Determinants of breast self-examination after a benign biopsy.

Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical screening techniques for the early detection of breast cancer, little is known about events that might negatively influence long-term adherence. The primary aim of this investigation was to determine if regularity of BSE would decline after a benign breast biopsy. Analyses are based on 655 women: 83 women who self-discovered the breast problem by BSE, 179 women in whom the problem was discovered by the health care system, and a control group of 393 women who had no history of breast problems. Frequency of BSE was assessed over two six-month periods and collapsed into three categories--nonpractitioner, irregular practitioner, and regular practitioner. Results indicated that the percentage of women in the self-discovered group who reported decreased regularity of BSE was over three times higher than that found in the control group. The largest percentage increase in BSE frequency was evidenced by the health care-discovered group. Logistic regressions revealed that the biopsy experience was a more powerful indicator of subsequent BSE practice than either sociodemographic characteristics or whether one engaged in other preventive health behaviors. The data provide substantial evidence that a benign biopsy can affect BSE practice, with the direction and magnitude of the change influenced by mode of discovery of the breast problem, perceived degree of confidence in ability to perform BSE, and level of practice before the biopsy. Postbiopsy educational strategies incorporating these findings and targeted at specific subgroups are outlined.

Alameda County redux: replication in Michigan.

This article describes an attempt to reproduce, in Michigan, cross-sectional findings concerning the relationship between health habits and health status previously obtained in Alameda County, California by Belloc and Breslow. Data for this study were gathered by a telephone interview of a state-wide sample of 3,259 adult Michigan residents. The ridit (relative to an identified distribution) analyses presented include a comparison of findings from the Michigan and Alameda County studies. In Michigan, as in Alameda County, health status was found to be associated with various health practices, both individually and in combination. Consistent relationships were found between physical health status and individual health practices regarding hours of sleep, eating breakfast, eating between meals, cigarette smoking, weight for height, and physical activity. Physical health status was also linked to the overall number of health practices individuals engaged in. When the confidence interval for each ridit value was taken into account, however, only some of the findings proved statistically reliable.

Psychosocial determinants of immunization behavior in a swine influenza campaign.

A prospective design was used to study factors which predisposed individuals to receive vaccination in response to the anticipated outbreak of swine influenza in the fall and winter of 1976. Data were obtained from a telephone survey of 286 adults in Oakland County, Michigan. Predictor variables included Health Belief Model (HBM) variables as well as measures of behavioral intention, social influence, physician's advice, socioeconomic status and past experience with flu shots. In multivariate analysis, over 40 per cent of the variance in inoculation behavior was explained by the predictors used. Path analysis revealed that most of the HBM variables' influence on behavior was mediated through behavioral intention. While behavioral intention was an important predictor of inoculation behavior, other psychosocial factors played a significant role in explaining variance in the dependent variable.

Effects of threatening communications and mothers health beliefs on weight change in obese children.

A field experiment was designed to test the effects on weight change in obese children of (1) communications varying in threat and (2) health beliefs of the child's mother, in terms of perceived vulnerability to health threats, the efficacy of taking actions, and barriers to acting. Treatments involved messages containing more or less threatening material regarding obesity, plus a control (no communication) condition. Beliefs were assessed by means of personal interviews. All mothers and children received dietary counseling and were scheduled for four follow-up visits, which included weighing. The 182 participants were from low-income areas served by a large hospital pediatric clinic. High-threat messages yielded the most consistent weight loss, followed by low threat and control. In addition, both general beliefs concerning health and specific beliefs about obesity and dieting predicted weight loss. Both messages and mothers' beliefs acted together on keeping appointments and making efforts to comply. Results are discussed in terms of the effects of threats and health belief-behavior linkages.

Scales for measuring health belief model dimensions: a test of predictive value, internal consistency, and relationships among beliefs.

Critiques of research on the Health Belief Model have been directed at the need for: (1) applying the Model to behavior related to chronic illness; (2) multivariate testing of the major dimensions of the Model; (3) developing reliable scales; and (4) explicating the relationships among the beliefs. In an attempt to respond to these concerns, data are presented from a prospective study of mothers' adherence to a diet regimen prescribed for their obese children. The Model components were found, both singly and in combination, to be correlated with the study's measure of dietary compliance. Multiple regression analysis utilizing five belief indices accounted for a substantial portion of the variance in children's weight change. Questionnaire items employed in creating indices for each Model dimension are presented, together with discussion of the internal consistency of each index. Belief intercorrelations appear to demonstrate that distinct Model dimensions exist.

A comparison of the effectiveness of the "Toothkeeper" and a traditional dental health education program.

A study was made of the effectiveness of two dental health education programs in an elementary school in Flint, Michigan. Following stratification by grades, random assignments of students were made by classrooms to either the Toothkeeper group or a "Traditional" group. No control groups were employed. Separate in-service training workshops were attended by the classroom teachers according to the education program to which they had been randomly assigned. An intensive 16-week program was conducted by the classroom teachers following the guidelines of the two programs. Dental examinations which included an assessment of plaque and gingivitis scores were conducted on all participants at baseline, at the end of 16 weeks, and at the conclusion of the school year, some seven months after the initiation of the program. Only minimal reductions in plaque scores were observed with either program and little comparative difference was found in the two programs at the end of the evaluation period. The Toothkeeper group experienced a somewhat greater reduction in plaque scores than the "Traditional" group during the intensive 16-week phase of the study, but these scores worsened from this time to the end of the school year. Gingivitis scores demonstrated more improvement than the reductions in plaque scores would indicate and may be related to the confounding factor of large numbers of children receiving dental treatment, especially prophylaxes during the course of this study. Differences in reductions in gingivitis between the two programs were not meaningful clinically.