A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n = 1,717). METHODS: CIS callers assigned to the intervention group (n = 861) received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention participants. Participants were interviewed by telephone at 4 weeks (n = 1,307), 4 months (n = 1,180), and 12 months for follow-up (n = 1,016). RESULTS: Results obtained from a single-item measure of fruit and vegetable consumption indicate a significant intervention effect of 0.88 servings per day at 4 weeks follow-up (P < 0.001), 0.63 servings per day at 4 months follow-up (P < 0.001), and 0.43 servings per day at 12 months follow-up (P < 0.001). Using a 7-item food frequency measure, an intervention effect of 0.63 servings per day was obtained at 4 weeks follow-up (P < 0.001), compared with 0.39 servings per day at 4 months follow-up (P = 0.002) and 0.44 servings per day at 12 months follow-up (P = 0.002). A 24-h recall assessment included in the 4-month interviews also yielded a significant intervention effect of 0.67 servings per day (P = 0.015). The vast majority of callers (90%) endorsed the strategy of providing 5 A Day information proactively within the CIS. CONCLUSIONS: This brief educational intervention was associated with higher levels of self-reported fruit and vegetable intake at both short- and long-term follow-up. Additional research is recommended to test this or a similar intervention in diverse populations.

A feasibility test of a brief educational intervention to increase fruit and vegetable consumption among callers to the Cancer Information Service.

BACKGROUND: In this paper, results are reported from a pilot study designed to test the feasibility of a proactive educational intervention delivered to callers of the Cancer Information Service (CIS). METHODS: The study used a randomized two-group design (intervention vs control). Callers assigned to the intervention condition received a brief educational intervention at the end of usual service to increase fruit and vegetable consumption. As part of the intervention, key education messages and materials drawn from the 5 A Day for Better Health program of the National Cancer Institute were provided to CIS callers over the telephone and then reinforced with two follow-up mailings. RESULTS: Results from this pilot study indicated high levels of adherence to protocol by CIS Information Specialists who delivered the intervention to eligible CIS callers. Results obtained from the 4-week telephone follow-up interviews indicated that intervention subjects (n = 142) reported higher consumption of fruits and vegetables, averaging approximately 0.75 servings more per day (P < 0.01) than control subjects (n = 134). CONCLUSION: Nearly 80% of CIS callers endorsed the strategy of providing 5 A Day information at the end of usual service, even if such information was not specifically requested by the caller (i.e., the information was provided to CIS callers proactively.

Coping with cancer: the impact of the Cancer Information Service on patients and significant others. Part 6.

The Cancer Information Service (CIS) has been the voice of the National Cancer Institute (NCI) for more than 20 years. In 1997, the CIS telephone service received 14,689 inquiries from the public about coping with cancer and its consequences (total calls = 500,000). In a random sample survey of 2,489 CIS callers conducted in 1996, respondents who stated they called the CIS for coping information were asked to evaluate the information provided by the CIS, overall satisfaction with this information, and what impact this information had on patients and significant others. Most of those who called about coping were not the patients (33%) themselves; rather, they were significant others of patients (spouses/partners [21%], parents [16%], friends/coworkers [11%], other family [19%], other [9%]). The information received was new to most callers (> or = 93%). Respondents were satisfied with the information (92%) and felt the CIS information specialist was knowledgeable (95%) and trustworthy (96%). Respondents (patients/significant others) stated that the information made it easier to adjust to the illness (52%/80%), reassured them (68%/69%), and helped them find community support (34%/39%). Patients and significant others evaluated the CIS information exchange differently; significant others rated it higher than did patients. Results indicated that the CIS model of health communications had a positive impact on persons coping with a diagnosis of cancer. Further research is needed to understand how the information needs of patients differ from those of their significant others, and training is needed to tailor the information exchange to meet those unique needs.

Sexual activity, contraception, and reproductive factors in predicting endometriosis.

To examine the belief that women with endometriosis have "voluntarily" delayed childbirth, the authors used a case-control approach to assess the relation between sexual, contraceptive, and reproductive factors and endometriosis. A total of 104 laparoscopically confirmed newly diagnosed cases of endometriosis were identified from a gynecologic specialty clinic in western New York state in 1987. Two control groups were used: 1) 100 friend controls, and 2) 98 medical controls. No differences were found between study groups on use of reliable birth control, use of birth control before a first pregnancy, age at first intercourse, frequency of intercourse, decisions to delay pregnancy, age at first pregnancy, or measures of body size. Cases were older than medical controls by about 1 year when they first began using birth control (19.8 vs. 18.6 years, p < 0.05). Cases were also 1 year older than friend controls when they began regular intercourse (20.9 vs. 19.5 years, p < 0.005) and at first marriage (22.8 vs. 21.7 years, p < 0.05). A larger percentage of cases than friend controls were never pregnant (p < 0.0001) and were more likely to have problems becoming pregnant (p < 0.0001). Results, overall, do not support simplistic assumptions that characterize endometriosis patients as career women who voluntarily delay pregnancy. Rather, the results point to a complex relation between endometriosis and reproductive, sexual activity, and fertility-related factors.

Endometriosis and body fat distribution.

OBJECTIVE: To examine the association of body fat distribution with risk of endometriosis in an effort to determine whether a specific somatotype is related to the disease. METHODS: We conducted a case-control study of 88 laparoscopically confirmed cases of endometriosis, identified in a specialty gynecologic practice in western New York, and 88 age-matched friend controls. Data were collected by standardized personal interview, and body measurements were taken in a standardized fashion by one interviewer. Risk of endometriosis associated with body fat distribution, as expressed by waist-to-hip and waist-to-thigh ratios, was assessed using logistic regression. RESULTS: For women under 30 years of age (45 cases, 46 controls), endometriosis was inversely related to both waist-to-hip ratio (odds ratio 6.18, 95% confidence interval [CI] 2.01-19.01) and waist-to-thigh ratio (odds ratio 3.64, 95% CI 1.23-10.78). This effect was not evident among women aged 30 years and older (43 cases, 42 controls). CONCLUSION: Our results suggest a specific somatotype with a predominance of peripheral body fat among women with endometriosis. This finding may provide information useful in both the diagnosis and understanding of the disease etiology.

Menstrual cycle characteristics and the risk of endometriosis.

The present study utilized a case-control design to assess the relation between menstrual cycle factors and risk of endometriosis in women age 19-45 years. From a gynecologic specialty clinic in Western New York in 1987, we identified 104 laparoscopically confirmed cases of endometriosis. We used two control groups: (1) 100 friend controls (friends of cases), and (2) 98 medical controls (patients from the same medical practice with conditions other than endometriosis). Controls were frequency matched to cases by age. Because crude odds ratios (ORs), stratified by age (< 30 vs > or = 30 years), revealed effect modification by age, we performed all analyses by age group. We used logistic regression to calculate ORs and 95% confidence intervals (CIs), controlling for pregnancy, religion, and body mass index. Among women under age 30, using friend controls, we observed elevated risks for menstrual flow > or = 6 days per month (OR = 2.5, 95% CI = 1.1-5.9), heavy flow (OR = 2.5, 95% CI = 1.1-6.3), severe cramps (OR = 2.5, 95% CI = 1.2-6.0), increasing symptoms (OR = 6.6, 95% CI = 2.6-16.5), and tampon use > or = 14 years (OR = 3.6, 95% CI = 1.04-13.5). Risks were also elevated for women age 30 and over, but not to the same degree as among younger women.(ABSTRACT TRUNCATED AT 250 WORDS)

Sociodemographic correlates of alcohol consumption among African-American and white women.

Correlates of abstention and heavier drinking were examined among 654 African-American and 474 white women, aged 19-70+, from a representative sample of households in Erie County, New York. Discriminant function analysis was employed to investigate the relationship between alcohol consumption and race, age, church attendance, family history of alcohol problems, household density, marriage, socioeconomic status (SES), employment and parity. Abstention was compared with drinking, and light/moderate drinking was compared with heavier drinking in the total sample and within each race. Compared to drinkers, abstainers were older, more religious, more likely to be African-American, or to be of lower SES. Racial differences in the correlates of abstention were found with respect to church attendance (positive association in African-Americans only), SES (negative association in African-Americans only), and household density (positive association in whites only). Compared to light/moderate drinkers, heavier drinking women were younger, less religious, more likely to be white, to have a positive family history, or to live in less crowded households. Racial differences in the correlates of heavier drinking were found with respect to church attendance (negative association in African-Americans only), parity (positive association in African-Americans only), and marital status (more heavier drinking among unmarried white women). Racial differences in the correlates of alcohol consumption document the need for further examination of the culture-specific determinants of women's drinking patterns.

Accuracy of self-measurement of body fat distribution by waist, hip, and thigh circumferences.

There are indications that body fat distribution, independent of obesity, may be a disease risk factor. The accuracy of self-measurement of waist, hip, and thigh circumferences, indicators of fat distribution, were examined for 227 women (aged 19-45) who were sent either a calibrated or uncalibrated tape measure and subsequently remeasured by a trained technician. Subjects tended to underestimate all circumferences somewhat. Spearman correlations between self-measurement and technician measurement were 0.88, 0.89, and 0.86 for the waist, hip, and thigh, respectively, and 0.65 and 0.77 for the waist-to-hip waist-to-thigh ratios. Correlations for waist, but not other measures, were better with the uncalibrated than with the calibrated tape. Accuracy did not vary within strata of education, body mass index, or waist-to-hip ratio. Subjects were able to measure their circumferences with reasonable accuracy. Circumference measures were more accurate than were computed ratios of circumferences; waist-to-thigh ratios were more accurate than were waist-to-hip ratios.

Women's knowledge and beliefs about breast cancer risk factors, symptoms, detection methods, and treatments.

This paper presents results from a survey of adult women that assessed knowledge, beliefs, and practices regarding the causes, symptoms, detection methods, and treatment of breast cancer. The study population was determined through random selection of household telephone numbers from the Buffalo, New York area telephone directory. Completed interviews were collected from 563 women over the age of 18. Telephone interviews were conducted by trained interviewers, between April and July of 1985. Survey results are compared to those found in the 1979 National Cancer Institute nationwide survey on breast cancer to evaluate if ther have been changes in public awareness about the disease. Differences in knowledge, beliefs, and practices regarding breast cancer were also studied in relation to age, race, and educational background. Overall, women's knowledge about breast cancer has significantly increased since the 1979 survey. However, while more women can name mammography as a diagnostic tool only 15% of women who have heard of mammography reported having had a mammogram. Generally, younger women, white women and those with some college education were more knowledgeable about breast cancer risk factors, symptoms, detection methods, and treatments. Results from this study suggest that although knowledge about breast cancer has improved, women have not adopted recommended early detection practices. Special efforts need to be directed toward health professionals, making mammography more accessible to women who are nonwhite, older and with no college education.