Search tips
Search criteria

Results 1-25 (36)

Clipboard (0)

Select a Filter Below

Year of Publication
more »
1.  Evolution of Hospital Medicine and the Impact on Residents’ Career Choices 
PMCID: PMC4061367  PMID: 24817282
2.  Infertility Care Among OEF/OIF/OND Women Veterans in the Department of Veterans Affairs 
Medical care  2015;53(4 0 1):S68-S75.
An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care.
We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)—Contingency Tracking System Deployment file of military discharges from October 1, 2001–December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes.
Less than 2% (n = 1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers.
Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women’s use of VA infertility services is an important component of understanding VA’s commitment to comprehensive medical care for women Veterans.
PMCID: PMC4410265  PMID: 25767979
women’s health; Veterans; infertility
3.  Feasibility of using an epigenetic marker of risk for lung cancer, methylation of p16, to promote smoking cessation among US veterans 
BMJ Open Respiratory Research  2014;1(1):e000032.
Providing smokers feedback using epigenetic markers of lung cancer risk has yet to be tested as a strategy to motivate smoking cessation. Epigenetic modification of Rb-p16 (p16) due to tobacco exposure is associated with increased risk of developing lung cancer. This study examined the acceptance of testing for methylated p16 and the understanding of test results in smokers at risk for development of lung cancer.
Thirty-five current smokers with airways obstruction viewed an educational presentation regarding p16 function followed by testing for the presence of methylated p16 in sputum. Participants were offered smoking cessation assistance and asked to complete surveys at the time of enrolment regarding their understanding of the educational material, perception of risk associated with smoking and desire to quit. Participants were notified of their test result and follow-up surveys were administered 2 and 10 weeks after notification of their test result.
Twenty per cent of participants had methylated p16. Participants showed high degree of understanding of educational materials regarding the function and risk associated with p16 methylation. Sixty-seven per cent and 57% of participants with low-risk and high-risk test results, respectively, reported that the information was more likely to motivate them to quit smoking. Smoking cessation rates were similar between methylated and non-methylated participants.
Testing for an epigenetic marker of lung cancer risk is accepted and understood by active smokers. A low-risk test result does not decrease motivation to stop smoking.
Trial registration number
PMCID: PMC4212704  PMID: 25478181
Tobacco and the lung; Lung Cancer
4.  Do High-Risk Preschoolers or Overweight Mothers Meet AAP-Recommended Behavioral Goals for Reducing Obesity? 
Academic pediatrics  2013;13(3):243-250.
The American Academy of Pediatrics (AAP) has issued specific behavioral recommendations to prevent obesity. It is unclear how often high-risk preschoolers and overweight mothers meet recommended behavior-goals, and whether meeting these goals is negatively associated with overweight/obesity.
Describe the proportion of preschoolers and mothers that meet AAP-recommended behavior-goals, and examine the associations of meeting goals with weight-status, and mothers meeting goals and children meeting corresponding goals.
Secondary analysis of baseline data (prior to an intervention) from mother-preschooler dyads in a weight-control study. Mothers were overweight or obese. Preschoolers were 2–5 years old. Dietary and feeding practices were assessed using questionnaires. Activity was measured directly using accelerometry. Outcomes included preschooler overweight and maternal obesity.
The respective proportions of children and mothers that met behavior-goals were: 17% and 13% for ≥5 fruits/vegetables/day, 46% and 33% for zero sugar-sweetened beverages/day, 41% and 13% for fast-food <1x/week, and 46% and 13% for screentime ≤2 hours/day. Moderate-to-vigorous physical activity did not exceed 60 minutes/day in any participant. 49% ate family meals together 7x/week. For each additional goal met, the adjusted odds for preschooler overweight was 0.9 (95% CI, 0.8–1.1), and for maternal obesity, 0.8 (95% CI, 0.6–0.9). Preschoolers had significantly greater odds of meeting each goal when mothers met the corresponding goal.
Few high-risk preschoolers or overweight mothers meet AAP-recommended behavior-goals. Meeting a greater number of behavior-goals may be particularly important for maternal weight. Preschoolers have greater odds of meeting behavior-goals when mothers meet behavior-goals.
PMCID: PMC3658466  PMID: 23491583
childhood obesity; behavioral modification; obesity prevention; maternal child health
5.  Telemedicine Cardiovascular Risk Reduction in Veterans 
American heart journal  2013;165(4):501-508.
Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical Pharmacy Specialist (CPS), telephone administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk.
Randomized controlled trial including patients with hypertension (blood pressure (BP) > 150/100 mmHg) or elevated low density liporotein (LDL) (> 130 mg/dl). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined.
Given the national prevalence of CVD and the dismal rates of risk factor control; intensive, but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans.
PMCID: PMC3766959  PMID: 23537965
6.  Parent-Focused Change to Prevent Obesity in Preschoolers: Results from the KAN-DO Study 
Preventive medicine  2012;55(3):188-195.
Present the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2–5 years old) dyads in North Carolina (2007–2011). The outcomes include change from baseline in the child’s diet, physical activity and weight, and in the mother’s parenting behaviors, diet, physical activity, and weight.
The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 Mother-child dyads were randomized.
Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (−0.24 vs. 0.01, p<0.001) and TV snacks (−.069 vs. −0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother’s sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons.
KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers’ diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.
PMCID: PMC3439558  PMID: 22705016
Obesity; randomized controlled trial; parenting; emotion regulation; physical activity; dietary intake
8.  The VA Women’s Health Practice-Based Research Network: Amplifying Women Veterans’ Voices in VA Research 
Journal of General Internal Medicine  2013;28(Suppl 2):504-509.
PMCID: PMC3695282  PMID: 23807057
women’s health; veterans; implementation research; quality improvement
9.  Smoking Cessation Interventions for Patients with Depression: A Systematic Review and Meta-analysis 
We conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. We examined the comparative effectiveness of smoking cessation strategies on abstinence rates, differential effects of cessation strategies by depression status (i.e., history positive vs. current depression), and differential effects by gender.
Peer-reviewed literature in MEDLINE, Embase, PsycINFO, and Cochrane Library.
Study eligibility criteria, participants, and interventions
Randomized controlled trials or secondary analysis of RCT data comparing two or more smoking cessation interventions or intervention to control, and reporting cessation outcomes in adults with depression.
Two trained researchers screened articles for inclusion. When possible, we estimated pooled risk ratios with 95% confidence intervals by using a random effects model with the Mantel–Haenszel method. We synthesized other studies qualitatively. We classified each intervention as antidepressants, nicotine replacement therapy (NRT), brief smoking cessation counseling, smoking cessation behavioral counseling, or behavioral mood management.
We identified 16 unique RCTs, of which, only three trials recruited participants with current depression. Meta-analysis demonstrated a small, positive effect of adding behavioral mood management (RR = 1.41, 95% CI 1.01–1.96). All included antidepressant trials showed small, positive effects, but risk ratio summary was not significant (RR = 1.31, 95% CI 0.73–2.34). Three NRT trials demonstrated small, positive effects on smoking cessation rates. We found insufficient evidence to examine gender and depression status moderator effects.
Few RCTs exist that test smoking cessation interventions among adults with depression. To make meaningful comparisons, we created broad intervention categories that contained heterogeneity.
Few trials enrolled smokers with current depression. Most of data identified were from subgroup analyses of patients history-positive for depression. However, several promising interventions exist. Healthcare providers should consider encouraging their patients with significant depressive symptoms or depression histories to seek smoking cessation services that include NRT and behavioral mood management.
PMCID: PMC3286553  PMID: 22038468
smoking cessation; depression; tobacco use; systematic review; meta-analysis
10.  Responses to Online GSTM1 Genetic Test Results among Smokers Related to Patients with Lung Cancer: A Pilot Study 
Providing smokers with personal genetic test results indicating increased lung cancer risk may increase uptake of effective smoking cessation services. Using the internet may increase reach and enable real-time assessment of how people process genetic risk information away from the clinic setting. We therefore explored smokers' responses to Web-delivered GSTM1 genetic test results indicating higher or lower lung cancer risk. Participants were smokers (n = 44) biologically related to patients with newly diagnosed lung cancer. Measures were assessed at baseline, before and immediately after receipt of online genetic test results, and at 6-month follow-up. Outcomes included accurate comprehension of results, regret about being tested, cessation-related cognitions (e.g., perceived response efficacy), and uptake of free smoking cessation services (nicotine replacement therapy, printed self-help materials, telephone counseling sessions). Twenty-two “relative smokers” received a GSTM1-missing (higher risk) and 22 a GSTM1-present (lower risk) result. All relative smokers with GSTM1-missing results and 55% of those with GSTM1-present results accurately interpreted their results. No relative smokers regretted having taken the test. Relative smokers receiving GSTM1-missing results reported lower confidence that quitting could reduce lung cancer risk (perceived response efficacy) than those receiving GSTM1-present results. There were no other significant between-group differences. Uptake of smoking cessation services was high (e.g., 91% nicotine replacement therapy uptake). Genetic test results may not influence uptake of free smoking cessation services because of ceiling effects. Further research is needed to determine the risks and benefits of Web-based disclosure of genetic test results.
PMCID: PMC3417294  PMID: 19567511
11.  Proactive recruitment of cancer patients’ social networks into a smoking cessation trial 
Contemporary clinical trials  2011;32(4):498-504.
This report describes the characteristics associated with successful enrollment of smokers in the social networks (i.e., family and close friends) of patients with lung cancer into a smoking cessation intervention.
Lung cancer patients from four clinical sites were asked to complete a survey enumerating their family members and close friends who smoke, and provide permission to contact these potential participants. Family members and close friends identified as smokers were interviewed and offered participation in a smoking cessation intervention. Repeated measures logistic regression model examined characteristics associated with enrollment.
A total of 1,062 eligible lung cancer patients were identified and 516 patients consented and completed the survey. These patients identified 1,325 potentially eligible family and close friends. Of these, 496 consented and enrolled in the smoking cessation program. Network enrollment was highest among patients who were white and had late-stage disease. Social network members enrolled were most likely to be female, a birth family, immediate family, or close friend, and live in close geographic proximity to the patient.
Proactive recruitment of smokers in the social networks of lung cancer patients is challenging. In this study, the majority of family members and friends declined to participate. Enlisting immediate female family members and friends, who live close to the patient as agents to proactively recruit other network members into smoking cessation trials could be used to extend reach of cessation interventions to patients’ social networks. Moreover, further consideration should be given to the appropriate timing of approaching network smokers to consider cessation.
PMCID: PMC3104120  PMID: 21382509
recruitment; social network; smoking cessation; lung cancer
12.  Kids and Adults Now! Defeat Obesity (KAN-DO): Rationale, Design and Baseline Characteristics 
Contemporary clinical trials  2011;32(3):461-469.
Prevention of childhood obesity is a public health priority. Parents influence a child’s weight by modeling healthy behaviors, controlling food availability and activity opportunities, and appropriate feeding practices. Thus interventions should target education and behavioral change in the parent, and positive, mutually reinforcing behaviors within the family.
This paper presents the design, rationale and baseline characteristics of Kids and Adults Now! – Defeat Obesity (KAN-DO), a randomized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight, and weight reduction in overweight children. 400 children aged 2–5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are randomized equally to control or the KAN-DO intervention, consisting of mailed family kits encouraging healthy lifestyle change. Eight (monthly) kits are supported by motivational counseling calls and a single group session. Mothers are targeted during a hypothesized “teachable moment” for health behavior change (the birth of a new baby), and intervention content addresses: parenting skills (emotional regulation, authoritative parenting), healthy eating, and physical activity.
The 400 mother-child dyads randomized to trial are 75% white and 22% black; 19% have a household income of $30,000 or below. At baseline, 15% of children are overweight (85th–95th percentile for body mass index) and 9% are obese (≥95th percentile).
This intervention addresses childhood obesity prevention by using a family-based, synergistic approach, targeting at-risk children and their mothers during key transitional periods, and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change.
PMCID: PMC3087307  PMID: 21300177
Overweight; obesity; randomized controlled trial; parenting; children; postpartum period
13.  Pain and smoking among cancer patients: the relationship is complex but the clinical implication is clear 
Pain  2011;152(1):10-11.
PMCID: PMC3053043  PMID: 21168757
14.  Multiparity is associated with High Motivation to Change Diet among Overweight and Obese Postpartum Women 
Pregnancy is associated with weight gain and obesity. The aim of this study is to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women.
Study Design
Active Mothers Postpartum (AMP) is a randomized controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, BMI category, and breastfeeding status.
Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared to primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared to any breastfeeding.
Although risk for obesity is incurred starting with a woman’s first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children and also how to improve motivation for primigravid women and women who are breastfeeding.
PMCID: PMC2849268  PMID: 20149971
postpartum obesity; parity; diet; weight loss
15.  Effects of the Wars on Smoking Among Veterans 
PMCID: PMC2837491  PMID: 20077050
smoking; veterans; tobacco control efforts
16.  Body Image and Body Satisfaction Differ by Race in Overweight Postpartum Mothers 
Journal of Women's Health  2010;19(2):305-311.
Body image (BI) and body satisfaction may be important in understanding weight loss behaviors, particularly during the postpartum period. We assessed these constructs among African American and white overweight postpartum women.
The sample included 162 women (73 African American and 89 white) in the intervention arm 6 months into the Active Mothers Postpartum (AMP) Study, a nutritional and physical activity weight loss intervention. BIs, self-reported using the Stunkard figure rating scale, were compared assessing mean values by race. Body satisfaction was measured using body discrepancy (BD), calculated as perceived current image minus ideal image (BD<0: desire to be heavier; BD>0: desire to be lighter). BD was assessed by race for: BDIdeal (current image minus the ideal image) and BDIdeal Mother (current image minus ideal mother image).
Compared with white women, African American women were younger and were less likely to report being married, having any college education, or residing in households with annual incomes >$30,000 (all p < 0.01). They also had a higher mean body mass index (BMI) (p = 0.04), although perceived current BI did not differ by race (p = 0.21). African Americans had higher mean ideal (p = 0.07) and ideal mother (p = 0.001) BIs compared with whites. African Americans' mean BDs (adjusting for age, BMI, education, income, marital status, and interaction terms) were significantly lower than those of whites, indicating greater body satisfaction among African Americans (BDIdeal: 1.7 vs. 2.3, p = 0.005; BDIdeal Mother: 1.1 vs. 1.8, p = 0.0002).
Racial differences exist in postpartum weight, ideal images, and body satisfaction. Healthcare providers should consider tailored messaging that accounts for these racially different perceptions and factors when designing weight loss programs for overweight mothers.
PMCID: PMC2834437  PMID: 20113143
17.  Contraceptive use by obese women one year postpartum 
Contraception  2009;80(5):463-468.
Obese women have higher rates of pregnancy complications, making the prevention of unintended pregnancies in this group of particular importance.
Study Design
We performed a secondary analysis of data from Active Mothers Postpartum (AMP), a randomized controlled trial aimed at postpartum weight reduction. We assessed contraceptive use among 361 overweight/obese women 12 months postpartum. Logistic regression was used to model the effect of BMI categories on effective contraceptive use (intrauterine, hormonal, or sterilization methods) while adjusting for potential confounders including age, race, parity, breastfeeding, education, and chronic illness.
Effective contraceptive use was reported by 45% of women. In the multivariable model, women with a BMI ≥ 35 kg/m2 were less likely to use effective contraception than women with a BMI <30 kg/m2 (OR 0.5, 95% CI 0.3–0.8). There was a trend towards less use of effective contraception among women with a BMI 30–34.9 kg/m2 as compared to women with a BMI <30 kg/m2.
At 12 months postpartum, obese women were less likely to use effective contraceptive methods than overweight women. Although certain contraceptive methods may be preferred over others in this population, providers should reinforce the importance of effective contraception to avoid unintended pregnancies in obese women.
PMCID: PMC2764535  PMID: 19835721
18.  Mortality Ascertainment of Women Veterans: A Comparison of Sources of Vital Status Information, 1979-2002 
Medical care  2009;47(1):125-128.
To support health research on the unique cohort of women with a history of military service, this study assessed the completeness of mortality ascertainment for Texas women veterans in Department of Veterans Affairs (VA) and non-VA databases.
We examined female-veteran-specific mortality ascertainment comparing the VA Beneficiary Identification and Records Locator Subsystem Death File (BIRLS DF), VA Patient Treatment Files (PTF) and Social Security Administration-Death Master File (SSA-DMF) with Texas death certificate data. Databases were deterministically crosslinked using female sex and social security numbers. Deterministic and probabilistic linkage methods were also compared.
Of 6,297 decedents identified by death certificates, SSA-DMF, BIRLS DF, and PTF databases identified 97.5 percent collectively and 94 percent, 77 percent, and 5 percent individually. Compared with Texas death certificates, sensitivity of VA and SSA databases improved with increasing age.
This study highlights that although the VA and SSA administrative databases have less complete ascertainment for younger decedents, combined these electronic databases provide nearly complete ascertainment for women veterans.
Challenges related to large female-specific cross-linkage studies are explored and a need to examine methods for female-specific health research studies in the general population is identified.
PMCID: PMC2943761  PMID: 19106741
Administrative Databases; Death Certificates; Female; Mortality; Veterans
19.  Active Mothers Postpartum A Randomized Controlled Weight-Loss Intervention Trial 
Pregnancy may contribute to overweight and obesity.
The primary objective of Active Mothers Postpartum was to promote a reduction in BMI through 24-months postpartum via sustainable lifestyle changes.
Behavioral intervention RCT to enhance postpartum weight loss.
A total of 450 overweight or obese women, enrolled 6-weeks postpartum, were recruited through obstetrics clinics and community posters in the Durham NC area.
Intervention participants were offered eight healthy-eating classes, ten physical-activity classes, and six telephone-counseling sessions over 9 months.
Main outcome measures
Changes from baseline (6-weeks postpartum) to 1-month post-intervention (12-months postpartum) in: (1) diet (caloric intake, calories from fat, intake of certain foods); (2) physical activity (self-reported physical activity, television time); and (3) weight (collected 2004–2007, analyzed 2007–2008).
Mean weight loss was 0.90 kg (±5.1 kg) in the intervention group and 0.36 kg (±4.9 kg) in the control group; this difference was not significant. There were also no significant group differences in improvement of diet or increased physical activity. In secondary analyses, there was a positive bivariate relationship between classes attended and weight loss (p=0.01).
There were no significant differences among the arms in diet, physical activity, or weight change. Home-based interventions via mail, telephone, or Internet/e-mail may be more feasible and successful in this population. The postpartum period is an important phase in women’s lives with regard to weight retention, but engaging them during this busy period remains a challenge.
PMCID: PMC2774935  PMID: 19595557
20.  Impact of Parity and Breastfeeding on Racial Differences in Obesity 
Journal of Women's Health  2009;18(9):1311-1312.
PMCID: PMC2825729  PMID: 19708808
21.  Promoting Regular Mammography Screening I. A Systematic Assessment of Validity in a Randomized Trial 
Most health promotion trials in cancer screening offer limited evidence of external validity. We assessed internal and external validity in a nationwide, population-based trial of an intervention to promote regular mammography screening.
Beginning in September 2000, study candidates age 52 years and older (n = 23 000) were randomly selected from the National Registry of Women Veterans and sent an eligibility survey. Consistent with intention-to-treat principles for effectiveness trials, we randomly assigned eligible respondents and nonrespondents to one of five groups. We mailed baseline surveys to groups 1–3 followed by intervention materials of varying personalization to groups 1 and 2. We delayed mailing baseline surveys to two additional control groups to coincide with the mailing of postintervention follow-up surveys to groups 1–3 at year 1 (group 4) and year 2 (group 5). Mammography rates were determined from self-report and Veterans Health Administration records. To assess internal validity, we compared groups on participation and factors associated with mammography screening at each stage. To assess external validity, we compared groups 3, 4, and 5 on mammography rates at the most recent follow-up to detect any cueing effects of prior surveys and at the respective baselines to uncover any secular trends. We also compared nonparticipants with participants on factors associated with mammography screening at the trial’s end.
We established study eligibility for 21 340 (92.8%) of the study candidates. Groups 1–3 were similar throughout the trial in participation and correlates of mammography screening. No statistically significant survey cueing effects or differences between nonparticipants and participants across groups were observed. Mammography screening rates over the 30 months preceding the respective baselines were lower in group 5 (82.3% by self-report) than in groups 1–4 (85.1%, P = .024, group 5 vs groups 1–4 combined), suggesting a decline over time similar to that reported for US women in general.
This systematic assessment provides evidence of the trial’s internal and external validity and illustrates an approach to evaluating validity that is readily adaptable to future trials of behavioral interventions.
PMCID: PMC2846634  PMID: 18314473
22.  Promoting Regular Mammography Screening II. Results From a Randomized Controlled Trial in US Women Veterans 
Few health promotion trials have evaluated strategies to increase regular mammography screening. We conducted a randomized controlled trial of two theory-based interventions in a population-based, nationally representative sample of women veterans.
Study candidates 52 years and older were randomly sampled from the National Registry of Women Veterans and randomly assigned to three groups. Groups 1 and 2 received interventions that varied in the extent of personalization (tailored and targeted vs targeted-only, respectively); group 3 was a survey-only control group. Postintervention follow-up surveys were mailed to all women after 1 and 2 years. Outcome measures were self-reported mammography coverage (completion of one postintervention mammogram) and compliance (completion of two postintervention mammograms). In decreasingly conservative analyses (intention-to-treat [ITT], modified intention-to-treat [MITT], and per-protocol [PP]), we examined crude coverage and compliance estimates and adjusted for covariates and variable follow-up time across study groups using Cox proportional hazards regression. For the PP analyses, we also used logistic regression.
None of the among-group differences in the crude incidence estimates for mammography coverage was statistically significant in ITT, MITT, or PP analyses. Crude estimates of compliance differed at statistically significant levels in the PP analyses and at levels approaching statistical significance in the ITT and MITT analyses. Absolute differences favoring the intervention over the control groups were 1%–3% for ITT analysis, 1%–5% for MITT analysis, and 2%–6% for the PP analysis. Results from Cox modeling showed no statistically significant effect of the interventions on coverage or compliance in the ITT, MITT, or PP analyses, although hazard rate ratios (HRRs) for coverage were consistently slightly higher in the intervention groups than the control group (range for HRRs = 1.05–1.09). A PP analysis using logistic regression produced odds ratios (ORs) that were consistently higher than the corresponding hazard rate ratios for both coverage and compliance (range for ORs = 1.15–1.29).
In none of our primary analyses did the tailored and targeted intervention result in higher mammography rates than the targeted-only intervention, and there was limited support for either intervention being more effective than the baseline survey alone. We found that adjustment for variable follow-up time produced more conservative (less favorable) intervention effect estimates.
PMCID: PMC2830858  PMID: 18314474
23.  Persistent Smoking after a Diagnosis of Lung Cancer is Associated with Higher Reported Pain Levels 
The purpose of this study is to evaluate the impact of smoking status after a diagnosis of lung cancer on reported pain levels. We conducted a telephone survey of patients with lung cancer identified from four participating sites between September 2004 and July 2006. Patients were asked to rate their usual pain level over the past week on a 0-10 rating scale on which 0 was ‘no pain’ and 10 ‘pain as bad as you can imagine’. We operationally defined persistent smokers as patients who reported continuing to smoke after their lung cancer diagnosis. A logistic regression analyses was used to test the hypothesis that persistent smokers report higher usual pain levels than non-smokers. Overall, 893 patients completed the survey. The majority (76%) was found to have advanced cancer (Stages IIIb and IV). The mean age was 63 (SD=10). Seventeen percent of the patients studied were categorized as persistent smokers. The mean pain score for the study sample was 3.1 (sd=2.7) and 41% reported moderate (4-6) or severe pain (7-10). A greater proportion of persistent smokers reported moderate or severe pain than non-smokers or former smokers (p<.001). Logistic regression analysis revealed that, smoking status was associated with the usual pain even after adjusting for age, perceived health status and other lung cancer symptoms such as dyspnea, fatigue and trouble eating. In conclusion, patients who continue to smoke after a diagnosis of lung cancer report higher levels of usual pain than non-smokers or former smokers. More research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression in late-stage lung cancer.
This article examines the relationship between pain and persistent smoking in patients with lung cancer. Although more research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression, physicians can promote smoking cessation in patients with lung cancer to improve health and quality of life.
PMCID: PMC2684817  PMID: 19254679
24.  Ovarian Preservation by GnRH Agonists during Chemotherapy: A Meta-Analysis 
Journal of Women's Health  2009;18(3):311-319.
Treatment with cyclophosphamide (CYC) confers up to a 40% risk of ovarian failure in women of reproductive age. The use of GnRH agonists (GnRHa) to preserve ovarian function has been investigated in several small studies. We performed a systematic review of studies examining whether a GnRHa administered during chemotherapy is protective of ovarian function and fertility.
We searched the English-language literature (1966–April 2007) using MEDLINE and meeting abstracts and included studies that reported an association between GnRHa and ovarian preservation in women receiving chemotherapy. Studies without a control group were excluded. Ovarian preservation was defined as the resumption of menstrual cycles and a premenopausal follicle-stimulating hormone (FSH) after chemotherapy. Fertility was determined by a woman's ability to become pregnant. We estimated the summary relative risk (RR) and associated 95% confidence intervals (95% CI) using a random-effects model.
Nine studies included 366 women. Three studies included women with autoimmune disease receiving CYC; six included women with hematologic malignancy receiving combination chemotherapy. In total, 178 women were treated with GnRHa during chemotherapy, 93% of whom maintained ovarian function. Of the 188 women not treated with GnRHa, 48% maintained ovarian function. The use of a GnRHa during chemotherapy was associated with a 68% increase in the rate of preserved ovarian function compared with women not receiving a GnRHa (summary RR = 1.68, 95% CI 1.34-2.1). Among the GnRHa-treated women, 22% achieved pregnancy following treatment compared with 14% of women without GnRHa therapy (summary RR = 1.65, CI 1.03–2.6).
Based on the available studies, GnRHa appear to improve ovarian function and the ability to achieve pregnancy following chemotherapy. Several randomized trials are underway to define the role and mechanism of GnRHa in ovarian function preservation. In the meantime, premenopausal women facing chemotherapy should be counseled about ovarian preservation options, including the use of GnRHa therapy.
PMCID: PMC2858300  PMID: 19281314
25.  Predictors of Perceived Susceptibility of Breast Cancer and Changes Over Time: A Mixed Modeling Approach 
We used longitudinal data to extend previous cross-sectional research on factors associated with perceived cancer susceptibility and to examine the temporal relations between variables. Additionally, we explored whether predictors differed depending on how perceived susceptibility was measured.
Annual self-report surveys were completed by US women veterans (N = 3758) aged 52 years and older who were participating in a repeat mammography intervention trial. To examine individual- and group-level change in perceived susceptibility to breast cancer, we conducted multivariable non-linear mixed model analyses.
Main Outcome Measures
We examined predictors of three single-item measures of perceived susceptibility to breast cancer (percent risk, ordinal risk, and comparative risk likelihood) and changes over time. Predictors included demographic, health status, health behavior, affect, knowledge, and subjective norm variables.
Breast symptoms and greater cancer worry increased perceived susceptibility to breast cancer for all three dependent measures. Other predictors varied by dependent measure. Random change, indicating individual variability, was observed with only the percent risk measure.
Despite small model effect sizes, breast symptoms and cancer worry appear to be consistent predictors and thus may be good targets for future interventions designed to influence women’s perceived susceptibility to breast cancer. Researchers attempting to measure change in risk perceptions may benefit from using measures with larger response scales, but additional measurement research is needed. Combining indicators of perceived susceptibility may be undesirable when different predictors are associated with different measures.
PMCID: PMC2819176  PMID: 18230016
attitude to health; perception; mammography; prospective studies; questionnaires

Results 1-25 (36)