Psychosocial factors associated with the public's willingness to pay for genetic testing for cancer risk: a structural equations model.

An adaptation of Andersen's behavioral model of health services utilization is used to examine the psychosocial and socio-demographic factors that directly and indirectly influence the likelihood of undergoing genetic susceptibility testing for cancer, and the amount of money that individuals would be willing to pay out-of-pocket for such a test. Apart from willingness and likelihood, the model also included perceived benefits and barriers, perceived susceptibility, dispositional optimism, information seeking, family history of cancer, socioeconomic status (SES), and age, and explained 30.3% of the variation in willingness. We found as hypothesized that likelihood of undergoing such tests was central to understanding willingness to pay. Being aware of genetic susceptibility testing for cancer, and talking and seeking information about it was directly associated with an increased chance of being willing to pay more, independent of other indirect associations (effects). Interventions targeting those with a family history of cancer and those with a higher SES should generate more awareness about the potential positive and negative consequences to one's family of testing, and the interface between family history of cancer and perceived susceptibility. Interventions should also motivate people to talk and seek more information about genetic testing for cancer risk to enable them take well-informed decisions.

Two community outreach strategies to increase breast cancer screening among low-income women.

BACKGROUND: Two approaches were designed for low-income women to promote their use of mammography screening. METHODS: During 1995-96, as part of a community outreach project in a Florida city, 1,157 women aged 45 years or older attended group education sessions on breast cancer screening, while another 1,450 participated in one-on-one talks about screening at display tables in various public places. County mammography registry data were used to assess changes in the use of mammography screening. RESULTS: Among women 55 years old or older, especially whites, the one-on-one approach was more often associated with subsequent mammography screening than was the group approach. African American women and Latina women appeared to benefit more from the group approach than from the one-on-one approach. CONCLUSIONS: Group or one-on-one breast cancer screening education can improve screening behaviors among low-income women, depending on the age and ethnicity of the women targeted.

Planning and initiation of the ONDCP National Youth Anti-Drug Media Campaign.

An alarming upsurge in substance use among American youth in the past decade prompted the Office of National Drug Control Policy (ONDCP) to organize the multifaceted, primary prevention National Youth Anti-Drug Media Campaign. The campaign focuses on adolescents (especially ages 11-13 years), but also targets adolescents' parents and other influential adults. The campaign's main goal is to educate and enable American youth to reject illegal drugs. The purpose of this article is to describe the origin of campaign objectives, processes for the development of specific advertising messages to fulfill these objectives, and how the ONDCP experience could provide a model for other health-oriented media campaigns.

Likelihood of undergoing genetic testing for cancer risk: a population-based study.

BACKGROUND: Studies on public perceptions of genetic susceptibility testing for cancer risks are few and tend to focus on specific cancer risks of higher-risk populations, ignoring the general population and their perceived risk of getting any cancers. This study develops and tests a psychosocial model of the proximal and distal influences on likelihood of undergoing genetic susceptibility testing for cancer risk among a population-based sample. METHODS: The sample consisted of 622 adults aged 18-75 interviewed by telephone. The survey instrument included measures derived from the Health Belief Model and adaptations of existing measures from the literature. Data were analyzed using structural equation modeling techniques. RESULTS: The model suggested independent main effects for perceived benefits, perceived barriers, perceived susceptibility, and pessimism while simultaneously accounting for the effects of age, socioeconomic status, family history of cancer, and awareness of the existence of genetic susceptibility testing for cancer risk. The model explained 34% of the variance in likelihood. CONCLUSIONS: While perceived benefits, perceived barriers, perceived susceptibility, and pessimism may directly impact likelihood, they may also mediate the effects of age, socioeconomic status, family history of cancer, and awareness of cancer genetic susceptibility testing, on likelihood.

The role of cultural variables in breast self-examination and cervical cancer screening behavior in young Asian women living in the United States.

This study examined cultural factors as predictors of breast self-examination (BSE) and participation in cervical cancer screening in young Asian and Caucasian women in the United States. Comparisons between Asian and Caucasian samples revealed significant differences in ever performing BSE and obtaining a pap test; the Caucasian women reported higher participation in both behaviors. Factor analysis of cultural barriers to screening revealed four factors: communication with mother, openness around sexuality, prevention orientation, and utilization of Western medicine. Logistic regression predicting BSE performance from demographics, acculturation, and cultural barriers revealed openness around sexuality to be a significant predictor. Pap test participation was predicted by year in college, ever having engaged in sexual intercourse, prevention orientation, and global acculturation. Cultural factors should be considered in programs to enhance participation in cancer screening.

Community-based promotion of breast screening using small group education.

Small Group Education (SGE) to promote breast cancer screening was implemented in a community-wide program. Based on diffusion of innovations theory, SGE initially was directed toward women at higher occupation and education levels and then progressively shifted toward more vulnerable populations of women at risk of not getting screening. During the four-year intervention, 116 volunteers led SGE presentations, with 8,184 women participating in 740 groups at work sites, organizations, residences, and churches. High participation in SGE and positive participant responses suggest that delivery of SGE using a social diffusion model was an effective method for reaching women throughout the community.

Referral patterns for the evaluation of non-palpable breast abnormalities.

BACKGROUND: Non-palpable suspicious mammographic abnormalities require image-guided breast biopsies. In this study, we examined primary care physicians' knowledge of breast biopsy procedures for non-palpable lesions and referral patterns for breast biopsies; we also identified channels to disseminate information. METHODS: We mailed a baseline survey to all primary care physicians, surgeons, and radiologists in Vermont. RESULTS: Primary care physicians are more likely to refer for excisional rather than percutaneous biopsy. Unlike surgeons and radiologists who learned about these procedures through journals and professional meetings, primary care physicians' most common source of information was from radiologists. CONCLUSIONS: Information about indications for using percutaneous breast biopsy should be available in journals and at meetings to help primary care providers decide on the most appropriate algorithm of workup for patients with non-palpable suspicious breast abnormalities requiring biopsy.

Research in using mass media to prevent smoking.

Mass media are particularly appropriate for reaching young people in smoking-prevention campaigns; however, past research has placed little emphasis on designing effective interventions. Only a few studies have been conducted to develop and evaluate methods to use media for smoking reduction among youth, and only one quasi-experimental study has demonstrated actual reductions in youth smoking. This research requires the use of large controlled field studies that cross disciplines. These lack an established funding base. Furthermore, campaign approaches seeking to reduce youth demand for tobacco products are currently receiving less attention from anti-tobacco policy makers than approaches restricting the supply of tobacco to youth. Scientists from various health behavior and education disciplines should join with creative media production professionals to develop more effective messages and message delivery systems to reach youth at high risk of smoking. Further efforts should be made to share information among these professionals and producers of entertainment programs for youth, as well as among anti-tobacco policy makers, so that the most effective approaches can be employed to reduce youth smoking on a broad scale.

Assessment of self-reward strategies for maintenance of breast self-examination.

This study examined the relative impact of different self-reward strategies on maintenance of breast self-examination (BSE) practice among 1649 women trained to do BSE. Training groups were randomized into four conditions: (a) self-reward instructions and materials delivered at the end of the BSE training session; (b) self-reward suggestions delivered through the mail each month, contingent upon the BSE performance; (c) external monetary rewards and self-reward suggestions delivered through the mail each month on an intermittent schedule, contingent upon BSE practice; and (d) a no-reward control condition. Follow-up assessments 12 months following training revealed a pattern of evidence in support of the benefits of external monetary rewards and self-reward prompts on BSE frequency and quality; however, it is likely that the value of that condition lies in the external reward component.

Three-year prospective adherence to three breast cancer screening modalities.

BACKGROUND: This study prospectively examined rates of adherence to mammography, clinical breast examination (CBE), and breast self-examination (BSE) in a cohort of women over 3 years to determine whether participation in BSE influenced participation in the other two screening modalities. METHODS: Women ages 51 and older (n = 450) who attended a small group educational session to learn BSE and to hear about CBE and mammography guidelines were assessed annually by telephone for 3 consecutive years to determine their subsequent breast cancer screening behavior. RESULTS: Annual CBE and mammography screening are highly positively associated. Regular performance of BSE has a modest positive association with both CBE and mammography adherence over time. CONCLUSIONS: Women who perform BSE regularly over time may be more likely to adhere to the other breast cancer screening guidelines.

A mass media programme to prevent smoking among adolescents: costs and cost effectiveness.

OBJECTIVE: To examine costs and cost-effectiveness ratios of a four-year mass media programme previously shown to prevent the onset of smoking among adolescents. DESIGN: A matched control design. SETTING: Two cities in Montana, one in New York and one in Vermont, USA. SUBJECTS: Students in grades 10-12 (ages 15-18). INTERVENTION: A four-year mass media campaign to prevent the onset of smoking. MAIN OUTCOME MEASURES: Cost per student potentially exposed to the mass media campaign; cost per student smoker potentially averted; and cost per life-year gained. Cost estimates were also made for a similar campaign that would be broadcast nationally in the United States. RESULTS: In 1996 dollars, the cost of developing and broadcasting the mass media campaign was $759,436, and the cost per student potentially exposed to the campaign (n = 18,600) was $41. The cost per student smoker averted (n = 1023) was $754 (95% confidence interval (CI) = $531-$1296). The cost per life-year gained discounted at 3% over the life expectancy for young adult smokers was $696 (95% CI = $445-$1269). The estimated cost of developing and broadcasting a similar four-year mass media campaign in all 209 American media markets would be approximately $84.5 million, at a cost of $8 per student potentially exposed to a national campaign, $162 per student smoker averted, and $138 (95% CI = $88-$252) per life-year gained. CONCLUSION: Estimates of the cost-effectiveness ratios of this mass media campaign in preventing the onset of smoking showed it to be economically attractive and to compare favourably with other preventive and therapeutic strategies.

Reliability of self-reported breast screening information in a survey of lower income women.

BACKGROUND: Self-reported behavior is widely used to estimate the prevalence of breast cancer screening and to evaluate programs for promoting screening, but detailed studies of reliability have not previously been performed. METHODS: Reliability was assessed by comparing responses to questions about screening behavior from repeat personal interviews of 382 women age 40 and older living in low-income census tracts of two Florida communities. Reliability was assessed using Pearson's correlation (r) and kappa (kappa) coefficients. RESULTS: Estimated reliabilities were kappa = 0.38 for "ever had clinical breast examination," kappa = 0.82 for "ever had mammogram," kappa = 0.65 for "mammogram in past year," r = 0.54 for "date of last mammogram," and r = 0.72 for "number of mammograms." The dates of last mammogram reported at the two interviews agreed within 1 month for 64% of the women, while the dates of last clinical breast examination agreed within 1 month for 50% of the women. Reliability of "ever had mammogram" was significantly related to demographic variables. CONCLUSIONS: Women reliably report ever having mammography, but information about timing and frequency has lower reliability. The results have implications for breast screening research because measurement error affects the precision of estimates and the sample sizes needed to detect program effects.

Long-term responses of higher and lower risk youths to smoking prevention interventions.

BACKGROUND: Adolescents at risk for cigarette smoking are difficult to reach with conventional interventions but have substantial exposure to the mass media. This study is the first to show that smoking prevention messages presented through the mass media can have large and durable effects on higher risk adolescents. METHODS: Students in two communities received media and school interventions beginning in grades 5-7; those in matched comparison communities received school interventions. Media interventions were targeted to higher risk youths. School surveys were conducted before and after the interventions, in grades 4-6 and grades 8-10. Two years after interventions ended, when participants were in grades 10-12, school and telephone surveys were conducted to assess smoking status. Survey participants (n = 2,860) were classified at baseline as having higher or lower risk for becoming a smoker. RESULTS: Smoking prevalence within the higher risk sample was significantly lower for those receiving media-school interventions than for those receiving school interventions only (odds ratio = 0.71). Effects on the lower risk sample were similar in magnitude but marginally significant. CONCLUSIONS: Mass media and school interventions achieved lower smoking rates among higher risk youngsters 2 years following completion of the interventions. This strategy represents a uniquely effective method for communicating with a high-priority group.

Modeling smoking cessation: exploring the use of a videotape to help pregnant women quit smoking.

This exploratory study examined the acceptability and efficacy of a videotape modeling smoking cessation as an adjunct to smoking cessation advice delivered during prenatal care. In a randomized controlled trial involving 60 women, we compared the delivery of brief smoking cessation advice and a tipsheet to the same advice and tipsheet plus provision of the videotape. Outcomes included opinions about content and acceptability of the videotape, and smoking behavior change during pregnancy. The most highly endorsed features of the videotape were seeing other women quitting smoking (77%), dealing with stress and bad feelings (69%), talking about what to do with urges to smoke (69%), and discussing ways to get support from families and friends (54%). The reported quit rate in the last month of pregnancy, validated by exhaled carbon monoxide levels, and including women lost to follow-up as smokers, was 19.2% in the intervention group and 0% in the comparison group (p = .02). This study suggests that the use of videotapes modeling smoking behavior change may increase the effectiveness of the assistance in quitting smoking that is generally available in obstetric and family practices or public maternity clinics.

Community education programs to promote mammography participation in rural New York State.

BACKGROUND: Rural women are less likely to receive screening mammography at recommended intervals. This study evaluated efforts to promote screening mammography among women in rural communities through community education interventions and low-cost mobile mammography van services. METHODS: Two matched sets of communities were identified in an isolated rural region. One area received community education programs in addition to the mammography van for 2 years; the second area received only the van services. The educational programs were designed using diagnostic research methods; they included recruitment of opinion leaders to organize small group breast screening education sessions, an information campaign using direct mail, and primary health care provider education. RESULTS: A household telephone survey conducted 6 months after completion of these programs indicated that mammography utilization and perceived mammography norms were higher among women in the Program area than among women in the Comparison area. Process data were consistent with these findings. Clinical examination and self-examination behaviors were not influenced by the programs. CONCLUSIONS: This study showed that well-focused educational interventions for rural women can increase utilization of screening mammography when access and cost barriers also are reduced.