The influence of knowledge and attitudes about breast cancer on mammography use among Latinas and Anglo women

We conducted a telephone survey of randomly selected Latinas (n = 208) and Anglo women (n = 222) to determine predictors of mammography use. The cooperation rate was 78.5%. Relatively high proportions of Latinas (61%) and Anglo women (79%) reported mammography use within the past 2 years. A logistic regression analysis revealed that knowledge and attitudes did not independently predict use. On the other hand, having health insurance, being married, and being Latino were consistent independent predictors. We conclude that mammography use among Latinas and Anglo women is increasing. However, further gains in use must address difficult barriers such as lack of health insurance.     

Breast cancer incidence in Asian migrants to the United States and their descendants

We studied breast cancer incidence during the period 1973-1986 in Asian residents of three U.S. geographic areas. The rate in Asian-American women born in China or Japan and in their U.S.-born counterparts was about 50% and 75% that of U.S.-born whites, respectively, and was approximately twice the rate of women residing in Asia. Breast cancer incidence was nearly identical in U.S.- and foreign-born Filipino-Americans, but it was 40% that of U.S.-born whites.     

Enhancing breast cancer screening in the university setting

Mammography, physical examination by a health care professional, and breast self-examination (BSE) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates. The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines. The following research questions were identified: (a) what are the attitudes of women toward breast cancer screening? (b) what are the barriers to compliance identified by women in breast cancer screening? and (c) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women? A quasi-experimental design was used to study the research questions. The population chosen for the study included female employees in a state university setting. Participants were randomly assigned to one of two groups. All participants were asked to complete a prestudy questionnaire measuring attitudes and beliefs, gathering demographic and health information, and surveying breast cancer screening practices. The experimental group then received coaching and supportive interventions over the course of the academic year. The remainder of the sample served as a control group. A poststudy questionnaire was then sent to the entire sample to identify behaviors related to breast cancer screening. A variety of beliefs and attitudes were observed in the groups. No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination. A difference was noted on compliance with BSE by the experimental group evidencing more compliance.     

Beyond instrument selection: Cultural considerations in the psychological assessment of U.S. Latinas/os.

Currently the second largest U.S. ethnic group, U.S. Latinas/os are projected to continue increasing as a proportion of the U.S. population over the next century. The culturally competent psychological evaluation of U.S. Latinas/os requires both the use of instruments that are adequately validated in that population and the adequate consideration of culturally linked factors known to influence the assessment process and its findings. This article makes foundational recommendations in this second area, organizing them along 4 stages of professional practice in psychological assessment. Consultation with qualified professionals is discussed as being important in ensuring the accurate and ethical psychological assessment of U.S. Latinas/os at all stages of professional practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of prognosis and risk of acute renal failure in bacterial endocarditis

BACKGROUND: Low-income, minority, and inner city women have breast cancer screening rates that are below those of the general population. METHODS: The authors surveyed women who received primary care at Seattle's county hospital about their mammography behaviors in early 1995. Data were analyzed within the context of the PRECEDE framework. RESULTS: Only half (48%) of the women were obtaining regular screening. Breast cancer and mammography beliefs differed by racial group. The following factors differentiated between inner-city women who were and were not regular users: mammography beliefs concerning early detection of disease, pressure from the machine causing breast cancer, and cost (these were less important among white women than members of other racial groups); previous physician discussions, concerns about appointment scheduling, and transportation problems; and social support from physicians, family, and friends. CONCLUSION: Interventions to encourage regular screening among inner-city women should address predisposing, enabling, and reinforcing factors.     

Impact of breast cancer on Asian American and Anglo American women

This pilot study constitutes the first exploration of the impact of breast cancer on Asian American women. Three hypotheses guided this study: (1) Asian American women would choose breast conserving therapy and breast reconstruction at a lower rate than the Anglo American women due to cultural differences in body image, (2) Asian American women with breast cancer would express psychological distress somatically and Anglo American women would express distress emotionally, and acculturation levels of the Asian American women would modify the expressions of distress such that women with high acculturation will express distress more emotionally and less acculturated women would express distress more somatically, and (3) Asian American women would seek assistance for psychosocial problems at a significantly lower rate than Anglo women. Ethnicity, age, and levels of acculturation were found to be significant variables that had to be considered simultaneously. The three hypotheses were only partially supported: (1) Asian American women chose breast conserving therapy and adjuvant therapy at a significantly lower rate than the Anglo American women, (2) Contrary to the hypothesis, somatization did not appear to be a dominant form of symptom presentation for Asian American women regardless of level of acculturation, and (3) Asian American women sought professional assistance for psychosocial problems at a significantly lower rate than Anglo women. Asian American women reported using different modes of help-seeking behavior for emotional concerns and receiving different sources of social support than the Anglo American women. Cultural interpretations of the findings are offered to explain the differences in the physical, emotional, and social responses to the breast cancer experience of Asian American women compared with the Anglo Americans, and notably between the Chinese- and Japanese Americans as well. The findings of this study warrant more refined exploration in order to improve the medical, psychological and social outcomes for Asian American women with breast cancer.     

Latino male attitudes and behaviors on their spouses' and partners' cancer-screening behavior: focus group findings

The following is a report of the first phase of exploratory research growing out of a parent grant on breast and cervical cancer screening among Latinas in Colorado. This paper reports data gathered from 14 focus groups conducted with Latino (Mexican, Mexican-American, and other Hispanic) males to identify their supportive and nonsupportive attitudes and behaviors toward their spouse's breast and cervical cancer screening. The men represent a cross-section of Latino males, yet the findings presented here are strongly suggestive and not representative of Latinos as a whole. Latinos exhibited three distinct modes of knowledge and attitudes toward their partners' health-seeking efforts. The first mode was characterized by limited knowledge, a lack of information, and for some, disinterest or even disdain. Those in the second mode can be considered "generalists" who knew only generalities concerning their wives' health states and practices. The third mode includes Latino males who were genuinely interested in seeking "meaningful ways" to promote their partners' health and well-being. These long-time married couples seemed to have strong relationships highlighted by a genuine concern for each others' well-being, including their health problems. The younger cohorts were generally unconcerned about their spouses' breast and cervical cancer screening and lacked knowledge in the area. As age and educational level increased, so too did the general awareness and knowledge of breast and cervical cancer increase. Most Latinos, however, lacked specific knowledge about screening, the procedures, or the recommended frequency of such examinations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Attitudes of Canadian oncology practitioners toward psychosocial interventions in clinical and research settings in women with breast cancer

The aim of this study was to survey Canadian oncology practitioners' attitudes toward psychosocial concerns and issues in women with breast cancer. Surveys were mailed to 351 medical, radiation and surgical oncologists and 375 oncology nurses. Standard questionnaires assessed attitudes towards psychosocial issues in women with primary and metastatic breast cancer and evaluated the practitioners' willingness to refer women to psychosocial intervention trials in the presence and absence of competing drug trials. Responses were obtained from 74% of those surveyed. Respondents reported being aware of the common occurrence of psychosocial problems in women with metastatic breast cancer, however, physicians were less likely than nurses to offer these women psychosocial support on a prophylactic basis (p < 0.0001) and they expressed greater concern than nurses about scientific validity of (p = 0.0003), and potential psychological damage from (p = 0.005), psychosocial support groups. Nurses were more likely than physicians to favour a study investigating group psychosocial support over competing drug studies (p < or = 0.003) in the metastatic setting. Physicians were less likely than nurses to deal with weight problems prophylactically in women with primary breast cancer (p = 0.0009) and they expressed greater concern over scientific validity of psychosocial interventions addressing weight than nurses (p = 0.0008); nurses were more concerned about excessive expectations of patients regarding potential benefits of such interventions (p < 0.0001). Regardless, nurses were more likely than physicians to favour a psychosocial intervention study focused on weight management over drug studies in pre- (p = 0.0006) and postmenopausal women (p = 0.05) with primary breast cancer. Canadian oncology practitioners are aware of the common occurrence of psychosocial distress in women with breast cancer. Physicians and nurses assigned differing priorities to psychosocial interventions in both clinical and research situations.     

Knowledge, beliefs, attitudes, and cancer screening among inner-city African-American women

Three hundred twenty-one inner-city African-American women were interviewed to determine their knowledge, attitudes, and beliefs regarding cancer and cancer screening, and their cancer screening histories. The women were recruited from a variety of sources in Atlanta and were interviewed in their homes by trained lay health workers. Half of the subjects had an annual household income of < $15,000. About half had received a Pap smear and clinical breast examination within the year preceding the interviews. For women > 35 years old, 35% had received a mammogram within the recommended interval. Younger women and women with higher incomes were more likely than older women and those with lower incomes to have received a Pap test and clinical breast examination within the preceding year, but income was not significantly associated with mammography histories. In general, women who were more knowledgeable about cancer and its prevention were more likely to have been appropriately screened. However, various attitudes and beliefs regarding cancer generally were not associated with screening histories. We conclude that cancer screening programs for inner-city minority women should focus on improving knowledge levels among older women rather than attempting to alter attitudes and beliefs.     

A randomized community trial to increase mammography utilization among low-income women living in public housing

BACKGROUND: A randomized trial was conducted to evaluate the impact of a community-based intervention on mammography use among low-income women living in public housing. METHODS: All 41 public housing high-rise buildings were randomized to treatment and delayed treatment (control) conditions. After a cross-sectional baseline survey, an intervention called Friend to Friend was conducted in the treatment buildings by American Cancer Society and building resident volunteers. The intervention consisted of a health professional talk, small group discussions, and an opportunity to request assistance in obtaining a mammogram or mammogram reminder. A second cross-sectional survey was conducted to measure differences in screening rates between the study groups. RESULTS: Participation in the intervention averaged 27%. The study groups were equivalent at baseline. At follow-up, the proportion of women age 50-79 years who reported mammography screening in the previous 15 months was significantly higher in the treatment group (64%) than in the control group (52%). Breast cancer knowledge, attitudes, and beliefs did not differ between groups. CONCLUSIONS: These findings suggest that a multidimensional intervention which reaches women within their social environment and uses community volunteers can increase mammography utilization among women in public housing.     

Racial/ethnic differences in breast cancer outcomes among older patients: Effects of physician communication and patient empowerment.

Objectives: To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. Methods: A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). Results: Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. Conclusion: Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asian women's attitudes to breast self-examination

This pilot study investigates the attitudes of Asian women towards breast self-examination and breast awareness. It attempts to identify why Asian women may not be aware of breast cancer or practise breast self-examination and discusses issues such as religious beliefs, psychological attributes, perception of the causes of breast cancer and the availability of resources and translated material.     

Use of specialty mental health services by Asian Americans with psychiatric disorders.

Research suggests that Asian Americans underutilize mental health services but an understanding of the multiple factors involved in utilization has not been examined in a nationally representative sample. The current study analyzed data from the National Latino and Asian American Study (NLAAS) and examined 368 individuals with disorders to understand utilization and what factors were related to the utilization of specialty mental health services. Significant underutilization was found for Asian Americans; moreover, underutilization was especially acute among Asian American immigrants. For U.S.-born Asian Americans, use of primary care services was significantly associated with use of mental health services, but for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. For both U.S.-born and foreign-born Asian Americans, use of alternative services appeared to significantly affect whether Asian Americans with disorders utilize mental health services, but the nature of the influence varied depending on the individual’s level of English-language proficiency. These findings revealed that a major mental health disparity, the underutilization of mental health services by Asian Americans, was nuanced by use of other health-related services and immigration-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer

CONTEXT: Breast cancer mortality is higher among African American women than among white women in the United States, but the reasons for the racial difference are not known. OBJECTIVE: To evaluate the influence of socioeconomic and cultural factors on the racial difference in breast cancer stage at diagnosis. DESIGN: Case-control study of patients diagnosed as having breast cancer at the University Medical Center of Eastern Carolina from 1985 through 1992. SETTING: The major health care facility for 2 rural counties in eastern North Carolina. SUBJECTS: Five hundred forty of 743 patients with newly diagnosed breast cancer and 414 control women from the community matched by age, race, and area of residence. MAIN OUTCOME MEASURES: Breast cancer stage at diagnosis. RESULTS: Of the 540 patients, 94 (17.4%) presented with TNM stage III or IV disease. The following demographic and socioeconomic factors were significant predictors of advanced stage: being African American (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.9-4.7); having low income (OR, 3.7; 95% CI, 2.1-6.5); never having been married (OR, 2.9; 95% CI, 1.4-5.9); having no private health insurance (OR, 2.5; 95% CI, 1.6-4.0); delaying seeing a physician because of money (OR, 1.6; 95% CI, 1.1-2.5); or lacking transportation (OR, 2.0; 95% CI, 1.2-3.6). Univariate analysis also revealed a large number of cultural beliefs to be significant predictors. Examples include the following beliefs: air causes a cancer to spread (OR, 2.8; 95% CI, 1.8-4.3); the devil can cause a person to get cancer (OR, 2.1; 95% CI, 1.2-3.5); women who have breast surgery are no longer attractive to men (OR, 1.9; 95% CI, 1.1-3.5); and chiropractic is an effective treatment for breast cancer (OR, 2.4; 95% CI, 1.4-4.4). When the demographic and socioeconomic variables were included in a multivariate logistic regression model, the OR for late stage among African Americans decreased to 1.8 (95% CI, 1.1 -3.2) compared with 3.0 (95% CI, 1.9-4.7) for race alone. However, when the belief measures were included with the demographic and socioeconomic variables, the OR for late stage among African Americans decreased further to 1.2 (95% CI, 0.6-2.5). CONCLUSIONS: Socioeconomic factors alone were not sufficient to explain the dramatic effect of race on breast cancer stage; however, socioeconomic variables in conjunction with cultural beliefs and attitudes could largely account for the observed effect.     

Breast cancer care in older women: sources of information, social support, and emotional health outcomes

BACKGROUND: The authors studied older women with breast cancer and asked: 1) where do older women get information regarding breast cancer care and how helpful do they perceive each of these sources to be? and 2) what aspects of social support are associated with older women's general and breast cancer specific emotional health outcomes? METHODS: To be eligible, women had to be at least 55 years of age and newly diagnosed with TNM Stage I or II breast cancer. Data were collected from women's surgical records and a 35-minute, computer-assisted telephone interview. RESULTS: Nearly all women rated information that was provided by their breast cancer physicians as very or somewhat helpful. Written materials provided by breast cancer physicians also were frequently rated as very or somewhat helpful. Women's marital status, religious service attendance, ratings of their physicians' technical and interpersonal care, and perceptions of their own abilities to communicate with their physicians were significantly associated with both general and breast cancer specific emotional health outcomes (all P < 0.05). CONCLUSIONS: Although older women obtained information regarding breast cancer from a variety of sources, they relied heavily on their physicians for information. To care most effectively for this group of patients, an increased understanding of the relation between the processes and outcomes of breast cancer care is needed Identifying older women with breast cancer at risk for poor emotional health outcomes and developing methods to enhance physician-patient communication in this setting may improve these outcomes.     

Mobilization of iron from neoplastic cells by some iron chelators is an energy-dependent process

Breast cancer is the second leading cause of cancer mortality in African American women. Low rates of cancer screening participation have been documented in inner-city elderly African American populations. Knowledge and beliefs about breast cancer and screening, and self-efficacy in performing breast self-examinations, are important components in an educational program aimed at increasing participation in breast cancer screening. The objectives of this study were to determine the breast cancer knowledge of subjects, their level of confidence when performing breast self-examination, and if individual instruction, one-to-one practice, and feedback on performance made a difference in screening practices. The findings suggest that a more intensive training intervention sustains breast examination self-efficacy.     

Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: Results from the Hispanic family study.

Although the largest immigrant group in the United States is Hispanic, little is known about their rates of traumatic experiences and psychiatric disorders, particularly for youth. Findings with adults suggest that recent immigrants have lower rates of mental illness than long-time residents or U.S.-born Hispanics, but use health-related services less often. The present study examined this relationship in a convenience sample of 131 foreign-born (64.5%) and 72 U.S.-born (35.5%) Hispanic youth, ages 8–17 years and a subset of their caregivers (n = 110). Findings from youth interview data suggest that immigrant and U.S.-born youth did not differ significantly in experiences of potentially traumatizing events or psychiatric disorders. However, findings from caregiver interview data suggest that there were significant disparities between the two groups in health service utilization for doctors and other medical professionals, with caregivers reporting that foreign-born youth utilize these health services at lower rates than U.S.-born youth. Results are discussed in the context of prior findings and recommendations offered for increasing service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of health beliefs on screening mammography utilization among a diverse sample of older women

Screening mammography is particularly effective in detecting breast cancer in elderly women. Yet, although half of all breast cancers are diagnosed in older women, statistics show that women aged 65 and over tend to underutilize screening mammography. Prior research has used the constructs of the Health Belief Model to explore attitudes and beliefs relative to breast cancer screening. Prior studies have also identified health beliefs and concerns relative to screening mammography and race/ethnicity as some of the patient-related predictors of screening mammography utilization among younger women. This study uses the theoretical framework of the Health Belief Model to explore the effects of these variables on utilization in a multiracial, multiethnic, random sample of 1011 women, aged 65 and over. Race/ethnicity, belief that mammograms detect cancer, ease the mind, and provide accurate results; concern over the radiation, pain, and cost associated with receiving a mammogram; and other independent variables were tested as predictors of screening mammography utilization. Regression analysis identified that the belief that having a mammogram eases recipients minds was the most significant predictor of screening mammography utilization. None of the other health beliefs or health concerns were significant predictors. Race/ethnicity had no direct effects on utilization nor was it a confounder in the relationship between health beliefs, concerns and utilization. These results indicate that, along with emphasizing the importance of mammograms in early detection of breast cancer, stressing the reassurance that mammography brings recipients may be an effective health education strategy for elderly women of different racial/ethnic backgrounds.     

Family planning practices and attitudes among former Soviet new immigrant women in Israel

One hundred young new immigrant women from the former U.S.S.R. now living in Israel answered a detailed semi-open questionnaire regarding their knowledge, attitudes and behaviors in fertility and birth control issues. A collective family planning profile of these women is largely in line with that of the urban population of Slavonic U.S.S.R., combining early marriage, early and low fertility, the latter achieved by both abortion and contraception. Most respondents and their partners tried to prevent unwanted pregnancies, usually starting from traditional methods and switching over time to modern ones. An IUD remained most popular contraceptive among parous women, while use of the pill, very rare in the U.S.S.R., has almost doubled upon migration, mostly among younger women. Still, they kept some misleading ideas on the pros and cons of traditional versus modern methods, suggesting lack of adequate information also upon migration. Like their ex-compatriots, our women preferred to solve their birth control problems without external professional involvement. Contrary to the expected, free abortion ideology was not universally advocated by our respondents, and most were fully aware of abortion limitations in Israel. While rationally condemning abortion in both moral and health terms, most respondents still use it, this gap between beliefs and practice being indicative of their readiness to adopt efficient contraception. This switch occurs faster in women actively involved with host society via work or studies. Younger women were found to be more flexible and advanced in their family planning practices than were older ones, while almost no differences were related to education and origin within the U.S.S.R. This exploratory study suggests that any investment into promotion of healthy fertility control practices among new immigrants will be cost-effective in the near future.