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.

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.

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.

Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention.

BACKGROUND: Tailoring is a promising technique for encouraging greater performance of health-related behaviors. Tailored interventions are designed to be more individualized to personal characteristics, in contrast to "standard" interventions where all participants receive the same materials. METHODS: A total of N = 1864 women aged 40-74 were recruited from a staff model HMO and randomly assigned to one of three intervention groups: (a) No Educational Materials, (b) Standard Materials, and (c) Stage-Matched Materials. A provider-directed component was common across all three conditions. The Standard and Stage-Matched groups each received two mailed educational packets after baseline and follow-up telephone interviews. The Stage-Matched intervention was based on the Transtheoretical Model of behavior change. RESULTS: Analyses of n = 1397 women (after all attrition) showed that receipt of mammography after the baseline interview was higher for the Stage-Matched group (63.6%) than for the No Materials group (54.9%; OR = 1.43, 95% CI = 1.10, 1.86). The Standard intervention group was intermediate (58. 5%). The Standard group did not differ from the No Materials group, but did differ from the Stage-Matched group in multivariate analysis. CONCLUSIONS: Stage-matched, tailored materials may be a means to encourage screening mammography. Such interventions can be implemented by telephone and mail.

Stages of adopting regular screening mammography: do women differ in decisional balance within stages?

This study examined whether distinct subgroups of women could be identified within stages of adoption for screening mammography. These subgroups may represent differential readiness to move to the next stage of the adoption continuum. Data were from a baseline survey of 1323 women between the ages of 50 and 74 years who were recruited through a staff- model HMO for an intervention study to increase rates of mammography. Multiple regression models were used to identify correlates of positive decisional balance within each of four stages of adoption, and an index of positive indicators was developed from the significant correlates for each stage. Analysis of variance showed that the number of positive indicators discriminated women within each stage. This information can be used to develop more effective tailored interventions to increase the percentage of women receiving mammograms on a regular schedule.

Integrating pros and cons for mammography and Pap testing: extending the construct of decisional balance to two behaviors.

BACKGROUND: The ability to study health-related behaviors in combination rather than singly will lead to a more comprehensive approach to health promotion. This investigation focused on mammography and Pap testing. One index was created to reflect the recency of receiving both examinations. A second index integrated opinions about the two procedures into a single measure, guided by the pros, cons, and decisional balance constructs of the Transtheoretical Model of behavior change. METHOD: Data were drawn from the baseline and 1-year follow-up surveys of an HMO sample of women ages 40-74 (N = 1,605). Data collection occurred by telephone. A series of analyses examined whether recency of screening was associated with opinions about screening. RESULTS: The first analysis showed that recency of Pap testing and whether or not a Pap test was obtained between the two surveys were associated with opinions about Pap testing. The next analysis examined the association between the indicator for regularity of both Pap testing and mammography, with the measure of opinions toward the two procedures. The variable measuring receipt of Pap test and mammography was associated with the combined measure of opinions. CONCLUSIONS: The ability to employ combined indicators for recency of testing and test-related opinions is promising for being able to take a more comprehensive approach to women's health. The paper discusses methodological considerations that arise when attempting to integrate two or more behaviors.

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.

Breast cancer screening practices among black, Hispanic, and white women: reassessing differences.

INTRODUCTION: We examine racial and ethnic variations in use of screening mammography. We first review recent literature on Blacks', Hispanics', and non-Hispanic Whites' mammography use. Here we extend that body of literature through use of a comprehensive national database and discussion of the implications of race- and nonrace-stratified mammography modeling. METHODS: Data were extrapolated from the 1990 National Health Interview Survey. Using the Transtheoretical Model as a conceptual guide, we derived a women's stage of mammography adoption by integrating screening history with intention to have a future mammogram. The outcome variables included (1) not being screened at regular intervals and (2) not intending to have a mammogram in the future. Analyses were stratified by three groups: Blacks, Hispanics, and non-Hispanic Whites. RESULTS: The results from the multiple logistic regressions demonstrate that race continues to be a factor influencing mammography use. Across all three groups, women who reported less regular cancer screening by clinical breast exam (CBE), Pap smear testing, or breast self-examination were less frequent users of mammography. However, the magnitude of the associations varied for the groups being compared. The findings also demonstrate that there were unique factors associated with not being screened routinely and not intending to have a mammogram in the future for all three racial/ethnic groups. CONCLUSIONS: Researchers must give explicit attention, both empirically and methodologically, to how race and ethnicity interact with sociodemographic factors, health practices, and access to health care to refine our understanding of barriers to breast cancer screening. Common barriers to routine screening may be perceived differently by Black, Hispanic, and White women and may contribute to underuse of mammography in distinct ways.

Mammography, clinical breast exam, and pap testing: correlates of combined screening.

This study examines the correlates of screening for both breast and cervical cancer combined in a single indicator. Data used were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. We used two indices to characterize the receipt of breast and cervical cancer screening among women 50-75 years of age. The first measure compared women who had three screening exams--clinical breast examination (CBE), mammography, and Pap test--in the past two years with those who had not received all three exams. The second measure compared women who had a Pap test and at least one breast screening exam (i.e., mammogram or CBE) in the previous two years with women who were underscreened. Age, level of education, smoking status, and access to health care were associated with both outcome measures. Black women were more likely to use screening services in the office setting (i.e., CBE and Pap), without a corresponding use of mammography. Nevertheless, more black than white women received a routine Pap test in combination with a CBE, a very positive trend with respect to the successful diffusion of at least two screening procedures among older black women. The data suggest that barriers to mammography screening remain even among women who are screened by CBE and Pap. Perhaps the biggest challenge is to educate primary care physicians and their patients to view different components of preventive health--CBE, Pap smear testing, breast self-examination, and mammographic screening--as equally necessary and interrelated. Medical Subject Headings (MeSH): screening, mammography, cervical cancer, Pap, breast exam.

Screening mammography and constructs from the transtheoretical model: Associations using two definitions of the stages-of-adoption.

The two purposes of this investigation were: (a) to examine whether an association existed between stages of adopting regular mammography and decision-making constructs from the Transtheoretical Model (TTM) of behavior change, and (b) to determine whether any such associations would be found for each of the two ways of defining the stages-of-adoption. One method integrated past screening history with a report of future intention for screening; the other method used a single item with predetermined response categories. Data were from the baseline survey of 1,323 women aged 50-74 who were recruited as part of an intervention study through a local Health Maintenance Organization. Results showed that both ways of defining stages of adopting regular mammography were associated with decisional balance and processes-of-change. The method that integrated past history plus intention provided somewhat better discrimination among stages. Women who were labeled as being at "Risk of Relapse," and those who said they waited for a "Provider's Recommendation," may be useful groups to add to the set of stages that have been employed so far by the TTM. In addition, a tendency to avoid the health care system in general was used as a process-of-change to complement the mammography-specific processes.

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.

Snuffing it out: a smokeless tobacco intervention with athletes at a small private college.

This study assessed attitude, knowledge, and use of smokeless tobacco (moist snuff, dry snuff, or chewing tobacco) among male varsity athletes at a small private college. Forty-three athletes were surveyed and 17 (40%) were found to be current users. Of these users, 27% reported dipping more than once a day, everyday; 25% of all users had noticed physical changes, such as white spots, inside their mouths. The wide acceptance of using smokeless tobacco was clear from the finding that 49% of those surveyed believed that athletes should be allowed to use "chew" during practice. These athletes also showed limited knowledge of the nicotine content and physiological effects of smokeless tobacco. As a result of the study, the authors developed a two-part intervention that included an educational presentation and oral screening by a local dentist and an administrative directive enforcing the National Collegiate Athletic Association's policy on smokeless tobacco use. A follow-up survey indicated the intervention had had some positive effects on the athletes' attitudes toward and knowledge about using smokeless tobacco. The survey also showed an increase from 4 to 7 in the number of former users who said they had stopped using smokeless tobacco.

Binding and degradation of insulin by plasma membranes from bovine liver isolated by a large scale preparation.

With the large-scale preparation described, as much as 1 kg of bovine liver can be processed, giving a yield of more than 1 g plasma membrane protein. From analytical and morphological criteria the plasma membrane fraction isolated mainly derives from bile-canalicular and contiguous areas of the hepatocytes. The insulin binding activity is quite similar to insulin receptors in other cell systems and membrane preparations. Insulin-degrading activity is very low in the isolated plasma fraction. Most of degrading activity is located in a microsomal membrane fraction. Nevertheless the Km and the pH dependence of the insulin-degrading activity in both fractions are nearly identical. From these studies we conclude that binding and degradation of insulin are two independent processes located on different cell organelles.