The Effects of a State-Wide Media Campaign on Mammography Screening1

A media campaign was constructed to promote mammography screening in North Dakota. The media included radio and newspaper advertisements that emphasized personal vulnerability to breast cancer. Persons in northern North Dakota were exposed to the ads; persons in southern North Dakota were not. Surveys conducted after the campaign showed that intervention women were aware of the ads. A state-wide longitudinal survey (N= 383) also suggested that the campaign may have influenced women who had been screened previously to have a repeat screening. However, the ads may have adversely affected those women who had never been screened. We discuss comparisons between media attempts and other strategies that can potentially influence health behavior in rural areas.     

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women’s mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women’s mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.     

Using the Theory of Planned Behaviour and implementation intentions to predict and facilitate upward family communication about mammography

Regular mammography facilitates early detection of breast cancer, and thus increases the chances of survival from this disease. Daughter-initiated (i.e. upward) communication about mammography within mother-daughter dyads may promote mammography to women of screening age. The current study examined this communication behaviour within the context of the Theory of Planned Behaviour (TPB), and aimed to bridge the intention-behaviour gap by trialling an implementation intention (II) intervention that aimed to facilitate upward family communication about mammography. Young women aged 18-39 (N=116) were assigned to either a control or experimental condition, and the latter group formed IIs about initiating a conversation with an older female family member about mammography. Overall, those who formed IIs were more likely to engage in the target communication behaviour, however the intervention was most effective for those who reported low levels of intention at baseline. Perceived behavioural control emerged as the most important variable in predicting the target behaviour. The altruistic nature of this behaviour, and the fact that it is not wholly under volitional control, may have contributed to this finding. Future studies that systematically explore the relative roles of intention and perceived behavioural control in behaviours of this nature are warranted.     

Distress, personality, and mammography utilization among women with a family history of breast cancer.

The authors examined the impact of psychological distress and the personality construct of conscientiousness (as measured by the Neuroticism, Extraversion, and Openness-Five Factor Inventory) on mammography utilization among women who were at increased risk for breast cancer. Participants were 200 women who had at least 1 first degree relative with breast cancer. Overall, 80% of the participants had obtained a mammogram in the previous year. Analyses controlling for potential confounders (perceived risk, decisional balance, and physician recommendation for mammography), revealed that distress was negatively associated with mammography utilization among participants who were low in conscientiousness. Distress was not significantly related to mammography utilization among highly conscientious women. The results are discussed in terms of their implications regarding interventions designed to increase mammography utilization in this population.     

“Social Separation” Among Women Under 40 Years of Age Diagnosed with Breast Cancer and Carrying a BRCA1 or BRCA2 Mutation

We conducted an exploratory, qualitative study investigating experiences of women who had developed breast cancer under the age of 40 and who were identified as BRCA1 or BRCA2 mutation carriers. These germline mutation carriers face an increased lifetime risk of a second primary breast cancer and an increased risk for a primary ovarian cancer. Thirteen women who fit this criteria participated in three focus groups conducted at a major cancer center in the UK during Spring 2003. We asked broad, open-ended questions that allowed for a wide range of responses about their cancer and genetic testing experiences, physical and psycho-social concerns, family and partner reactions and their need for social support. The women expressed feelings of devastation, loneliness, feeling different and isolation, ambivalence about having to support family members, worries about partner’s anxiety and depression, and anxiety about talking to family members, especially children. These feelings were stronger after the cancer diagnosis and compounded by the genetic test results that occurred at a later time. We also found that, at least temporarily, the women experienced what we call “social separation”—emotional distance from, or dissonance with groups they interact with or are part of, e.g., family and friends, frequently leading to a reduction in communication or a change in previously unstated, but accepted normal interaction. We concentrate on a few characteristics of social separation—feelings of aloneness, isolation and separation, use of silence and verbal discretion, the relationship between estrangement and kinship interaction and norm disruption, and are looking at social patterns of interpersonal relationships that may occur when risk and illness statuses are new and framing and feeling rules have not as yet been clearly developed due to a cultural lag.     

Social support and cancer: Adult patients' desire for support from family,friends, and health professionals

Examined cancer patients' desire for social support from family, friends, and health professionals upon whom they most depended for support. Before a single interaction with each of these sources, nonhospitalized adult cancer patients (N = 64) completed a questionnaire indicating their desire for support from the source on 11 functional components. Results indicated that emotional and instrumental functions of support were distinct and required separate examination. Distinctiveness of primary sources was manifest by patients' overall preference for tangible aid from family, modeling from friends who had cancer, and open communication and clarification from health professionals. Family and friends were equally preferred sources for dealing with affective reactions to the stressfulness of cancer. All three sources were similarly desired for self-esteem enhancement and for relief from decision-making and problem-solving responsibilities. Finally, patients' perceived prognosis but not the objective severity of their illness was associated with a heightened desire for support, especially for instrumental support functions.     

On Using a Cancer Center Cancer Registry to Identify Newly Affected Women Eligible for Hereditary Breast Cancer Syndrome Testing: Practical Considerations

The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., “tester” category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., “nontester” category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.     

Cancer Genetics Service Interest in Women with a Limited Family History of Breast Cancer

Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.     

Perceived social support, self-efficacy, and adjustment to abortion

Prior to their having a 1st trimester abortion, women's perceptions of social support from their partner, family, and friends and self-efficacy for coping were assessed. Depression, mood, physical complaints, and anticipation of negative consequences were measured after the 30-min recovery period. As predicted, perceived social support enhanced adjustment indirectly through its effects on self-efficacy. Women who perceived high support from their family, friends, and partners had higher self-efficacy for coping. Higher self-efficacy, in turn, predicted better adjustment on the psychological measures but not on the physical complaint measure. No direct path between social support and adjustment was observed. In addition, women who told close others of their abortion but perceived them as less than completely supportive had poorer postabortion psychological adjustment than either women who did not tell or women who told and perceived complete support.     

Posttraumatic Stress Among Women With Breast Cancer and Their Daughters: Relationship With Daughters' Breast Cancer Screening

Cancer-related posttraumatic stress (PTS) in women with breast cancer, perceived risk of cancer in these women's daughters, and daughters' PTS related to their mothers' breast cancer were tested for relationships to daughters' breast self-examination (BSE) and mammography activity. Daughters' mammography frequency was related to her own PTS, but not to her perceived risk or her mothers' PTS. In contrast, daughters who overperformed BSE had mothers reporting significantly greater PTS than those performing BSE at recommended rates or underperforming BSE. Daughters' BSE and mammography frequency were not correlated. Differing demands related to BSE and mammography, and their relationship to different distress variables are discussed.     

Cognitive and affective correlates of decisional balance regarding screening mammography in older women

Participation in screening mammography remains suboptimal. This research aimed to improve understanding of ways to facilitate screening mammography attendance. One hundred and forty-two women from Gold Coast, Australia, aged 50-75, participated in the study. Social cognitive variables were assessed as potential predictors of mammography attendance. Most participants (79%) were maintaining regular screening mammography. Greater knowledge of breast cancer was the strongest predictor of decisional balance in favor of attending screening. Women who had relapsed from screening had significantly lower breast cancer worry than those contemplating attending for the first time. The results were consistent with previous research and point to factors screening services could consider to increase uptake.     

Breast cancer representations in Canadian news media: a critical discourse analysis of meanings and the implications for identity

Despite the importance of critical media work, much is to be learned about breast cancer representations within media discourses and the implications for women’s identity construction. Building on research from Australia from a discursive perspective, this article used an eclectic approach to critical discourse analysis to explore the cultural construction of breast cancer in 25 detailed stories within Canada’s two national newspapers, The Globe and Mail and the National Post. Ten images accompanying stories and 17 advertisements/public service announcements were also analyzed to contextualize discourses and subject positions/identities within the stories. Analysis of this media affords the unique opportunity to explore taken for granted assumptions and prevailing meanings about breast cancer and the implications for subjectivity. Two primary discourses were identified: a discourse of biomedicine and a discourse of healthism. Subject positions identified included “breast cancer survivor,” “the good consumer,” and the “medical expert.” The psychological, social, political, and health promotion implications are discussed.     

Social and Psychological Determinants of Breast-Feeding and bottle-Feeding Mothers

Our study examined the psychological and sociological factors of mothers who breast-feed and mothers who bottle-feed. Most of the data came from 124 Israeli mothers who had just given birth, but selective data were also collected on three additional samples—108, 465, and 135 new mothers. The psychological measures included the Bar-Ilan Sex Role Inventory (Tzuriel, 1984) and body image as measured by the drawing of a dressed and a naked woman. None of the psychological factors distinguished between the two groups of women. Social factors, however, did distinguish between the two groups: Mothers who breast-fed were of Asian-African background; were less educated; held blue collar jobs or did not work; perceived their husbands, relatives, and friends as supporting their decision to breast-feed; and tended to be more religious. The discriminant function analysis—which predicted 73% of the cases—showed that the mother's education, her religiousness, and her perceived support of friends and relatives were the most important factors.     

Are Religious Women More Likely to Have Breast Cancer Screening?

The study objective was to investigate whether women who frequently attend religious services are more likely to have breast cancer screening—mammography and clinical breast examinations—than other women. Multivariate logistic regression models show that white women who attended religious services frequently had more than twice the odds of breast cancer screening than white women who attended less frequently (Odds Ratio (OR) = 2.61; 95% Confidence Interval (CI) = 1.12, 6.06). The behavior of white women was different from African American women (religious attendance-race interaction term p-value = 0.008); African American women who attended religious services frequently were possibly less likely to have breast cancer screening (OR 0.49; CI = 0.19–1.31).     

Peer relationships as a source of support for adolescent mothers

There is speculation that the pregnancy and parenthood of adolescent mothers cause changes in their peer relationships such that their peers become less able to provide support. Little empirical evidence exists to support such speculation. The authors assessed the relative amounts and types of support provided by friends and relatives to adolescent mothers, and examined peer support in relation to parenting stress. Invitations were sent to all 480 women recruited through public access birth records in two northeastern Ohio counties who were 19 years old and younger and who had given birth to their first child during the previous nine months. The counties incorporate urban, suburban, and rural communities. 66 women volunteered, of whom 46 eventually participated in the study. They were aged 13-19 years (mean age, 17.43 years) at the birth of their child. Approximately 66% were White and 12 were married. Of the 36 women who reported their family income, 88% reported yearly income of less than $20,000; of those, 15 reported income of less than $5000. 28 of the adolescent mothers were unemployed. 22 were enrolled in school at the time of data collection. Of the 24 who were not enrolled in school, 15 had already completed 12th grade. The Inventory of Social Contacts measured levels of perceived child-rearing, emotional, and material support and interference from family and friends, while the Parenting Stress Index assessed self-reported parenting stress arising from child and parent characteristics. Results of repeated-measures ANOVAs and Pearson correlations indicate that, compared to family, friends provide more emotional support and less interference. Parenting stress is buffered more effectively by the support provided by friends.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Role model influencers of nontraditional professional women

A sample of 142 women college graduates now employed in engineering, natural science, and architecture or pursuing advanced degrees in these three areas or law, business administration, or social science allowed a test of the hypothesis that these women had received a family environment congruent with their nontraditional work orientation. Five types of influencer—parents, siblings, teachers, friends, and other adults—of both sexes were found at three points in time (high school, undergraduate years, and graduate school) to significantly influence the women in a positive direction. Further, when the pairs of each type of influencer were compared, there was no evidence that females or males were more effective at influencing nontraditional professional women.     

The relationship between viewing US-produced television programs and intentions to drink alcohol among a group of Norwegian adolescents

The aim of this study was to examine the influence of exposure to US-produced television programs and family rules prohibiting alcohol use on the development of normative beliefs, expectancies, and intentions to drink alcohol in the next 12 months among a group of Norwegian adolescents who reported that they had not previously consumed alcohol. Data were collected via a survey administered to 622 eighth and ninth graders enrolled at ten junior highs in southeastern Norway. To examine these relationships we tested the fit of a structural equation model which was based on the Theory of Planned Behavior (Ajzen, 1988). Data from the non-drinkers (n= 392, 63% of the respondents) were used. To control for the influence of peer drinking on behavioral intentions, our model was tested under two group conditions: (1) those subjects reporting that they have no friends who drink alcohol and (2) those subjects reporting that they have one or more friends who drink. The findings indicate that the influence of TV exposure was a significant predictor (directly) of normative beliefs, expectancies (indirectly) and intentions to drink (both directly and indirectly) only for those subjects who reported having no friends who drink. For the group with non-drinking friends, family rules constrain intentions only indirectly by influencing normative beliefs. For those with friends who drink, however, family rules have a direct (inverse) effect on intentions. It is concluded that exposure to US-produced television programs functions as a limited knowledge source only for those subjects who had little or no personal experience with alcohol while the presence of family rules have limited impact on behavioral intentions.     

Breast cancer: The intention to have a mammography and a clinical breast examination - application of the theory of planned behavior

Abstract

The purpose of these cross sectional studies was to identify the psychosocial factors explaining women's intention to have a mammography within the next two years and their intention to have a clinical breast examination (CBE) by a professional within the next year. Two random samples of women aged 40–69 years (n_a = 354, n_b = 344) completed a self-administered questionnaire that investigated theoretical constructs of the theory of planned behavior. The results of structural equation modeling showed that subjective norms and perceived behavioral control explained 81 % of the variance in intention of having a mammography. Sixty-five percent (65%) of the variance in intention of having a CBE was explained by attitude and perceived behavioral control. In conclusion, women need to be better informed, have better skills to overcome psychological and physical barriers in performing preventive breast behaviors, and promotion of preventive breast cancer methods should consider people significant for women.     

Assessment of coping strategies, social support, and general health status in individuals with diabetes mellitus

This study examined 51 individuals (30 men, 21 women) who participated in an outpatient diabetes education program. Participants with higher perceived support by friends and problem-solving coping strategies were healthier, while those exhibiting a wish-fulfillment coping style were less healthy. Perceived family social support was much greater for Type II (noninsulin-dependent) individuals than for Type I (insulin-dependent) individuals. Men perceived greater family support, were more likely to use problem-solving coping, and were healthier than women; however, both wish fulfillment and detachment coping were more prevalent in women. Perceived support from family and friends increased with education. Implications for diabetes education programs are also introduced.