCLUSIONS: Future interventions focused on improving informed decision-making by educating primary care patients about the risks and benefits of specific test options and about the importance of early detection of CRC could prove to be effective for increasing CRCS.

Aged↗
PubMed2006

Test-retest reliability of self-reported mammography in women veterans.

BACKGROUND: Mammography self-report is used to monitor screening and evaluate intervention trends; however, few studies have examined reliability. METHODS: Reliability of self-reported lifetime number of mammograms, most recent mammogram date, and predictors of reliability were assessed using data from Project H.O.M.E. The study population was 2,494 women 52 years and over, listed in the U.S. National Registry of Women Veterans, with no history of breast cancer, who completed both baseline (2000-2002) and year 1 (2002-2003) surveys. RESULTS: Reliability of lifetime number of mammograms was 60.9% for exact consistency and 79.9% for consistency within one mammogram. Thirty-five percent was exactly consistent in reporting mammogram date; 55.6% was consistent within 3 months. Completing both surveys by mail and reporting fewer lifetime mammograms at baseline were positively associated with consistency of reporting lifetime number. White race/ethnicity, having a Bachelor's degree, reporting a health care provider's recommendation for a mammogram, having a screening mammogram, completing both surveys by mail, and being in the maintenance or action stages of change were associated with consistency in reporting date. CONCLUSIONS: Reliability varies with the measure of self-reported mammography. Likewise, predictors show different patterns of association with different definitions. Our findings call attention to the need for explicit definitions and measures of mammography use.

Adult↗
PubMed2006

Enhancing adherence among older African American men enrolled in a longitudinal cancer screening trial.

PURPOSE: The purpose of this study was to enhance adherence among older (aged 55 years and older) African American men enrolled in a cancer screening trial for prostate, lung, and colorectal cancer. For this study, we defined adherence as completing the trial screenings. DESIGN AND METHODS: We used a randomized trial design. Case managers contacted intervention group participants (n=352) at least monthly by telephone and provided information and referral services. The control group included 351 participants. RESULTS: Among participants with low income, those in the intervention group had higher screening adherence rates than did participants in the control group for (a) prostate-specific antigen test for prostate cancer (74.3% vs 53.0%, p=.001), (b) digital rectal exam for prostate cancer (66.2% vs 46.1%, p=.011), and (c) chest x-ray for lung cancer (70.9% vs 51.3%, p=.012). We found no statistically significant differences in adherence rates for flexible sigmoidoscopy screening for colorectal cancer. In contrast, among participants with moderate-to-high income, we found no statistically significant differences in adherence rates between intervention and control group participants for any of the screening tests. IMPLICATIONS: The case management intervention was effective in enhancing adherence among participants with the lowest income, who in many studies are the most difficult to retain.

Black or African American↗
PubMed2006

Brief report: physicians and their personal prostate cancer-screening practices with prostate-specific antigen. A national survey.

BACKGROUND: There is inconclusive evidence that prostate cancer screening with prostate-specific antigen (PSA) reduces mortality. Although PSA testing is widespread, it is unknown how many physicians have taken the PSA test themselves. OBJECTIVE: To determine the prevalence of PSA testing among physicians. DESIGN: Cross-sectional survey. SUBJECTS: A nationwide stratified random sample of urologists (response rate 61%, n=247), Internists (response rate 51%, n=273), and family physicians (response rate 64%, n=249) were surveyed by mail in 2000. After excluding female respondents and men who either reported a positive history of prostate cancer or did not respond to that query, there were 146 urologists, 96 Internists, and 118 family physicians. MEASUREMENTS: Whether physicians had undergone prostate cancer screening with PSA. RESULTS: Eighty-seven percent (155/178) of male physicians aged, 50 and older and 21% (31/150) of white male physicians under age 50 reported having had a PSA test. More urologists than nonurologists in both age groups reported having had a screening PSA test. CONCLUSION: Most physicians aged 50 and older report undergoing PSA testing. This may reflect a belief in its efficacy and contribute to its widespread use.

Confidence Intervals↗
PubMed2006

Are there gender differences in colorectal cancer test use prevalence and correlates?

Despite evidence that screening tests reduce colorectal cancer incidence and mortality, screening prevalence is low. Gender differences in test uptake have been reported, but few studies examine correlates of test use by gender. Differences, if present, may inform strategies to increase test use. We examined gender differences in the prevalence and correlates of colorectal cancer test use [fecal occult blood test (FOBT) and endoscopy] using data from the 2002 to 2003 Health Information National Trends Survey. Male (n = 999) and female (n = 1687) respondents ages > or =50 years, without a personal history of colorectal cancer, were interviewed by telephone. Age-adjusted prevalence rates were reported for lifetime, recent, and repeat use by gender and test type. Multivariable logistic regression analyses were used to identify correlates of test use stratified by gender and colorectal cancer test type. More females reported only using FOBT in lifetime and in the past year, whereas more males reported repeat endoscopy use. The use of other tests or combinations of tests did not differ by gender. Consistent positive correlates of colorectal cancer test use for both genders included age, recent physician visits, recent breast or prostate cancer screening, and knowledge of test-specific screening intervals. Correlates that differed by gender included comparative perceived risk, belief that colorectal cancer testing was too expensive, fear of finding colorectal cancer if tested, and attention to and trust in media sources of health information. Such differences, if confirmed in future studies, may inform the use of gender-specific intervention strategies or messages to increase colorectal cancer test use.

Aged↗
PubMed2006

Patterns of colorectal cancer screening uptake among men and women in the United States.

OBJECTIVE: The purpose of this report is to examine (a) gender-specific correlates of colorectal cancer test use using recent national data from 2003 and (b) patterns of colorectal cancer screening by gender and test modality over time. METHODS: We analyze data from the 1987, 1992, 1998, 2000, and 2003 National Health Interview Surveys. Our sample consists of men and women > or = 50 years never diagnosed with colorectal cancer and who reported a recent fecal occult blood test and/or endoscopy. RESULTS: In 2003, both men and women reported higher rates of colonoscopy (32.2% and 29.8%, respectively) than use of FOBT (16.1% and 15.3%, respectively) or sigmoidoscopy (7.6% and 5.9%, respectively). Men reported higher use of endoscopy than women if they had a usual source of health care, had talked to a general doctor, and had two to five visits to the doctor in the past year. Men and women 65 years and older had higher rates of any recommended colorectal cancer test (55.8% and 48.5%, respectively) than persons 50 to 64 years (males, 41.0%; females, 31.4%). Use of colorectal cancer tests also was higher among both genders if they were not Hispanic, had higher educational attainment, were former smokers, had health insurance or a usual source of care, or if they talked to a general doctor. Recent use of colorectal cancer tests has increased since 2000 for both women and men largely due to increased use of colonoscopy. CONCLUSIONS: Colorectal cancer testing is increasing for both men and women, although the prevalence of testing remains higher in men. Our data support previous findings documenting socioeconomic disparities in colorectal cancer test use. Access barriers to screening could be particularly difficult to overcome if colonoscopy becomes the preferred colorectal cancer screening modality.

Aged↗
PubMed2006

Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003).

BACKGROUND: Most national-level mammography data are for ever-had and most-recent screening. There are few national-level data on rates of repeat, on-schedule mammography, and on the prevalence and correlates of repeat mammography. It is also important to investigate the similarity of correlates for repeat and recent mammography. METHODS: Analyses were from data for women ages 45 to 75 in the 2002 to 2003 Health Information and National Trends Survey (HINTS 2003; N = 1,581). The two dependent variables were self-report of repeat mammography (two exams on schedule, based on an every-other-year interval) and recent mammography only (one mammogram within the past 2 years). RESULTS: The prevalence of recent mammography was 81.6% (95% confidence interval, 79.1-84.1) and for repeat mammography was 72.2% (95% confidence interval, 69.0-75.4). An access to care variable combining insurance coverage and regular source of care was the strongest sociodemographic correlate of both mammography indicators. Most other sociodemographic variables were not associated with mammography status. Five psychosocial/behavioral variables were associated with both mammography indicators (smoking status, attention to health information, knowledge of screening interval, worry about breast cancer, and recent mood status). Correlates were very similar for repeat and recent mammography. CONCLUSIONS: Although access to care had the strongest association with mammography, psychosocial and behavioral variables did better as a group than the sociodemographic variables. A standard set of such variables should be considered for all national surveys.

Aged↗
PubMed2006

Factors influencing behavioral intention regarding prostate cancer screening among older African-American men.

PURPOSE: To assess factors associated with perceptions of prostate cancer screening among African-American men aged > or = 55 years based upon items developed using the Preventive Health model (PHM). RESEARCH APPROACH: Focus group research and thematic coding using content analysis. SETTING: A large midwestern, private, nonprofit health system. PARTICIPANTS: African-American men aged > or = 55 years. Focus group 1 included 10 men who ranged in age from 55-87 years, with a mean age of 73.4 years. The 11 participants in focus group 2 ranged in age from 55-81 years, with a mean age of 68.7 years. METHODOLOGICAL APPROACH: Focus group questions were developed based on the conceptual framework of the PHM. African-American men aged > or = 55 years were randomly selected from the patient population of the healthcare system to participate in one of two focus groups. Content analysis was used to code the focus group transcripts. MAIN RESEARCH VARIABLES: Self-reported perceptions of prostate cancer screening. FINDINGS: Major themes emerging from the focus groups related to prostate cancer screening include: lack of knowledge regarding cancer, fear of cancer, confusion between prostate cancer screening and prostate cancer diagnostic tests, encouragement by others as motivation for cancer screening, intergenerational transfer of health information, lack of health insurance coverage as a barrier to prostate cancer screening and treatment, and limited availability of screening clinic hours during nonworking hours. INTERPRETATION: The information gained from this study could be used to develop interventions promoting informed and shared decision-making by patients and their providers regarding prostate cancer screening.

Black or African American↗
PubMed2005

Psychological impact of genetic testing for hereditary nonpolyposis colorectal cancer.

PURPOSE: This study examines the impact of hereditary nonpolyposis colorectal cancer (HNPCC) genetic test results on psychological outcomes among cancer-affected and -unaffected participants up to 1 year after results disclosure. PATIENTS AND METHODS: A total of 155 persons completed study measures before HNPCC genetic testing, and at 2 weeks and 6 and 12 months after disclosure of test results. RESULTS: Mean scores on all outcome measures remained stable and within normal limits for cancer-affected participants, regardless of mutation status. Among unaffected carriers of HNPCC-predisposing mutations, mean depression, state anxiety, and cancer worries scores increased from baseline to 2 weeks postdisclosure and decreased from 2 weeks to 6 months postdisclosure. Among unaffected noncarriers, mean depression and anxiety scores did not differ, but cancer worries scores decreased during the same time period. Affected and unaffected carriers had higher mean test-specific distress scores at 2 weeks postdisclosure compared with noncarriers in their respective groups; scores decreased for affected carriers and all unaffected participants from 2 weeks to 12 months postdisclosure. Classification of participants into high- versus low-distress clusters using mean scores on baseline psychological measures predicted significantly higher or lower follow-up scores, respectively, on depression, state anxiety, quality of life, and test-specific distress measures, regardless of mutation status. CONCLUSION: Although HNPCC genetic testing does not result in long-term adverse psychological outcomes, unaffected mutation carriers may experience increased distress during the immediate postdisclosure time period. Furthermore, those with higher levels of baseline mood disturbance, lower quality of life, and lower social support may be at risk for both short- and long-term increased distress.

Colorectal Neoplasms, Hereditary Nonpolyposis↗
PubMed2005

Factors associated with men's use of prostate-specific antigen screening: evidence from Health Information National Trends Survey.

BACKGROUND: Rapid uptake of prostate-specific antigen (PSA) testing has occurred in the United States despite inconclusive evidence regarding mortality benefit. METHODS: We examined data (n=927) from the 2003 Health Information National Trends Survey to assess prevalence of self-reported PSA use and its association with patients' decision making. RESULTS: Over half (55.2%) the sample reported ever having had a PSA test. Men aged 65-74 (OR=2.53, 1.49-4.31), with some college (OR=2.41, 1.22-4.77) or college degrees (OR=5.01, 2.53-9.90) were more likely to have had PSA tests, while men without health insurance (OR=0.32, 0.12-0.88) or a usual source of care (OR=0.35, 0.22-0.54) were less likely. In a model including healthcare provider communication and information seeking, men who reported that providers involved them in decisions (OR=1.76, 1.02-3.03) and recommended PSA (OR=236.3, 70.5-791.4) were more likely to have had the tests. Men aged 65-74 (OR=2.30, 1.33-4.00), with college degrees (OR=2.91, 1.45-5.82), and greater information attention/seeking (OR=1.23, 1.07-1.40) were more likely to report PSA recommendations, while those without usual care were less likely (OR=0.37, 0.22-0.64). Men without usual care (OR=0.38, 0.20-0.71) and Hispanic men (OR=0.40, 0.19-0.85) were less likely to report that healthcare providers involved them in healthcare decisions. CONCLUSIONS: Results emphasize the relevance of patient decision making and the importance of healthcare providers in PSA testing.

Aged↗
PubMed2005

Validation of scales measuring attitudes and norms related to mammography screening in women veterans.

Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item inventory. The study participants consisted of a national, randomly sampled population of women veterans (n = 2,910). After minor revision of scales, the authors found independent measures for 4 constructs: pros, cons, cancer worries, and subjective norms. The authors concluded that these scales have acceptable psychometric properties; support construct validity; and provide brief, reliable, and valid measures of attitudes toward and norms regarding mammography screening. These scales may be useful for intervention research.

Attitude to Health↗
PubMed2005

Hereditary nonpolyposis colorectal cancer family members' perceptions about the duty to inform and health professionals' role in disseminating genetic information.

This study's aim was to ascertain hereditary nonpolyposis colorectal cancer (HNPCC) families' views on the duty to inform with particular focus on the role of health professionals in disseminating familial genetic information. Eighty members of 16 families with a clinical or molecular diagnosis of HNPCC completed qualitative interviews regarding views on family members' right to know and who should disseminate familial genetic information. Most indicated that everyone in the family should know about the presence of a mutation in the family, with family members themselves being the preferable informant, supported by health professionals who were seen as helpful in overcoming barriers. All but one respondent indicated that if a parent did not test and presumably did not inform his/her child about the family mutation, the child should be informed by other family members or by a health professional. Many were attuned to confidentiality concerns, but judged them to be outweighed by the importance of family members knowing about the mutation and undertaking proper surveillance. Respondents were more private about the disclosure of individual results to other family members, clearly distinguishing personal results from familial genetic information. These families with a hereditary colon cancer syndrome favor open sharing of genetic information within the family, and desire the supportive involvement of health care professionals in disseminating genetic information.

Adult↗
PubMed2005

Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.

BACKGROUND: Barriers to colorectal cancer (CRC) screening are not well understood. OBJECTIVES: We sought to compare barriers to CRC screening reported by primary care physicians (PCPs) and by average-risk adults, and to examine characteristics of average-risk adults who identified lack of provider recommendation as a major barrier to CRC screening. RESEARCH DESIGN: This was a comparative study using data from the 1999-2000 Survey of Colorectal Cancer Screening Practices and the 2000 National Health Interview Survey (NHIS). SUBJECTS: We recruited nationally representative samples of PCPs (n= 1235) from the SCCSP and average-risk adults (n = 6497) from the NHIS. MEASURES: We measured barriers to CRC screening identified by PCPs and average-risk adults who were not current with screening. RESULTS: Both PCPs and average-risk adults identified lack of patient awareness and physician recommendation as key barriers to obtaining CRC screening. PCPs also frequently cited patient embarrassment/anxiety about testing and test cost/lack of insurance coverage, but few adults identified these as major barriers. Of adults not current with testing, those who had visited a doctor in the past year or had health insurance were more likely to report lack of physician recommendation as the main reason they were not up-to-date compared with their counterparts with no doctor visit or health insurance. Only 10% of adults not current with testing and who had a doctor visit in the past year reported receiving a screening recommendation. CONCLUSIONS: A need exists for continued efforts to educate the public about CRC and the important role of screening in preventing this disease. Practice-based strategies to systematically prompt health care providers to discuss CRC screening with eligible patients also are required.

Aged↗
PubMed2005

Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among African Americans and Caucasians.

BACKGROUND: Psychosocial constructs are widely used to predict colorectal cancer screening and are targeted as intermediate outcomes in behavioral intervention studies. Reliable and valid instruments for measuring general colorectal cancer screening psychosocial constructs are needed; yet, few studies have conducted psychometric analyses. This study replicated a five-factor structure for 16 theory-based, general colorectal cancer screening items measuring salience and coherence, cancer worries, perceived susceptibility, response efficacy, and social influence. In addition, we examined factorial invariance across race and sex. METHODS: African American and Caucasian patients (n = 1,413) attending an urban, primary care clinic were included in this study. These individuals completed a baseline survey as part of a colorectal cancer screening intervention trial. Single and multigroup confirmatory factor analyses using maximum-likelihood estimation were done. RESULTS: The five-factor general colorectal cancer screening model provided excellent fit and was invariant across race-sex subgroups. CONCLUSIONS: The findings of invariance across sex and race subgroups support the use of these scales to measure group differences.

Black or African American↗