Showing papers by "Karen M. Emmons published in 2004"

Reducing Social Disparities in Tobacco Use: A Social-Contextual Model for Reducing Tobacco Use Among Blue-Collar Workers

Abstract: In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers’ lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

Decreasing women's anxieties after abnormal mammograms: a controlled trial.

Abstract: Background: Few studies have evaluated interventions to decrease a woman’s anxiety after she receives an abnormal mammogram (i.e., one with a recommendation for follow-up). We performed a controlled trial to compare the effects of both an immediate reading of mammograms (i.e., a radiology intervention) and of an educational intervention that taught skills to cope with anxiety on the psychological status of women whose mammograms were normal or abnormal. Methods: Eligible women (n 8543) aged 39 years or older were recruited from seven mammography sites at the time of their scheduled mammography screening and assigned to receive no intervention, either the radiology or the educational intervention, or both interventions. We used the Impact of Events Scale (IES) and the Hopkins Symptom Checklist subscales for Anxiety (HSC-A) and Depression (HSC-D) in structured telephone interviews of 2844 women to assess the psychological status of all women with abnormal mammograms (excluding women diagnosed with breast cancer) and of a random sample of women with normal mammograms at 3 weeks and 3 months after their mammograms. All statistical tests were two-sided. Results: We obtained usable 3-week interviews for 2390 (84%) women. By the 3-week interview, 1037 (72.1%) of the 1439 interviewed women with abnormal mammograms had completed the recommended work-up and knew that their abnormal mammograms were false positives. Women with abnormal mammograms had higher IES and HSC-A scores (i.e., more anxiety) than women with normal mammograms (mean IES scores: 4.97 [95% confi dence interval {CI} 4.47 to 5.50] and 1.82 [95% CI 1.51 to 2.14], respectively; P<.001; mean HSC-A scores: 1.14 [95% CI 1.12 to 1.15] and 1.11 [95% CI 1.09 to 1.13], respectively, P .002). Among women with false-positive mammograms, those who had received the radiology intervention reported less anxiety than those who had not (mean IES scores: 4.42 [95% CI 3.73 to 5.07] and 5.53 [95% CI 4.82 to 6.28], respectively, P .026). The educational intervention was not associated with any difference in psychological outcomes. Three months after the mammogram, by which time more than 80% of the women with abnormal results knew their mammograms to be false positives, anxiety levels of women with false-positive mammograms remained higher than those of women with normal mammograms (mean IES scores: 2.34 [95% CI 1.99 to 2.69] and 1.15 [95% CI 0.87 to 1.47], respectively, P<.001). Conclusion: Immediate reading of screening mammograms, but not an educational intervention targeting coping skills, was associated with less anxiety among women with false-positive mammograms 3 weeks after mammography. [J Natl Cancer Inst 2004;96:529 –38]

Colon Cancer: Risk Perceptions and Risk Communication

Abstract: Members of a health maintenance organization (N=353) interacted with a computer program that provided personalized information about their risk of developing colon cancer in the next 20 years. Prior to computer feedback, most people greatly overestimated their numerical, absolute risk (chances per 1000) and also overestimated their relative risk compared to peers (e.g., "above average"). Their relative risk estimates were correlated with several risk factors, whereas their absolute risk estimates were not, suggesting that assessing individual risk perceptions with numerical, absolute risk scales may provide misleading information about what people believe. Computer feedback improved the accuracy of mean risk estimates, but about half of participants did not accept the personalized feedback as correct. In fact, correlations between actual and perceived risk were no greater among participants who received risk scores than among those who did not. Three possible explanations for resistance to lower-than-expected risk feedback are considered.

Characteristics associated with use or intention to use indoor tanning among adolescents.

Abstract: Background Indoor tanning is a popular behavior that may increase skin cancer risk. Objective To examine characteristics associated with use or intention to use indoor tanning among adolescents. Methods A telephone interview was conducted with 1273 adolescents, aged 14 to 17 years, in the Minneapolis– St Paul, Minn, and Boston, Mass, metropolitan areas. Questions included demographic and phenotypic characteristics, knowledge, attitudes, social factors, use of indoor tanning, and intention to tan indoors. Results Twelve percent of boys and 42% of girls had tanned indoors. Among nontanners, 22.4% planned to start, and 77.2% of tanners planned to continue tanning indoors. Nontanners and tanners at risk for future indoor tanning use were each significantly more likely to be female, less likely to use sun protection, less knowledgeable about skin cancer risks, more likely to agree that tans were attractive, and more strongly influenced by social factors compared with their low-risk counterparts. Conclusions Our data suggest that intention to tan indoors may identify a group of adolescents at risk for adopting the behavior; prospective studies are needed for confirmation.

The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

Abstract: BACKGROUND The current study characterized the self-reported cancer screening practices of adult survivors of childhood cancer. METHODS A cohort of 9434 long-term survivors of childhood cancer and a comparison group of 2667 siblings completed a 289-item survey that included items regarding cancer-screening practices. RESULTS Overall, 27.3% of female respondents reported performing breast self-examination (BSE) regularly, 78.2% reported undergoing a Papanicolaou smear within the previous 3 years, 62.4% underwent a clinical breast examination (CBE) within the last year, and 20.9% had gotten a mammogram at least once in their lifetime. Approximately 17.4% of male respondents reported performing regular testicular self-examination (TSE). Women age ≥ 30 years who had been exposed to chest or mantle radiation therapy were more likely to report undergoing CBE (odds ratio [OR], 1.59; 95% confidence interval [95% CI], 1.32–1.92) and mammography (OR, 1.92; 95% CI, 1.47–2.56). Compared with the sibling comparison group, survivors demonstrated an increased likelihood of performing TSE (OR, 1.52; 95% CI, 1.22–1.85) or BSE (OR, 1.30; 95% CI, 1.10–1.52), of having undergone a CBE within the last year (OR, 1.18; 95% CI, 1.02–1.35), and of ever having undergone a mammogram (OR, 1.82; 95% CI, 1.52–2.17). CONCLUSIONS The results of the current study demonstrate that the cancer screening practices among survivors of childhood cancer are below optimal levels. Primary care physicians who include childhood cancer survivors among their patients could benefit these individuals by informing them about future cancer risks and recommending appropriate evidence-based screening. Cancer 2004. © 2003 American Cancer Society.

Tailored Computer-Based Cancer Risk Communication: Correcting Colorectal Cancer Risk Perception

Abstract: We developed a computer-based tailored risk presentation and risk communication aid for colorectal cancer prevention. To evaluate the effectiveness of the tool, we randomized 353 participants to receive different risk presentation formats (relative plus absolute risk vs. absolute risk only vs. none) and different levels of engagement with the risk communication (active vs. passive). Findings suggest the tool to be useful for correcting misperceptions about personal risk. Of those with inaccurate risk perception at baseline, more than half of the participants in intervention groups had corrected risk perceptions at post-test, compared to only 12% in the control group.

Multiple risk behaviors among smokers in the childhood cancer survivors study cohort

Abstract: The literature on health behaviors of young adult cancer survivors is very limited, and thus little is known about preventable risk factors in this population. This paper describes the prevalence of five behavioral risk factors among 541 young adult survivors of childhood cancers from the CCSS cohort who were identified as smokers and enrolled in a randomized controlled trial of a smoking cessation intervention. The relationship between presence of multiple risk factors and a number of smoking-related factors was examined. About 31% of the sample engaged in zero or one health-risk behavior in addition to smoking; 63% engaged in 2 or 3, and 6% engaged in 4 or 5. There were positive linear relationships between number of risk factors and smoking rate and nicotine dependence. Number of risk factors was not associated with self-efficacy for quitting, but was related to readiness to quit. This study demonstrated that childhood cancer survivors who smoke have a number of other risk factors for the development of preventable disease and the presence of these risks was associated with factors that decrease the likelihood of quitting smoking. Attention to other health behaviors may be an important strategy for helping smokers quit. In particular, helping childhood cancer survivors who smoke to reduce other risk behaviors might also encourage them to quit smoking.

Oncology Physician and Nurse Practices and Attitudes Regarding Offering Clinical Trial Results To Study Participants

Abstract: Despite recent interest on the part of advocates and researchers of oncology clinical trials in sharing study results, participants in these trials are not routinely informed about the results. We identified oncology physicians and nurses through the Cancer and Leukemia Group B database and surveyed them about sharing clinical trial results with participants. Of 1977 eligible members, 796 (40.3%) responded to the mailed survey, 497 (62.4%) of whom reported that they offer trial results to participants less than one-fifth of the time. A total of 576 (72.4%) of responders believed that most patients want to know the results of studies, and 634 (79.7%) of responders expressed willingness to offer results to most study participants in the future, believing that most patients want to know trial results and that routinely offering results would not have a negative effect on patients. Concerns of some responders about routinely offering trial results included negative emotional effect on patients, patient difficulty understanding the information, and resources required to offer the results. Of concern, 16.2% (129/796) of responders believed an obligation to offer results to study participants would make them less likely to enroll patients on studies. Future studies should consider sharing trial results with patients and evaluating the process and its effect on both patients and clinicians.

Undoing an epidemiological paradox: the tobacco industry's targeting of US Immigrants.

Abstract: Objectives. We sought to ascertain whether the tobacco industry has conceptualized the US immigrant population as a separate market.Methods. We conducted a content analysis of major tobacco industry documents.Results. The tobacco industry has engaged in 3 distinct marketing strategies aimed at US immigrants: geographically based marketing directed toward immigrant communities, segmentation based on immigrants’ assimilation status, and coordinated marketing focusing on US immigrant groups and their countries of origin.Conclusions. Public health researchers should investigate further the tobacco industry’s characterization of the assimilated and non-assimilated immigrant markets, and its specific strategies for targeting these groups, in order to develop informed national and international tobacco control countermarketing strategies designed to protect immigrant populations and their countries of origin.

Comparison of motivations and concerns for genetic testing in hereditary colorectal and breast cancer syndromes

Abstract: Genetic testing for predisposition cancer syndromes has been broadly implemented in the clinical setting in the last several years. Some of the most recognisable familial cancer syndromes for which genetic testing is available are hereditary non-polyposis colorectal cancer (HNPCC), familial adenomatous polyposis (FAP), and hereditary breast and ovarian syndrome (HBOS). Genetic testing in these individuals may have relevant medical and psychological implications for them and their families. Whether individuals at risk for hereditary colorectal syndromes such HNPCC or FAP have different motivations and concerns about genetic testing than individuals with HBOS is not known. The first studies addressing motivations for genetic testing for cancer predisposition were carried out in the mid 1990s.1–6 These studies were conducted not in people actually undergoing testing but in the general population or among first-degree relatives of individuals with breast, ovarian, or colon cancer. They revealed that willingness to undergo genetic testing was associated with higher perception of cancer risk or of being a gene carrier and that the most common reasons for their stated intent to pursue genetic testing were to learn about one’s children’s risks, be reassured regarding one’s own risk, and a wish to increase screening practices. Concerns about genetic testing included mistrust of test accuracy, worry about losing health insurance, and fear of emotional reactions if the test was positive. Despite the high uptake for genetic testing predicted by the above studies, rates of testing were lower than expected when it actually became available for families with HBOS or HNPCC syndromes.7,8 Reported barriers to genetic testing among individuals at risk for HBOS were concerns about losing health insurance, and the belief that test results might not be accurate.7 A low level of education and the presence of depression symptoms, especially among women, were found to be …

Age-related vulnerabilities of older adults with colon adenomas: evidence from Project Prevent.

Abstract: BACKGROUND This report addresses the interface between cancer and aging in the context of colorectal carcinoma (CRC), the second leading cause of cancer death in the U.S. overall and the first leading cause among individuals age ≥ 75 years. Because polyp risk increases with age, interventions to prevent recurrent polyps among older adults likely would reduce CRC morbidity and mortality. METHODS Data for this study derive from Project Prevent, a multisite, randomized controlled trial designed to reduce behavioral risk factors for CRC among 1247 adults who underwent the removal of ≥ 1 adenomatous colon polyps. Middle-aged and older patients were compared on key cognitive-behavioral mechanisms associated with CRC risk and established age-related factors associated with adverse health outcomes. Relations between cognitive-behavioral mechanisms and age-related vulnerability factors identified subgroups of older polyp patients that may have an enhanced risk for CRC. RESULTS Compared with middle-aged patients, older patients were less concerned about developing CRC, less motivated to reduce their risk, and less confident that their behavior change efforts would succeed. As expected, they also reported more age-related physical, social, and economic vulnerabilities, as expected. Evidence for enhanced CRC risk was found for older patients with multiple comorbid conditions, low social support for change, and perceptions of income inadequacy. CONCLUSIONS The presence of age-related vulnerability factors may enhance the risk of CRC among older cancer patients by creating barriers to behavioral change. Efforts to reduce the cancer burden in older populations will require attention beyond early detection and surveillance to interventions that account for the unique physical and psychosocial characteristics of older adults. Cancer 2004;100:1085–94. © 2004 American Cancer Society.

Colon Cancer Risk Counseling by Health-Care Providers: Perceived Barriers and Response to an Internet-Based Cancer Risk Appraisal Instrument

Abstract: Background. Risk appraisal instruments may be helpful in reinforcing prevention messages, although little is known about physician acceptance of such instruments. Objective. We explored perceived barriers to colon cancer risk counseling and responses to the colon cancer component of an Internet-based risk appraisal instrument. Methods. We qualitatively assessed provider perceptions of barriers to colon cancer prevention and screening, and their responses to the Harvard Cancer Risk Index using focus groups of primary care providers. Results. Many providers commented that the risk appraisal instrument may be most helpful to reinforce messages by a health-care provider. The tool may increase awareness about modifiable risk factors for cancer and help patients prioritize changes as well as improve screening acceptance. With regard to barriers to counseling patients about colon cancer prevention and screening, providers expressed concerns that behaviors are too difficult to change. In addition, they were frust...