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Biomedical subjects

W Rakowski

Publications and source records attributed to W Rakowski.

At least 19 recordsLinked to original sources
PubMed2000

Breast and cervical cancer screening: associations with personal, spouse's, and combined smoking status.

The objective of this study was to examine the association of women's cancer screenings with both personal and spouses' smoking status, as well as with the broader context of household smoking, in a United States national-level sample of women aged 42-75 years. Data were from the 1994 National Health Interview Survey Health Promotion Supplement. The sample included 1586 women who reported they were married and living with a spouse in a two-person household. Three measures of smoking status were used: personal smoking status, smoking status of spouse, and household smoking status (self and spouse smoked, spouse only smoked, self only smoked, and both nonsmokers). Using logistic regression modeling, associations were examined between the smoking status measures and three cancer screening indicators: mammogram < or =2 years, clinical breast exam < or =2 years, and Pap test < or =3 years. The both nonsmokers group consistently had the highest screening rates for all three exams. The spouse only smoking group was 10-12% less likely to obtain all three cancer screening tests compared to the both nonsmokers group. The self and spouse group was less likely to report a recent mammogram and clinical breast exam. The self only group did not differ significantly from the both nonsmokers group on any of the cancer screening measures. Results suggest that smoking status of a spouse may be an important correlate of women's cancer screenings.

Adult↗
PubMed1999

Smoking and cancer screening for women ages 42-75: associations in the 1990-1994 National Health Interview Surveys.

BACKGROUND: Previous studies have found an association between current smoking and lower rates of mammography and Pap testing. The objective of this study was to investigate the association of smoking status with breast and cervical cancer screening across the 1990-1994 National Health Interview Surveys (NHIS). The NHIS provides a consistent set of independent and dependent variables across several surveys, with data collected by a similar in-person interview methodology from year to year. This report employs more databases than have been used in other analyses that have examined associations between smoking and cancer screening. METHODS: Data were from the health promotion and cancer control supplements to the 1990-1994 NHIS. The target population was women ages 42-75. Associations were examined between smoking status (never, former, <1 pack/day, >/=1 pack/day) and three screening indicators: ever had a mammogram, mammogram in the past 2 years, and Pap test in the past 3 years. Sample sizes ranged from about 3,000 to over 10,800 depending on the respective NHIS survey and dependent variable. Data analyses were conducted by bivariate and multiple logistic regression. RESULTS: Women who smoked >/=1 pack of cigarettes per day were significantly less likely to have had mammography screening in all NHIS surveys, compared to women who never smoked. Adjusted odds ratios were 0.63 to 0.74 for ever had a mammogram, and 0.56 to 0.66 for mammography in the past 2 years. Women who smoked >/=1 pack per day also had lower Pap test rates than women who never smoked in 1992-1994 (adjusted odds ratios of 0.51-0.71). Results for lighter smokers were not as consistent. Former smokers often had significantly higher screening rates than never smokers. CONCLUSIONS: Research still needs to identify reasons for lower screening among women who smoke. Factors to explore include the social networks of smokers and broader health behavior patterns. Clinicians should consider heavier smoking as a marker for risk of not obtaining screening and make assessment of screening status a priority at each visit.

Adult↗
PubMed1999

The potential variances of tailoring in health behavior interventions.

The success of tailored print communications depends upon having a sufficiently diverse inventory of both content messages and delivery formats to respond to important differences among individuals. This article discusses means by which this diversity--the variances of tailoring--may be developed. One of the foundations of tailoring is the definition of a "focal point" for intervention. A focal point is characterized by a simultaneous combination of variables which specify a population group of interest, a target health behavior, and a setting in which the behavior occurs. All persons defined by the focal point may receive some intervention in common (i.e. targeted intervention). Tailored content responds to individuals within the focal point, based upon the antecedents of behavior within that focal point. This article elaborates on the focal point concept and then discusses factors that contribute to variations of tailoring. The psychosocial resources required by health behaviors are also reviewed, because tailoring must prepare the individual to make changes specific to the nature of a particular health behavior. This article does not specify what the variations of tailoring should be; the potential diversity of tailored messages is too great. Instead, the article presents basic elements that will go into the development of tailored interventions.

Health Education↗
PubMed1999

Thorough skin examination for the early detection of melanoma.

BACKGROUND: Melanoma is a major public health problem for which early detection may reduce mortality. Since melanoma is generally asymptomatic, this requires skin examination. We sought to evaluate the extent to which the general public has their skin examined by themselves, their partners, or health care providers and the frequency of these examinations. METHODS: Random-digit-dial survey of adult Rhode Islanders. RESULTS: Only 9% performed a thorough skin examination (TSE) at least once every few months, although over half of the sample reported conducting skin self-examination "deliberately and systematically." Participants were more likely to perform TSE if they were women and if their health care provider had asked them to examine their skin. Most participants reported that their health care provider never or rarely looked at the areas of their skin in which melanoma is most likely to arise. CONCLUSIONS: The reported frequency of skin self-examination depends critically on the manner of inquiry. TSE by self or a partner is uncommon, and health care providers do not routinely examine the areas of the skin on which melanomas commonly arise.

Adult↗
PubMed1999

Screening for breast and cervical cancers: the importance of knowledge and perceived cancer survivability.

INTRODUCTION: This study examines the association between recent screening for breast and cervical cancers, knowledge of cancer risk factors, and perceptions of surviving cancer. METHODS: Data were from the Cancer Control Supplement to the 1992 National Health Interview Survey (NHIS-CCS). The dependent variable combined breast and cervical cancer screening practices into a single composite index. Two independent variables combined women's knowledge about breast and cervical cancers into single indicators--one representing risk factor knowledge, the other representing perceived likelihood of surviving breast and cervical cancers following early detection. RESULTS: Multivariate analysis showed that recency of screening for both breast and cervical cancers was associated with knowledge of cancer risk factors and perceptions of surviving cancer. Education, household income, and smoking status also were correlates of comprehensive screening. Significant interactions between income and perceived survivability, and between education and perceived survivability suggested that the effects of income and education on comprehensive screening varied with perceptions about surviving cancer. CONCLUSION: The study suggests that knowledge and attitudinal questions can be combined for two diseases to enhance understanding of who is most likely to be screened comprehensively for breast and cervical cancers. Although national trends show that large percentages of women over age 50 are having mammograms and Pap tests, this progress is not likely to be sustained unless existing barriers are eliminated. Limited knowledge about breast and cervical cancer risk factors and misperceptions about survival from cancer represent two of these barriers.

Aged↗
PubMed1998

Do groups of women aged 50 to 75 match the national average mammography rate?

CONTEXT: As mammography rates increase, an important question is how closely groups of women match or do not match the national-level, average screening percentage. OBJECTIVE: This study employed a classification-tree methodology to combine individual risk factors from multiple logistic regression, in order to more comprehensively define groups of women less (or more) likely to be screened. DESIGN/SETTING: This report was a secondary data analysis drawing on data from the 1992 National Health Interview Survey, Cancer Control Supplement (NHIS-CCS). PARTICIPANTS: Analyses examined mammography status of women aged 50-75 (n = 1,727). MAIN OUTCOME MEASURE: The dependent variable was having a screening mammogram in the past 2 years. Multiple logistic regression (SUDAAN) was conducted first to select significant correlates of screening. A classification-tree analysis (CHAID subroutine of SPSS) was then used to combine the significant correlates into exclusive and exhaustive subgroups. RESULTS: A total of 13 subgroups were identified, of which only six approximated the overall population screening rate. The lowest screening occurred in small clusters of women, which, when added together, formed a larger percentage of the population who were not screened within the past 2 years. CONCLUSIONS: Efforts to increase mammography may face the challenge of identifying relatively small pockets of women and addressing their individual barriers. Further work should be done to find efficient ways to combine individual risk factors into groups at risk for not being screened.

Aged↗
PubMed1997

Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions.

OBJECTIVE: To examine associations between sociodemographic and psychological characteristics of smokers and delivery of 5 types of smoking cessation counseling interventions by physicians and office staff. METHODS: We used a telephone survey of a population-based sample of adult cigarette smokers (N = 3037) who saw a physician in the last year. Primary outcomes included patients' report of whether a physician or other health care provider (1) talked about smoking, (2) advised them to quit, (3) offered help to quit, (4) arranged a follow-up contact, and (5) prescribed nicotine gum or other medication. RESULTS: Fifty-one percent of smokers were talked to about their smoking; 45.5% were advised to quit; 14.9% were offered help; 3% had a follow-up appointment arranged; and 8.5% were prescribed medication. In multivariate analyses, the most consistent predictors of receipt of almost all counseling behaviors were medical setting (private physician's office only > care in other settings), health status (fair or poor > good, very good, or excellent), more years of education, greater number of cigarettes smoked per day, stage of readiness to quit smoking (preparation > precontemplation), and greater reported benefits of smoking. CONCLUSIONS: Physicians and other health care providers are not meeting the standards of smoking intervention outlined by the National Cancer Institute and the Agency for Health Care Policy and Research. Health care providers who intervene only with those patients who are ready to quit smoking are missing opportunities to provide effective smoking interventions to the majority of their patients. Interventions are also less likely to be provided to healthier and lighter smokers.

Adult↗
PubMed1997

Confirmatory analysis of opinions regarding the pros and cons of mammography.

This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.

Aged↗
PubMed1997

Age and stage of readiness for smoking cessation.

Using the 1992 National Health Interview Survey Cancer Control Supplement, relationships were analyzed between stage of readiness for smoking cessation and background characteristics, smoking behaviors, and smoking-related attitudes among smokers aged 18-29, 30-49, and > or = 50 years. For each age group, an ordinal logistic regression model was computed to identify correlates of readiness to quit. The youngest smokers had attitudes most favorable to being ready to try to quit smoking. For smokers aged 30-49, the influence of a medical provider and perceived health effects of smoking were important correlates of readiness. Among smokers 50 and older, those with realistic health consequences of smoking and those who perceived smoking as addictive were more likely to be ready to quit. The effectiveness of smoking cessation programs might be improved by matching interventions to a smoker's age and stage in the smoking cessation process.

Adolescent↗
PubMed1997

Why do women's attitudes toward mammography change over time? Implications for physician-patient communication.

The present study examines women's decision making about mammography over a 1-year period, using "decisional balance," a summary of women's positive and negative perceptions about mammography derived from the Transtheoretical Model (TTM). Data were from a survey of women ages 50-74 years who completed both the baseline and 1-year follow-up telephone surveys (n = 1144) for an intervention study to increase the use of mammography screening. A shift toward less favorable perceptions about mammography was related to being a smoker and not having a recent clinical breast examination and Pap test. Change in women's attitudes toward mammography was also related to four dimensions of a woman's information environment. Women who rated the opinions of a physician as somewhat or not important, those who reported that at least one family member or friend discouraged them from having a mammogram, and women who felt they lacked enough people in their social network with whom they could discuss health concerns were less likely to express favorable attitudes about mammography over 1 year. In contrast, women who consistently communicated the value of mammography to others expressed more favorable views of screening over the study period. Interventions designed to promote breast cancer screening must recognize that a woman not only reacts to mammography information provided by significant others in her social network but may proactively reach out to others as an advocate of breast cancer screening, thus reinforcing or changing others' opinions or behavior as well as her own.

Aged↗
PubMed1995

Correlates of mammography among women with low and high socioeconomic resources.

BACKGROUND: Although screening mammography rates have increased, even women with higher incomes and more formal education do not all obtain the exam. This study examined why a modest proportion of higher income/higher education women do not get screened and, conversely, why a small percentage of lower income/lower education women do receive screening. METHODS: Data were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. A total of 3,014 women, ages 40-75, were in the sample. Low-resource women had incomes of less than $20,000 and less than a high school diploma. High-resource women had incomes of $30,000 or more and at least some college education. RESULTS: Correlates of screening status were similar for both resource groups. Recency of Papanicolaou test, recency of clinical breast exam, and regular breast self-examination were associated with higher rates of screening. Four or more persons in a household were associated with lower rates. Among low-resource women, incomes of $10,000-$19,999 were associated with higher likelihood of screening. An income of $50,000 or more was associated with screening among high-resource women. CONCLUSIONS: The fact that several variables were important for both resource groups suggests that targeted interventions could have benefits across a wide population. Nonetheless, in the high-resource group, 2-year rates never exceeded 80% and repeated screening never exceeded 60%. Rates for low-resource women were over 30% lower. Medical care utilization data did not differ between the two resource groups sufficiently to account for the discrepant rates. Improving screening rates in both resource groups remains a major challenge.

Adult↗
PubMed1994

Stages of change and decisional balance for 12 problem behaviors.

This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.

Adult↗
PubMed1994

An investigation of nonresponse to self-assessment of health by older persons. Associations with mortality.

This study examined the association between mortality and nonresponse to questions about health status (both refusals and "don't know" responses) using a national sample of persons aged 70 and over. Data were drawn from the 1984-1990 Longitudinal Study of Aging. Three time points of vital status were used as the outcome indicators (1984-1986, 1984-1988, 1984-1990). Five self-assessment questions were examined; three of the five questions had bivariate odds ratios that indicated significant associations between a nonresponse and all three mortality indexes. Results of the study suggest that nonresponses by older persons can convey meaningful information. Research on self-assessments of health in later life should not routinely exclude nonresponses as missing data, even if they are an infrequent response.

Aged↗
PubMed1994

Functional transitions among the elderly: patterns, predictors, and related hospital use.

OBJECTIVES: This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use. METHODS: The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status. RESULTS: The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization. CONCLUSIONS: This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use.

Activities of Daily Living↗
PubMed1993

Women's decision making about mammography: a replication of the relationship between stages of adoption and decisional balance.

The motivational and cognitive processes of behavior change in the area of screening mammography were investigated. A total of 676 women, 40 to 79 years old, were recruited for telephone interview through random selection from designated census tracts and were asked questions that assessed mammography stage-of-adoption and decisional balance constructs from the trans-theoretical model of behavior change. Two definitions of stage of adoption were used. Analysis of covariance showed that a history of regular screening and an intention to continue having the exam were associated with a more favorable decisional balance. Results replicated a prior investigation and demonstrated the usefulness of stage of adoption and decisional balance as guides for designing stage-matched interventions to increase rates of mammography.

Adult↗