Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.

BACKGROUND: Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity. METHODS: A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention. RESULTS: A small improvement in travel agents overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores. CONCLUSIONS: Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.

Geographic assessment of breast cancer screening by towns, zip codes, and census tracts.

Early detection is the primary way to control breast cancer, and mammography screening can reduce breast cancer mortality 30 to 40 percent among women aged 50 years and older. Geographic areas with a high proportion of cases with late-stage diagnoses may reflect gaps in screening efforts. We used a spatial scan statistic, adjusting for the multitude of possible region locations and sizes, to test whether any particular region of Massachusetts had statistically significant excesses of late-stage diagnoses during the period 1982 to 1986. The novel geographic analysis technique utilized here can also be used in the control of other types of cancer.

The role of personal health concerns and knowledge of the health effects of hormone replacement therapy (HRT) on the ever use of HRT by menopausal women, aged 50-54 years.

UNLABELLED: Previous studies of factors important in a woman's decision to use hormone replacement therapy (HRT) infrequently have simultaneously considered the effects of personal concern for chronic medical disorders that begin at the time of the menopause (such as osteoporosis and heart disease) and knowledge of the beneficial and adverse effects of HRT on these conditions (increased risk of uterine and breast cancers). Moreover, few studies have been performed in broad-based populations that have included black women. This study was undertaken to determine the cross-sectional association of concern for chronic medical disorders that begin at the time of the menopause and knowledge of the effects of HRT on these disorders on the ever use of HRT in a biracial cohort of postmenopausal women. Two hundred eight-eight women, aged 50-54 years, who were members of an HMO, who reported their last menstrual period to be more than 1 year ago, and who were aware of HRT, were examined by questionnaire. Of the cohort, 21.2% were black. Concern for chronic medical disorders that begin at the time of the menopause was modest (approximately 50%). Knowledge of the effects of HRT on breast cancer, uterine cancer, and heart disease was low (approximately 30%). Only for osteoporosis was knowledge high (approximately 65%). On adjusted analysis, concern for heart disease was weakly associated with ever use of HRT, but only for white women. The factors most strongly associated with initiating HRT were a doctor's recommendation to use HRT and satisfaction with a doctor's counseling. Having menopausal symptoms was associated with ever use of HRT in black women. Black women were only 30% as likely as white women to ever use HRT after adjustment for baseline differences. CONCLUSION: In this study, personal concerns for medical conditions that begin at the time of the menopause and knowledge of the effects of HRT on these conditions were low. Only personal concern for heart disease among white women was independently, but weakly, associated with ever use of HRT. Black women were less likely than white women to ever use HRT, even after adjustment for baseline differences between them.

Hormone replacement therapy awareness in a biracial cohort of women aged 50-54 years.

OBJECTIVES: Previous studies of hormone replacement therapy (HRT) among women have focused on factors associated with the use of such therapy. Most of the studies involved populations of white women. Consequently, little is known about HRT awareness among the general population of women, and particularly among black women. The present study focused on factors associated with HRT awareness among a cohort of black and white women aged 50-54 years. DESIGN: Of more than 2,700 women, aged 50-54 years, who were members of a health maintenance organization, 700 were randomly selected and mailed a questionnaire addressing their awareness of HRT, as well as their menopausal status, medical history, and sources of information on HRT. RESULTS: Of the 700 women, 479 (68.4%) responded to the questionnaire. After exclusions, 421 (88%) were analyzed. On adjusted analysis, the factors most strongly associated with HRT awareness were a higher educational level, the perception of going or having gone through menopause, the presence of menopausal symptoms, and having undergone a bilateral oophorectomy. Black race (independent of educational level) was associated with a lower likelihood of HRT awareness. The most common source of information on HRT for women in this cohort was the physician, followed by the media. CONCLUSIONS: HRT awareness among women is strongly influenced by race, educational level, and the perception of going or having gone through menopause. Public health efforts to encourage wider use of HRT among older women should focus on increasing HRT awareness among black women and women with a lower educational level.