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Purpose: The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined.Patients and Methods: The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress.Results: The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility.Conclusions: These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs. [ABSTRACT FROM AUTHOR]

Using a snowball technique, in-depth interviews were conducted with 108 girls emanating from seven demographically dissimilar social networks. Girls were asked to classify 58 items as either a risk or protective factor for smoking initiation and then to assign an importance weighting to each. All items except one (worries about her weight) were clearly categorized as risk or protective; mean levels of agreement were 80.8% for perceived risk items and 92.6% for perceived protective items. Principal components analysis (PCA) of the weights given to the perceived risk items found that 28 items loaded on seven factors (social, affect, access, media, offers, family, and image) and explained 71.26% of the variance. PCA of 25 protective items revealed four factors (health, family, looks, and barriers) that explained 73.35% of the variance. Significant group differences on the importance weights were found, primarily by school (public or private), age (12-14 years or 15-16 years), having a friend who smokes (yes or no), and having tried smoking (yes or no). These group differences support the idea of having a broader array of antismoking messages for adolescent girls so that important subgroups can be targeted. Additional results support the position of developing antismoking messages with positive, affirming themes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the interactive effects of message frames and CVD risk factors on women's knowledge, beliefs, efficacy, and behavioral intentions. METHODS: In a randomized experiment, women (n = 395) read either a loss- or gain-framed heart disease prevention message to test differential effects by risk factor status. RESULTS: Messages significantly increased knowledge, self-efficacy and intervention efficacy beliefs, and behavioral intentions. Frames had significantly different effects on self-efficacy and behavioral intent to engage in detection behaviors by parental risk factor status. CONCLUSIONS: Further study is warranted to assess effects of frames on behavioral outcomes among women at elevated CVD risk. [ABSTRACT FROM AUTHOR]

This analysis examines the applicability of the emotional labor scale from the Emotions at Work Scale (EWS) through the assessment of its psychometric properties in a sample of young workers. Factor analysis and test-retest reliability were conducted on a 13-item scale measuring emotional labor. The EWS 13-item emotional labor scale was refined to 9 items. Two subscales were delineated: 5 items measured surface acting and 4 items measured deep acting, each with a mean inter-item correlation of 0.33. Cronbach's alpha was .96 for the 9-item scale, and .71 and .67 for the surface acting and deep acting subscales, respectively. Test-retest reliability was 0.64 for surface acting and 0.51 for deep acting during a mean interval of 3 months. Emotional labor can be quantitatively measured among young workers using the derived 9-item scale, although additional studies further evaluating its use should be conducted. [ABSTRACT FROM AUTHOR]

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mm Hg; diastolic blood pressure (DBP)increased 10.63 mm Hg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBP - 140 mm Hg and/or DBP - 90 mm Hg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping. [ABSTRACT FROM AUTHOR]

A total of 262 women in the USA (161 breast cancer survivors and 101 controls) were exposed to a video vignette using modeling in which a physician discussed the concept of a clinical trial (CT) with a woman who was in the process of making a treatment decision. A pretest-post-test design was used and improvements in clinical trial knowledge and beliefs were assessed. Results indicate that video modeling is a powerful tool for increasing CT knowledge (pretest mean=41.5% correct, post-test mean=77.5% correct) but not for improving CT beliefs. Increased clinical trial knowledge, as measured by change scores, was associated with white race, lower levels of education and pretest breast cancer knowledge, more negative pretest CT beliefs, and a higher estimate of the lifetime probability that a woman will have breast cancer. When pretest CT knowledge was added to the analysis using hierarchical multiple regression, all variables except white race became nonsignificant; an increase in CT knowledge was associated with having lower pretest CT knowledge. Results indicate that the effects of low education, low breast cancer knowledge, and biased probability assessment were mediated through the pretest score. An increase in post-test positive CT beliefs was associated with older age, thinking about breast cancer less often, and having lower pretest CT knowledge in the total sample. When pretest CT beliefs was added to the analysis using hierarchical multiple regression, all other variables became nonsignificant; an increase in CT beliefs was associated with having lower pretest CT beliefs, again indicating mediation of the effects of other variables. [ABSTRACT FROM AUTHOR]

Shahnaz Sultan,1–4 Melissa R Partin,1,2 Phalgoon Shah,5 Jennifer LeLaurin,4 Ivette Magaly Freytes,4 Chandylen L Nightingale,6 Susan F Fesperman,4 Barbara A Curbow,7 Rebecca J Beyth3,4,8 1Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 2Department of Medicine, University of Minnesota, Minneapolis, MN, 3Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 4Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 5Department of Medicine, Tripler Army Medical Center, Honolulu, HI, 6Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem NC, 7Department of Community and Behavioral Health, University of Maryland, College Park, MD, 8Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA Background: A recommendation to undergo a colonoscopy, an invasive procedure that requires commitment and motivation, planning (scheduling and finding a driver) and preparation (diet restriction and laxative consumption), may be uniquely challenging for individuals with multiple chronic conditions (MCCs). This qualitative study aimed to describe the barriers and facilitators to colonoscopy experienced by such patients.Materials and methods: Semistructured focus groups were conducted with male Veterans who were scheduled for outpatient colonoscopy and either failed to complete the procedure or completed the examination. Focus group recordings were transcribed and analyzed by an inductive grounded approach using constant comparative analysis.Results: Forty-four individuals aged 51–83 years participated in this study (23 adherent and 21 nonadherent). Participants had an average of 7.4 chronic conditions (range 2–14). The five most common chronic conditions were hypertension (75%), hyperlipidemia (75%), osteoarthritis/degenerative joint disease (59%), atherosclerotic heart disease (48%), and diabetes mellitus (36%). We identified four unique themes that influenced motivation to undergo a colonoscopy: competing medical priorities, low perceived benefit, a prior negative colonoscopy experience, and pre-existing medical conditions. Additionally, we identified four themes that influenced individuals’ ability to complete the examination: difficulty with bowel cleansing, difficulty with travel, worry about exacerbation of pre-existing conditions, and heightened concerns about potential complications.Conclusion: MCCs are common in individuals referred for colonoscopy and generate unique barriers to colonoscopy completion related to medication, dietary changes, transportation, preparation processes, symptoms exacerbation, and complication concerns. Future research should examine whether tailored interventions that include education and support in addressing the unique barriers can enhance colonoscopy completion. Keywords: adherence, colonoscopy barriers, multiple chronic conditions, Veterans

Because minority women remain underusers of screening, strategies to increase preventive health behavior may involve affordable screening as well as cultural determinants. Most studies have used a theoretical model inconsistently to assess characteristics, such as attitudes, beliefs, and perceptions about adherence to mammography screening, whereas other studies have lacked sociocultural dimensions that may be relevant in promoting repeat screening in certain populations. This two-phase study examined adherence to mammography screening among 150 African-American women aged 40 to 49 years who had received one to five mammograms. Phase I included an elicitation procedure, a focus group, and pretests as steps in constructing a telephone interview. In Phase II, 150 telephone interviews were completed. Women's intentions regarding repeat mammography screening were assessed using the theory of planned behavior, expanded to include sociocultural, religious, and psychological variables. Only the attitude and perceived behavioral control components of the theory explained the women's intentions. In the expanded model, a positive previous experience with mammography, low income and educational level, positive beliefs about breast health, and lack of trust in health care providers explained increased intention to have another mammogram. The study's clinical and policy implications were positive: When low-income AfricanAmerican women are exposed to screening programs that provide positive experiences with mammography and include a strong component to enhance adherence, their intention to seek repeat screening increases. This level of health care needs to be adopted as standard practice for optimal breast health among all women. [ABSTRACT FROM AUTHOR]

Objective: To determine the health, functional ability, and employment status of adults who survive bone marrow transplantation.Design: Inception cohort study.Setting: Patients who received transplants at a single referral-based center.Patients: Adults of 18 years of age or older who had received bone marrow transplants at least 6 months previously and who were not in a life-threatening relapse were surveyed a mean of 47 months after transplant (median, 37 months; range, 6 to 149 months). Of 171 eligible patients, 157 were contacted and 135 (86%) responded.Measurements and Main Results: Patients completed a mailed survey. Medical records were also reviewed. Most patients (93%) reported they could do normal activities with minor or no physical problems (Karnofsky scores, greater than or equal to 80%). Global health was described as good to excellent by 67% of subjects. Most perceived social activities (80%) or physical functional abilities (67%) to be unimpaired or only slightly affected. Moderate or severe pain was uncommon (13%). Sixty-five percent had returned to full- or part-time employment, and one third of those who were not employed were attending school. Job discrimination and problems in obtaining insurance were reported by 23% and 39%, respectively. Among those who had been employed before illness, loss of employment was associated with lower social functioning, chronic graft-versus-host disease, greater job discrimination, and female gender using multivariate logistic regression.Conclusions: Most subjects surviving bone marrow transplant reported good to excellent health and functional ability. Three fourths were employed or enrolled in school. These outcomes are comparable to outcomes in survivors of cancer who received less intensive treatments. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the correlation between the age of college student who patronized traditional and hookah bars and alcohol consumption in southeastern U.S. in 2009. College students who frequented hookah and traditional bars were surveyed based on their willingness to consume alcohol before the survey and their drinking behavior during the evening. It is shown that college students who planned to return to their own residence after drinking at traditional bars.

Background: In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual's preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age., Methods: Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance., Results: Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights., Conclusions: We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49., (© 2021. The Author(s).)

Introduction: Colonoscopy screening is an effective method of detecting and preventing colorectal cancer. Standard procedure for most colonoscopies (98%) is to use conscious sedation, which can cause short-term cognitive impairment postprocedure, including communication difficulties. In this study, we explored providers' (gastroenterology doctors and nurses) perceptions of the barriers to optimal communication with patients immediately following colonoscopy., Methods: We conducted interviews with 61 providers across 5 clinical configurations. Interviews were transcribed and coded with NVivo version 11 software., Results: Themes emerged regarding barriers to optimal provider-patient communication postcolonoscopy: patient barriers (sedation and patient characteristics), caregiver barriers, and system characteristics., Conclusions: Providers' perceived barriers to communication are an important topic to study. They endorsed, in particular, interventions that target the postcolonoscopy time frame when patients may still be sedated, but providers must convey important discharge and follow-up instructions., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC., Method: A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results., Results: Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role., Conclusions: Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.

The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The Internet has become a ubiquitous venue for information seeking, especially for health information. Public health practitioners have noticed the promise and potential of the Internet, however, little is known about individuals' skills of their eHealth literacy. The eHealth Literacy Scale, eHEALS, was designed to measure perceptions of individuals' eHealth literacy skills., Objective: The objective of the study was to examine the psychometric validity and reliability of the eHEALS with two adult populations using the Rasch Model., Methods: A college-aged sample and an Internet-based sample (Amazon's MTurk) were recruited to complete the eHEALS, demographic questions, and a health literacy scale. Using WINSTEPS and SPSS, unidimensionality, item fit, rating scale, item hierarchy, person ability-item match, and reliability were analyzed, compared, and contrasted against each sample and to other samples found in the literature., Results: An exploratory factor analysis supported unidimensionality in both samples. More than 90% of respondents from both samples fit the model. No items were outright misfitting. Both samples separated into three distinct groups., Conclusions: Based on the results, the eHEALS is a reliable and consistent measurement tool for a college sample and an Internet-based sample. As these individuals are most likely to use the Internet as a health resource, it is necessary to learn and know their skills versus perceiving that they can critically and successfully navigate the Internet. Further analyses are necessary to ensure that the eHEALS can serve as a standard eHealth literacy measure for public health.

Objective: Colonoscopy is a complex procedure that requires bowel preparation, sedation, and has the potential for substantial risk. Given this, we investigated colonoscopy patients' perceived and actual understanding of the procedure., Methods: Consecutive colonoscopy patients were enrolled and surveyed, with their caregivers, immediately prior to their procedure. Demographics, health literacy, socioeconomic status and perceived risks/benefits were assessed. Thematic analysis was conducted on open-ended responses and a 3-level outcome variable was created to categorize correctness of patients' and caregivers' understanding. Multinomial logistic regression was used to determine predictors of response level., Results: Patients (N=1821) were 77% White, 60% female, and averaged 54 years old; caregivers were demographically similar. Among patients, bivariate analysis revealed that younger age, minority race, and low income, education, and health literacy were associated with incomplete understanding. Multinomial regression revealed that age, education, health literacy, first-time colonoscopy, and perceived risk-benefit difference discriminated among groups. Bivariate and multinomial results for caregivers were similar., Conclusion: Patients and caregivers varied on information, understanding and misconceptions about colonoscopy. Implications are discussed for inadequate: 1. informed consent, 2. bowel preparation, and 3. emotional preparation for cancer detection or adverse events., Practice Implications: Attention should be paid to patients' understanding of the purpose, anatomy, and logistics of colonoscopy, preferably prior to bowel preparation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The HIV-prevention behaviors of "abstinence" from sex, "being faithful" to one sexual partner, and "condom use" (ABC) are the focus of many international HIV interventions. Kenyan in-school youth ages 13-19 years (N = 1,375) were surveyed before the intended HIV-prevention intervention was implemented. As part of the survey, students wrote their definitions of the terms in a space provided. These definitions were qualitatively analyzed by determining recurrent themes, developing a codebook, and having two coders code the responses. The entire definition was assigned an overall fully comprehended, partly comprehended, did not comprehend, or no response code in comparison to the conventional definition of the term. Overall, 48% fully comprehended abstinence, 20% fully comprehended being faithful, and 7% fully comprehended consistent condom use. This suggests that these terms, and the meanings behind them, need additional clarification and discussion if they are to be used appropriately in HIV-prevention programs.

Within the workplace, there is less reliance on engineering controls for dermal exposure protection and more reliance on the worker's motivation and training in use of personal protective equipment. Behavior thus becomes a significant determinant of dermal exposure, and its assessment paramount in examining and understanding factors influencing exposure. The main objectives of this study were to: (i) assess worker knowledge, attitudes, and perceptions (KAP) of workplace dermal hazards using a self-complete questionnaire and to examine KAP associations with behavior and exposure; (ii) compare worker and manager scores to identify potential gaps in KAP between the two groups; (iii) utilize a semiquantitative observational DeRmal Exposure Assessment Methodology (DREAM) to evaluate worker dermal exposure; and (iv) identify potential behavioral factors underlying exposure using DREAM and KAP. Nineteen industries across the Baltimore, Md. and Lancaster, Pa., regions participated in the study including a total of 89 workers and 17 managers. The scales within the KAP questionnaire that served as the outcome measure included knowledge, training, behavior, behavior beliefs, information beliefs, self-efficacy, and overall beliefs. DREAM scores ranged from 0.15 to 545 with a median of 8 and a mean (SD) of 22 (62.5). Whereas worker self-efficacy with respect to PPE use, and the group "workers with 10-20 years of experience" were marginally positively associated with protective behavior (p < 0.08 and p < 0.06, respectively), a question related to barriers to PPE use was negatively associated with precautionary behavior (p < 0.01). Dermal exposure was positively associated with workers in the age group 40-49 years as compared with those less than 40 years of age (OR = 4.86, 95% CI = 0.93, 25.62). There were no statistically significant associations between KAP and DREAM. This is one of the first studies to begin to elucidate worker knowledge, attitudes, and perceptions that underlie behaviors that lead to occupational dermal exposures. Results of the KAP questionnaire can inform strategies to improve awareness and protective practices in the workplace through factors such as increased worker dermal hazard knowledge, well-informed company PPE selection and availability, and improved worker training.

This study examined the association of sociodemographic characteristics and smoking behaviors (i.e., cigarette, cigar, and waterpipe) with nicotine product harm perception in college freshmen. Students were asked to compare the perceived harmfulness of 11 nicotine-delivering products with that of a regular cigarette. Data were from a cross-sectional Internet survey conducted during the spring 2004 semester at a private university (N = 411). Binomial logistic regression was used to determine the association between sociodemographic and behavioral factors with nicotine product harm perception. A statistically significant association was found between nicotine product harm perception and sex, race, income, citizenship, and smoking behavior (p< or =.05). Regarding the three medicinal nicotine replacement therapies, 19.6% of respondents incorrectly perceived the nicotine patch to be as harmful as or more harmful than a regular cigarette; corresponding values were 24.1% for nicotine gum and 52.9% for nicotine inhaler. Respondents incorrectly perceived the following smoked tobacco products to be less harmful than regular cigarettes: ultra-light cigarettes (40.4%), waterpipe (37%), light cigarettes (35.2%), cigarillos (17.4%), and cigars (16.9%). Regarding smokeless nicotine products, 89.3% of respondents incorrectly perceived dip and chew to be as harmful as or more harmful than regular cigarettes; corresponding values were 36.2% for nicotine lollipops and 35.2% for nicotine water. Our findings reveal misperceptions about nicotine product harmfulness and underscore the importance of developing a science base to inform policies and educate consumers about these products.

Purpose: The etiology of dry eye disease is poorly understood, and a significant percentage of the population reports experiencing frequent and burdensome symptoms. Recent evidence from other disciplines has shown a relation between self-rated mood and symptom reporting, and the purpose of this work was to explore the relation between self-rated mood and dry eye symptoms., Methods: A cross-sectional/nested case-control study was used to examine factors associated with self-reported dry eye disease. Logistic and linear regression analyses were used to examine the relation between self-reported dry eye and positive and negative affect. All models included age, sex, education, income, race, and marital status, when appropriate., Results: Four hundred fifteen individuals were enrolled in the study. Two thirds were women, and the average age was 30.6 +/- 11.2 (SD) years. Two hundred fifteen (51.8%) self-reported dry eye. The average positive-affect scores were 34.6 +/- 5.9 and 34.9 +/- 6.0 (t = 0.58, P = 0.56) for those self-reporting dry eye and not reporting dry eye, respectively. The average negative-affect scores were 19.4 +/- 6.0 and 18.6 +/- 5.7 (t = -1.38, P = 0.17) for the dry eye and non-dry eye groups, respectively. After controlling for age, neither logistic regression nor linear regression showed a relation between positive or negative affect and self-reported dry eye., Conclusion: Preliminary analyses suggest that self-reported mood is not related to dry eye status in contact lens wearers. Although symptoms are a hallmark of dry eye disease, they may not be significant enough such that they relate to affective states in the way they do for other symptomatic diseases with more associated pain (eg, arthritis).

Eight videotaped vignettes were developed that assessed the effects of three physician-related experimental variables (in a 2 x 2 x 2 factorial design) on clinical trial (CT) knowledge, video knowledge, information processing, CT beliefs, affective evaluations (attitudes), and CT acceptance. It was hypothesized that the physician variables (community versus academic-based affiliation, enthusiastic versus neutral presentation of the trial, and new versus previous relationship with the patient) would serve as communication cues that would interrupt message processing, leading to lower knowledge gain but more positive beliefs, attitudes, and CT acceptance. A total of 262 women (161 survivors and 101 controls) participated in the study. The manipulated variables primarily influenced the intermediary variables of post-test CT beliefs and satisfaction with information rather than knowledge or information processing. Multiple regression results indicated that CT acceptance was associated with positive post-CT beliefs, a lower level of information processing, satisfaction with information, and control status. Based on these results, CT acceptance does not appear to be based on a rational decision-making model; this has implications for both the ethics of informed consent and research conceptual models.

In this cross-sectional study of US military combat veterans, we assessed the helpfulness of different media for providing health risk communication messages. We have provided preliminary results from a postal survey of 5000 veterans sampled because of their deployment to Vietnam, the Persian Gulf, or Bosnia-Kosovo. Respondents endorsed the primary care provider as the most helpful source of health information. Access to the Internet and use of this medium for seeking health information differed by race, age, and cohort.

Background: Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies., Methods: A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations., Results: Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance., Conclusion: Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.

Some asthma patients and physicians who treat asthma have reported that stress worsens their disease. It has also recently been shown that chronic stressful life events increase airway inflammation 6-24 h after inhalation of antigen in patients with allergic asthma. However, there is no data regarding the effect of an acute stressor on the airway constriction that occurs within minutes of antigen inhalation (early pulmonary response) in this same population. The aim of this study was to examine this effect in eight females with allergic asthma. Each subject was challenged with increasing concentrations of inhaled allergen on a control visit (no stress) and on a stress visit, when they were asked to verbally recount an emotionally stressful situation between each concentration. Systolic (SP) and diastolic (DP) blood pressure, cardiac frequency (fC) and forced expiratory volume in one second (FEV1) were measured on both visits. SP, DP and fC were statistically increased on the stress visit as compared to control. Per cent decrease in FEV1 at the same last dose of allergen was significantly less on the stress visit (11.2 +/- 7.0%) compared to control (15.0 +/- 8.7%). These findings suggest that the early pulmonary response to inhaled allergen is attenuated while verbally re-experiencing an acute emotional stressor in females with allergic asthma.

While aspects of the national response to the last years' terrorist attacks have included preparedness training for health care institutions, much of the focus has been on clinician recognition of biologic exposures. However, many hospital workers have nonclinical responsibilities (such as housekeepers and mailroom workers) and many more, though active in clinical care, are para-professionals with limited medical training (such as nursing assistants). These workers are critical to the achievement of our institution's mission to provide competent and compassionate medical care, even during an emergency. In recognition of this, and to understand their attitudes and concerns, we conducted focus groups. The process provided a forum to receive immediate feedback from the workers, and will be used to design customized knowledge and skills training sessions that empower them to take proper responsive action should a terrorist attack occur. Our experience may be useful to others who are planning terrorism preparedness training programs.

Background: As a part of the U.S. Department of Energy (DOE) Former Workers' Medical Surveillance Program, a Needs Assessment was conducted at Los Alamos National Laboratory (LANL). The objective was to identify former LANL employees who may be at significant risk for occupational disease and determine whether a medical examination program could reduce morbidity or mortality. We describe the needs assessment approach used at LANL., Methods: An algorithm was developed to make needs determinations. Information on factors including exposure, health impacts, size of exposed populations, and LANL worker concerns and recommendations were obtained. Each of these factors was scored from 1 to 3. The resulting factor sum was then multiplied by a binary (1 or 0) intervention suitability factor which was 1 if both of the following were available: (1) a screening test with acceptable sensitivity and specificity for the health outcome of concern; and (2) an intervention that decreases morbidity or mortality. This resulted in an Intervention Needs Score that was used to set priorities for the medical examination program for the estimated 35,000 former LANL workers., Results: Analysis of the algorithm output suggested that six exposure categories be recommended for consideration in a medical examination program. Beryllium, asbestos, and noise clearly warranted inclusion. Lead and ionizing radiation required careful consideration regarding availability of screening tests. Solvents were problematic due to the lack of screening tests and suitable intervention in formerly exposed workers., Conclusions: The algorithm approach to the needs assessment at LANL documented that six chemical and physical agents should be considered as candidates for inclusion in a medical examination program for former workers., (Copyright 2002 Wiley-Liss, Inc.)

Occupational low back pain (LBP) is a major cause of morbidity and cost. Efforts to control LBP are largely unsuccessful, and better understanding of risks is needed, especially psychological factors. The purpose of this research was to assess the association between worker attributions and LBP. Attributing LBP to internal causes may increase the worker's perceived control, whereas external attribution may cause distress. A new model was developed to explore these associations. A cross-sectional design was used in this study of 278 garment workers. Data were gathered by a self-administered questionnaire and through direct observation. Responses to questions on worker attributions of LBP cause and knowledge of back safety were subjected to factor analysis and other psychometric evaluation to develop scales. Six hypotheses were tested using multivariate logistic regression. Workers who scored high in internal attribution were more likely to be knowledgeable of back safety (OR = 3.7, 95% CI = 2.0-6.7). Workers reporting high demand were more likely to report LBP (OR = 2.3, 95% CI = 1.2-4.4). Workers attributing LBP to job tasks were more likely to report LBP (OR = 3.2, 95% CI = 1.5-6.9), and those reporting high supervisor support were less likely to report LBP (OR = 0.23, 95% CI = 0.08-0.66). Workers with annual incomes above 15,000 dollars were more likely to report LBP in the test of both the Demand-Control-Support and Attribution models (OR = 2.8, 95% CI = 1.2-6.9 and OR = 4.1, 95% CI = 1.5-11.1, respectively). While both models appeared to be useful for the study of low back pain, the R(2)(L) of the Demand-Control-Support model equaled only 11.9 percent, whereas the Attribution model equaled 26.2 percent. This study provides evidence that attribution theory is useful in the study of LBP, including in future interventions in the prevention of LBP.

Objectives: This study explored wait-listing decisions among African American and White men and women eligible for kidney transplants, focusing on lifetime experiences of race and sex discrimination as a possible influence., Methods: Patient records from 3 Baltimore-area hemodialysis units were reviewed, and semistructured face-to-face interviews were conducted with transplant-eligible patients and with unit staff members., Results: African American patients reported more racial discrimination, and women reported more sex discrimination. Women and older patients were less likely to be placed on the waiting list, as were patients with previous experiences of racial discrimination. Discrimination measures predicted list access more strongly than patient race., Conclusions: Lifetime experience of and response to discrimination may contribute to race and sex differences in access to care and should be included in research on health care disparities.

This article suggests reasons for the difficulty in understanding and preventing low-back pain (LBP), provides a framework for understanding the causes of reported LBP, and highlights an important new direction in research that could accelerate progress in reducing LBP. Fundamental to understanding LBP is the recognition that it is a symptom not an underlying condition. Worker reports of LBP depend not only on the extent and nature of underlying injury but also the worker's perceptions and the likelihood of reporting the symptoms. Each of these factors, in turn, depends on a number of other proximal and distal factors. Identifying the root causes of underlying injury is essential to improving prevention programs. Yet, many of the methods used to study LBP and its causes have serious shortcomings, adding to the confusion over appropriate preventive strategies. An important gap in LBP research has been the factors influencing preventive behaviors for both workers and managers. If workers or managers attribute the causes of LBP to the wrong factors, preventive behaviors will be misdirected and ineffective. Attribution theory, a relatively recent application in the occupational health field, offers promise for identifying incorrect attributions and modifying these attributions so that appropriate protective actions are taken.

The purpose of this study was to design a multidimensional measure of ethnic identity (EI) that would be appropriate for research on acculturating and modernizing cultural groups. Four qualitative approaches were utilized: in-depth interviews, free-listing exercise, card-sorting technique, and cognitive interviews. Qualitative interviews conducted with Taiwanese American subjects identified ten major domains related to EI. Fifty items were generated from the four qualitative approaches and the psychometric properties of the Taiwanese Ethnic Identity Scale (TEIS) were tested with two samples: 305 Taiwanese American (TA) and 354 Taiwanese (T) women. Factor analysis yielded a 26-item TEIS with six factors. The six factors and the percentage of variance accounted for by each factor were: rituals and traditions (22.8%), language (10.3%), family dynamics/good child (7.1%), parental opinion (6.0%), individualism (4.5%), and collectivism (4.5%). Components of content, construct, and known groups validity were assessed, as well as reliability.

The authors performed a principal components factor analysis on the 18-item Brief Symptom Inventory (BSI-18), a new brief screening inventory. The factor analysis, in which four factors were specified, is consistent with findings in a previous community sample. The study sample consisted of 1,543 cancer patients who completed the full BSI as part of their entry into care at a regional cancer center. The reliability of the BSI-18 was determined based on the calculation of the internal consistency, mean item scores, and correlations with the total score of the BSI. In addition, sensitivity and specificity was calculated to determine the ability of the BSI-18 to discriminate positive and negative cases. The BSI-18 is a shortened version of the BSI that can serve as a brief psychological screening instrument. The BSI-18 can be incorporated into outpatient clinics to prospectively and rapidly identify cancer patients with elevated levels of distress who are in need of clinical interventions. Early identification of distress with appropriate interventions can reduce distress, enhance quality of life, and decrease health care costs.

Purpose: To use a standardized videotape stimulus to assess the effect of physician compassion on viewers' anxiety, information recall, treatment decisions, and assessment of physician characteristics., Participants and Methods: One hundred twenty-three healthy female breast cancer survivors and 87 women without cancer were recruited for this study. A randomized pretest/posttest control group design with a standardized videotape intervention was used. Participants completed the State-Trait Anxiety Inventory (STAI), an information recall test, a compassion rating, and physician attribute rating scales., Results: Women who saw an "enhanced compassion" videotape rated the physician as warmer and more caring, sensitive, and compassionate than did women who watched the "standard" videotape. Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group. Nevertheless, information recall was relatively low for both groups, and enhanced compassion did not influence patient decisions. Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes, such as wanting what was best for the patient and encouraging the patient's questions and involvement in decisions., Conclusion: The enhanced compassion segment was short, simple, and effective in decreasing viewers' anxiety. Further research is needed to translate these findings to the clinical setting, where reducing patient anxiety is a therapeutic goal.

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.