Factors influencing time to diagnosis after abnormal mammography in diverse women.

BACKGROUND: Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. METHODS: Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. RESULTS: In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p=0.03), income < $10,000 (HR 0.55, 95% CI 0.31-0.98, p<0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p<0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p=0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p=0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p=0.02) rather than in person were all associated with significant delays in diagnosis. CONCLUSIONS: Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.

Effectiveness of adult vaccination programs in faith-based organizations.

Elderly persons of African American and Latino descent have lower rates of immunizations after adjustment for insurance and education. Interventions that use faith-based organizations (FBOs) are promising but have not been well evaluated. We examined the effectiveness of an FBO adult vaccination program in minority communities. From December 2003 through January 2004 and November 2005 through February 2006, 15 churches were randomized to intervention with onsite adult vaccinations or to comparison with no vaccinations. Participants were eligible if they had not been previously vaccinated with pneumococcal vaccine, did not regularly receive influenza vaccine, were aged > or =65 years, and had a clinical indication for vaccination. Baseline and follow-up surveys were conducted. Primary outcome was rates of influenza and pneumococcal vaccinations. The study sample (N=186) was 44% African American, 43% Latino, 8% White, and 3% Asian. Of those eligible, 90 of 112 (80%) in the intervention group used the influenza vaccine compared to 32 of 70 (46%) in the comparison group (P < .001). Of those eligible, 58 of 88 (66%) in the experimental group used the pneumococcal vaccine compared to 20 of 57 (35%) in the comparison group (P < .001). Participants in the intervention group were significantly more likely to receive influenza vaccinations (odds ratio [OR] 4.8, 95% confidence interval [CI] 2.5-9.4) and pneumococcal vaccination (OR 3.6, 95% CI 1.8-7.2). More than ninety percent of all participants reported willingness to participate in FBO education and promotion programs. This onsite, FBO adult vaccination program was effective in increasing vaccination rates and may be promising for decreasing raciallethnic disparities in vaccination rates.

Depressive symptoms, physical activity, and weight gain in premenopausal Latina and White women.

OBJECTIVES: Describe changes and examine the association between depressive symptoms, physical activity, body mass index (BMI), and perceived health among Latina (n=81) and White (n=151) women in the first year of the late-premenopausal stage. METHODS: Longitudinal study focused on the biopsychosocial health of midlife women (ages 40-50 years) with regular menstrual cycles and not taking hormones. Frequency of depressive symptoms, BMI, waist to hip ratios, and self-reported physical activity levels were obtained at 6-month intervals and perceived health at 12 months. Results are reported here for 232 women who remained premenopausal (low FSH/regular cycles) for the first 12 months. RESULTS: Depressive symptoms were similar for Latinas (11.1+/-9.8) and Whites (11.1+/-8.2) and increased by 2.3 points over time for all women. Latinas had higher BMI (28+/-5.7, p<0.01) than Whites (26+/-5.7). Body weight increased an average of 1.2 lbs over 12 months for both groups. Both groups reported sub-optimal levels of physical activity that did not change over time, but Latinas reported higher levels at all 3 time points. Controlling for age and ethnicity, women in service or agricultural occupations reported higher activity levels than women in other roles. Better perceived health at 12 months was predicted by lower baseline BMI (r=0.43, p<0.01) and fewer depressive symptoms (r=0.38, p<0.01). CONCLUSIONS: Depressive symptoms, weight gain and physical inactivity among women in the late-premenopausal stage point to the need for interventions focused on causal factors other than hormonal changes and menopause.

Depressive symptoms among women with an abnormal mammogram.

An abnormal mammography finding constitutes a stressful event that may increase vulnerability by developing or intensifying pre-existing psychological morbidity. We evaluated depressive symptoms using the Composite International Diagnostic Interview among women of four ethnic groups who had an abnormal mammography result controlling for the effect of demographic, psychosocial and medical factors on recent onset of depressive symptoms. Telephone surveys were conducted among women aged 40-80 years recruited from four clinical sites in the San Francisco Bay Area after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. Among the 910 women who completed the interview, mean age was 56 (S.D.=10), 42% were White, 19% Latina, 25% African American, and 14% Asian. Prevalence of lifetime depressive symptoms was 44%, and 11% of women had symptoms in the previous month. Multivariate logistic regression models showed that Asian ethnicity, annual income >$10 000 and weekly attendance at religious services were significantly associated with decreased depressive symptoms. Having an indeterminate result on mammography and being on disability were significantly associated with more depressive symptoms. Reporting a first episode of depression more than a year before the interview was associated with significant increase in depressive symptoms in the month prior to the interview regardless of mammography result. Women with an indeterminate interpretation on mammography were at greater risk of depressive episode in the month prior to the interview compared to women with probably benign results (odds ratio=2.41; 95% CI=1.09-5.31) or with a suspicious finding. Clinicians need to consider depression as a possible consequence after an abnormal mammography result.

From sunrise to sunset: an ethnography of rural Ecuadorian women's perceived health needs and resources.

In this ethnographic study, we describe the perceived health needs and resources of women in two rural Ecuadorian communities. Nineteen women participated in semistructured interviews. Women worked 3 to 30 hours outside the home each week but described their financial resources as insufficient. Most participants perceived their health as fair to poor. Four themes emerged related to the participants' health needs: (1) lack of money, (2) "it's better to be alone," (3) the physical burden of women's roles, and (4) suffering/self-sacrifice. Traditional medicine, local experts in traditional remedies, and nutrition emerged as resources to prevent illness. We believe our results offer valuable information in facilitating participatory health projects for social change.

Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography?

OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. A telephone-administered survey asked about breast cancer risk factors (family history, estrogen use, physical inactivity, age of menarche, age at birth of first child, parity, alcohol use), and self-reported use of diagnostic tests (follow-up mammogram, breast ultrasound, or biopsy). RESULTS: Nine hundred and seventy women completed the interview, mean age was 56, 42% were White, 19% Latina, 25% African American, and 15% Asian. White women were more likely to have a positive family history (20%), use estrogen (32%), be nulliparous (17%) and drink alcohol (62%). Latinas were more likely to be physically inactive (93%), African Americans to have early onset of menarche (53%) and Asians first child after age 30 (21%). White women were more likely to have suspicious mammograms (40%) and to undergo biopsy (45%). In multivariate models, Latinas were more likely to report breast ultrasound, physical inactive women reported fewer follow-up mammograms, and care outside the academic health center was associated with fewer biopsies. Indeterminate and suspicious mammography interpretations were significantly associated with more biopsy procedures (OR=8.4; 95% CI=3.8-18.5 and OR=59; 95% CI=35-100, respectively). CONCLUSIONS: Demographic profile and breast cancer risk factors have little effect on self-reported use of diagnostic procedures following an abnormal mammography examination. Level of mammography abnormality determines diagnostic evaluation but variance by site of care was observed.

Poor patient comprehension of abnormal mammography results.

BACKGROUND: Screening mammography for women 50 to 69 years of age may lead to 50% having an abnormal study. We set out to determine the proportion of women who understand their abnormal mammogram results and the factors that predict understanding. METHODS: We surveyed 970 women age 40 to 80 years identified with abnormal mammograms from 4 clinical sites. We collected information on demographic factors, language of interview, consultation with a primary care physician, receipt of follow-up tests, and method of notification of index mammogram result. This study examines the following outcomes: the participant's report of understanding of her physician's explanation of results of the index mammogram, and a comparison of the radiology report to the participant's report of her index mammogram result. Multivariate models controlled for age, education, income, insurance status, and clinical site. RESULTS: The majority (70%) reported a "full understanding" of their physician's explanation of their abnormal mammogram, but a significant minority (30%) reported less than a full understanding (somewhat, not at all, did not explain). Among women of Asian ethnicity, only 63% reported full understanding. Asian ethnicity was a negative predictor (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.3 to 0.7), and consultation with a primary care physician was a positive predictor (OR, 2.3; 95% CI, 1.7 to 3.3) of reported full understanding. Of the 304 women with a suspicious abnormality, only 51% understood their result to be abnormal. Women notified in person or by telephone were more likely than women notified in writing to understand their result to be abnormal (OR, 2.3; 95% CI, 1.2 to 4.8). CONCLUSION: Almost half of women with the most suspicious mammograms did not understand that their result was abnormal. Our data suggest that direct communication with a clinician in person or by phone improves comprehension.

Focus group interviews on racial and ethnic attitudes regarding adult vaccinations.

UNLABELLED: Adult immunizations have dramatically improved the health of many Americans. In the United States, researchers have documented disparities in the utilization of adult vaccinations between whites and racial and ethnic minority populations. This article examines racial and ethnic attitudes regarding recommended adult vaccinations. METHODS: Four adult focus groups (N=22) were conducted in community churches in San Francisco, CA. Participants were either age-appropriate or had clinical indications to receive a strong recommendation for influenza and pneumococcal immunizations but had not been routinely immunized against influenza and had never been vaccinated against pneumococcal disease. Content analysis was used to analyze narrative data and identify emerging themes. RESULTS: Participants reported that they lacked information about the benefits or potential side effects of influenza and pneumococcal vaccinations and that their physicians were not routinely informing them of, or recommending, these vaccinations. Meanwhile, most participants expressed a willingness to be vaccinated against pneumococcal infection and influenza. All focus group participants felt that community churches were a potential venue for delivery of adult vaccines. CONCLUSIONS: Many adult racial and ethnic minorities have basic information regarding the influenza vaccine but lack sufficient information regarding the benefits of pneumococcal vaccinations. Physicians should provide information regarding adult vaccinations to all patients. On-site vaccination and vaccine education programs in community churches may be successful in increasing the utilization of adult vaccinations in unvaccinated church populations.

Physical activity beliefs, behaviors, and cardiovascular fitness of Mexican immigrant women.

This descriptive study examined physical activity beliefs, behaviors, and cardiovascular fitness of a convenience sample of 51 married Mexican immigrant women (MIW) with children in Northern California. Standardized tools/procedures were used to measure the variables of interest and to determine cardiovascular fitness levels. The majority (78%) was not involved in regular physical activity and had below average or poor cardiovascular fitness (76%). However, 93% had a positive attitude, were well-informed of the benefits, and perceived physical activity to be a health-promoting behavior. Cultural values and beliefs about physical activity, gender roles, and social and physiological factors were described as barriers to women's intention to engage in physical activity.

Perceived benefits and barriers to physical activity among older Latina women.

Evidence of the benefits of physical activity in the health of aging women continues to grow but questions remain about the factors that influence these women's ability to engage in this behavior. The authors used a qualitative design to describe the social and culture-specific perceived benefits and barriers to physical activity among 143 Latina women, ages 40 to 79. Content analysis of these women's responses revealed that perceived benefits (health promotion, physical fitness, improved roles) and barriers (time constraints of women's roles, personal health, internal and external factors) function as competing elements that may explain physical inactivity. Health care providers should emphasize overcoming barriers and promote perceived benefits as clinical interventions that may pose the greatest potential to increase physical activity among aging Latina women. This emphasis holds promise as a feasible and effective primary care intervention for achieving increased physical-activity-related health benefits.