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OBJECTIVE: Individuals’ beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State (n=1,002). DESIGN: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models. RESULTS: Hispanic women had a higher probability of not believing ‘at all’ in inheritance and physical activity as causes of obesity—an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing ‘at all’ in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women. CONCLUSIONS: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.

Between 2005 and 2008, we conducted separate phase II clinical testing of three distinct anti-VEGF therapies for patients with relapsed/refractory CLL. Collectively, 46 patients were accrued to trials of single-agent anti-VEGF antibody (bevacizumab, n = 13) or one of two receptor tyrosine kinase inhibitors (AZD2171, n = 15; sunitinib malate, n = 18). All patients have completed treatment. Patients received a median of two cycles of bevacizumab, AZD2171, or sunitinib malate. All three trials were closed early due to lack of efficacy. No complete or partial remissions were observed. Individually and collectively, these studies indicate that single-agent anti-VEGF therapy has minimal clinical activity for patients with relapsed/refractory CLL.

This study examined breast cancer survivors' reports of continuing efforts to make sense of their breast cancer experience and associations of such efforts with post-traumatic stress symptomology (PTSS) and long-term health related quality of life (HRQOL). A cross-sectional survey was conducted with 636 women in 2002-2003 two, five and ten years after their diagnosis of breast cancer. Only a minority of women with breast cancer reported frequently searching for sense in their cancer experience, or wondering "why did this happen to me?" two or more years after diagnosis. Controlling for key demographic and disease variables, greater involvement in search two, five and ten years post-diagnosis was associated with higher levels of PTSS (R2 = 0.26; p0.001) and with reduced HRQOL as measured using the SF-36 scale (p0.01 for all scales). It appears that continued efforts to search for sense in the cancer experience two or more years after cancer diagnosis are associated with PTSS and lower levels of HRQOL in long-term survivors of breast cancer.

Little is known about the spectrum or frequency of comorbidities in patients with chronic lymphocytic leukemia (CLL). We investigated the prevalence and prognostic implications of comorbidities in patients with newly diagnosed CLL. Local/non-referred patients with CLL evaluated by a hematologist at Mayo Clinic within 1 year of diagnosis were eligible for this retrospective review. Of 1195 individuals evaluated for newly-diagnosed CLL between 1995 and 2006, 373 (31%) were local/non-referred. At diagnosis, 89% of these patients had one or more comorbidities, and 46% had at least one major comorbidity. Twenty-six percent of patients failed to meet NCI working group guidelines to participate in a clinical trial. On multi-factor analysis, Rai risk category (1.39 per each risk category increase; p < 0.0001) and age (1.056 per year increase; p < 0.0001) were the only factors associated with overall survival. We conclude that, although common, comorbid conditions are less important than age and stage in predicting prognosis in newly diagnosed patients with CLL. Clinical trials evaluating treatments that are designed to be tolerated by patients who do not meet traditional clinical trial eligibility criteria are needed.

Obesity is a risk factor for multiple disease outcomes, including cancer and cardiovascular disease. A healthy diet and physically active lifestyle can prevent obesity. Sexual orientation is an important demographic factor that has been suggested to affect engagement in health-related behaviors, and interventions developed for the general population of women are likely to be less effective in assisting sexual minority women to make healthy choices. We conducted seven focus groups with sexual minority women (i.e., lesbians and bisexual women) to explore issues, including barriers and motivations, regarding healthy eating, physical activity, and weight in this population. The participants reported a wide range of levels of engagement in health-related behaviors. While nearly all of the participants reported some awareness of the importance of good dietary choices, the majority reported some confusion about what constitutes a healthy diet. In contrast, the majority of participants seemed clearly aware that regular exercise was important for good health. These data can guide the design of effective intervention strategies to improve health behaviors in sexual minority women.

Objectives. Area probability sampling was used to conduct a women's health survey in Boston, MA. Sexual minority women (SMW) and heterosexual adult women were compared on a variety of health-related measures. Methods. SMW-rich census tracts were identified and mapped onto zip code boundaries. Eligible respondents were women 18 and older who lived within the defined area, who were able to complete a personal interview or self-administered questionnaire in English. Differences in significant health-related outcomes by sexual orientation were examined. Results. SMW and heterosexual women differed on access to health care and utilization of screening tests. There were no significant differences in smoking rates, eating less calories or fat, and intentions to follow mammography recommendations. Conclusions. In certain respects, study results are congruent with previous non-probability surveys, while in others the results are different. It is likely that real differences exist in some health-related va...

We collected data on several aspects of resilience and related them to personal perceptions of breast cancer risk and worry about cancer.As part of an ongoing series of studies to examine women's needs for and responses to breast cancer risk counseling, women with a family history of breast cancer (n = 357) completed questionnaires as part of their ongoing follow-up for counseling interventions. The questionnaire contained several measures of resilience: Optimism, the Life Attitude Profile-Revised, and single item scales measuring the worst to best possible life for past, present and future time periods. We also measured quality of life, social desirability, cancer worry, and personal perceived risk of breast cancer. We analyzed the relationships among resilience variables to determine the best measures of resilience from among the measures used. We then related resilience measures to breast cancer worry and risk.Overall, the relationships among the resilience variables varied considerably. The average worst to best possible life ratings increased from past to present to future, and only current and future estimates were highly correlated (r = .62; p0.01). Optimism was not correlated with any other resilience variable, suggesting that it is measur- ing some other construct. None of the resilience measures were highly correlated with social desirability, indicating that resilience is not simply a measure of self-promotion. Quality of life measures correlated most highly with present life ratings (r = .54; p0.01). Perceived cancer worry and risk were negatively correlated with future and present life ratings, but at very low levels (r' s = -.20 and -.21; p0.001 for both). Analyses predicting risk and worry using a subset of resilience variables are presented.These data will help to identify resilient women and how they view and manage their health risks.

Recently, worksites have become an important avenue for health promotion activities due to the number of people that can be reached at work places. The worksite is a good channel through which many types of intervention can be delivered, rather than merely a location for holding groups or classes on a particular health promotion topic. This paper presents the results of a feasibility study for a worksite-wide nutrition intervention using worksites as an intervention channel. Four public sector worksites were recruited to participate in the feasibility study. Two of the worksites were randomized to an intervention condition, and the other two were randomized to a comparison condition. As part of an ongoing worksite health promotion programme, the intervention worksites received a multicomponent worksite-wide nutrition intervention aimed at reducing fat and increasing fruit and vegetable consumption. Nutrition-related and demographic variables were measured at baseline and at two years post-randomiz...

Previous research has documented post-traumatic stress disorder among Salvadoran refugees in this country, but information on refugees living in El Salvador is not available. This study investigated the patterns of psychological distress and documented the existence of PTSD in Salvadoran refugee women in El Salvador. A team of U.S. mental health workers traveled to a refugee camp in El Salvador to interview women about their traumatic experiences and current symptoms of distress. This study provides strong evidence that many refugee women in El Salvador have developed PTSD and that many others show significant signs of distress. Data from this study also provided insight into clinical issues for Salvadoran women experiencing PTSD. In response to requests from Salvadoran mental health providers, a treatment program was developed to help Salvadoran women reduce their distress. Goals of the treatment included associating distress with the trauma as a normal reaction to a very abnormal event, reducing feeling...

It has become virtually a truism that communication is the glue that holds us together, solidifying relationships within and across families, social structures, distance, professional hierarchies, and cultures. In the oncologic context, being able to communicate effectively has been shown to facilitate the transfer of information and needed facts about cancer prevention and control from person to person, between persons and providers, and between persons and the health care system and the broader community. Assessing and addressing individuals’ communication needs is increasingly essential in an era where computer technology has dramatically expanded the ability to present and frame information for specific subgroups of people. The advent of web-based channels of information delivery has also allowed for the packaging of information in ways that can convey risk feedback in a supportive fashion, involve and mobilize the person’s social support network, and provide incentives, cues, and resources for motivating and sustaining high quality health protective decisions, action plans, and behaviors.. However, the combined promise of behavioral science and computer technology for improving access to personally relevant and accurate information, enhancing informed health choices, and ultimately improving people’s health status, has not yet been fully realized. Therefore, in March 2008, the Cancer Special Interest Group (SIG) of the Society of Behavioral Medicine commissioned a pre-conference scientific meeting on Communication in Cancer. Prevention and Control. This meeting was co-sponsored by the National Cancer Institute (NCI), along with the Society of Behavioral Medicine and the American Cancer Society, With the further support of the National Cancer Institute, the Cancer SIG organizing team invited manuscripts from the meeting participants, including the primary guest speakers as well as the break-out session roundtable participants, and has integrated them into this special issue. The NCI has long recognized that an understanding of the basic principles of cancer communication at the micro (clinical) to macro (media) levels, in conjunction with the design and evaluation of messaging channels for conveying that information, is fundamental to cancer prevention and control, along the entire cancer continuum, In accordance with this comprehensive approach, each paper presents a distinctive, but complementary, view on the field of cancer and communication. The issues discussed range from a focus on communication patterns between people as they deal with their health care options and choices, to perspectives on how health care policy influences – and is reciprocally influenced by – available communication concepts, tools, and challenges. We asked the primary presenters to provide synthesized overviews of the specific areas that they had discussed at the pre-conference, and we asked the breakout session participants to succinctly summarize the discussions of their assigned topics, resulting in more focused documents for inclusion. The papers contained in this volume present the state of the science in cancer-related communication, and are geared to be equally useful for cancer researchers and providers. The overarching goal of this special issue is not only to distill out the existing evidence base on communication in cancer prevention and control, but also to provide a roadmap for future research and to strengthen multi-disciplinary collaborations. Accordingly, the roster of contributors includes both independent investigators and NCI staff, to gain perspective from the vantage points of their respective positioning in the field, and to work towards medling these viewpoints together.