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1.  Depressive Symptoms and Serum Lipid Levels in Young Adult Women 
Journal of behavioral medicine  2012;36(2):143-152.
Accumulating data suggest that depression is associated with risk factors for cardiovascular disease, but few studies have investigated potential behavioral mediators of such associations, particularly among women. In this study of healthy young adult women (n = 225), we examined associations among depressive symptoms, health behaviors, and serum lipid levels. Depressive symptoms were assessed with the 20-item Center for Epidemiologic Studies – Depression (CES-D) scale, and a fasting blood sample was obtained for serum lipid levels, including total cholesterol, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C). Diet was measured using 24-hour recalls, and other health behaviors (physical activity, smoking) were assessed via self-report questionnaire. Results indicated a modest negative association between depressive symptoms and LDL-C levels. Higher levels of depressive symptoms were also associated with lower total and insoluble dietary fiber intake, both of which were associated with HDL-C and LDL-C. Mediational analyses indicated a significant indirect effect of depressive symptoms on LDL-C via total and insoluble dietary fiber in unadjusted analyses, but not in adjusted analyses. The present findings suggest that depressive symptoms are inversely associated with serum LDL-C levels in young adult women, but that these associations are not likely mediated by adverse lifestyle behaviors.
doi:10.1007/s10865-012-9409-1
PMCID: PMC3376669  PMID: 22382824
Depression; cholesterol; health behaviors; diet
2.  Health Beliefs Associated with Cervical Cancer Screening Among Vietnamese Americans 
Journal of Women's Health  2013;22(3):276-288.
Abstract
Background
Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs.
Objective
The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women.
Methods
Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese.
Results
The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test.
Conclusion
Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.
doi:10.1089/jwh.2012.3587
PMCID: PMC3601630  PMID: 23428284
3.  Challenges and Needs of Chinese and Korean American Breast Cancer Survivors: In-Depth Interviews 
Breast cancer incidence and the number of breast cancer survivors have been rapidly increasing among Chinese and Korean women in the United States. However, few data are available regarding quality of life in Asian American breast cancer survivors. This qualitative study aims to describe Asian American women’s perceptions of quality of life and their breast cancer experiences. In-depth interviews with four Chinese and five Korean American breast cancer survivors and three oncologists were conducted in Chinese, Korean, or English. Interviews were recorded and transcripts were translated into English. Qualitative analyses were performed by two independent coders and then discussed and agreed upon by the research team. The respondents reported that the breast cancer experience had affected various domains of quality of life, but women reported having limited resources with which to cope effectively. Depression, anxiety, and stress were commonly reported, but women rarely discussed these issues with family and friends or sought professional help. As immigrants, women’s loneliness and a lack of social support and culturally relevant resources seemed to be major barriers to maintaining good quality of life. Women also expressed interest in learning more about alternative therapies and relaxation skills. These findings can be used to help inform the development of a culturally appropriate intervention for Asian American breast cancer survivors. Future programs may provide information in women’s native languages to teach skills to cope with stress and anxiety, increase women’s self-efficacy within the context of their cultural background, and enhance social support among women from the same ethnic group.
doi:10.7156/najms.2013.0601001
PMCID: PMC3766352  PMID: 24019995
breast cancer; quality of life; survivorship; Asian American; Chinese American; Korean American
4.  Pathways of Breast Cancer Screening Among Chinese American Women 
Objective
The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.
Methods
A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women.
Results
Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women.
Conclusions
The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.
doi:10.4172/2161-0711.1000209
PMCID: PMC3762685  PMID: 24013711
Mammograms; Breast cancer screening; Chinese women
5.  Pilot Study: Health Behaviors Associated with HPV Vaccine Uptake among Adolescents 
Background
Despite approval of a vaccine found to be very effective in preventing human papillomavirus (HPV) infection and related cancers, many young people have not yet been vaccinated. Since health behaviors tend to co-occur, the purpose of the current study was to examine relationships among HPV vaccine uptake and other health behaviors among adolescents.
Methods
Fifty-nine high school students completed a paper-and-pencil pilot survey regarding HPV vaccine knowledge and attitudes as well as HPV vaccination and other health behaviors.
Results
We found that HPV vaccination was significantly associated with health-promoting behaviors among girls (e.g., not smoking, p = .02), whereas vaccination willingness was associated with health risk behaviors among boys (e.g., higher sugar diet, p = .03).
Conclusions
Effective interventions to promote HPV vaccination among adolescents may benefit from a simultaneous focus on multiple health behaviors and/or health in general. Interventions tailored by gender may also be beneficial.
doi:10.1177/2150131911429574
PMCID: PMC3695443  PMID: 23803777
HPV vaccine acceptance; health risk behaviors; health promotion behaviors; adolescents
6.  What Is Lacking in Patient-Physician Communication: Perspectives from Asian American Breast Cancer Patients and Oncologists 
Journal of behavioral health  2012;1(2):10.5455/jbh.20120403024919.
Objectives
Interactions between breast cancer patients and their oncologists are important as effective patient-physician communication can facilitate the delivery of quality cancer care. However, little is known about patient-physician communication processes among Asian American breast cancer patients, who may have unique communication needs and challenges. Thus, we interviewed Asian American patients and several oncologists to explore patient-physician communication processes in breast cancer care.
Methods
We conducted in-depth interviews with nine Chinese- or Korean American breast cancer patients and three Asian American oncologists who routinely provided care for Asian American patients in the Washington DC metropolitan area in 2010. We conducted patient interviews in Chinese or Korean and then translated into English. We conducted physicians’ interviews in English. We performed qualitative analyses to identify themes.
Results
For women with limited English proficiency, language was the greatest barrier to understanding information and making treatment-related decisions. Both patients and oncologists believed that interpretation provided by patients’ family members may not be accurate, and patients may neglect to ask questions because of their worry of burdening others. We observed cultural differences regarding expectations of the doctor’s role and views of cancer recovery. As expressed by the patients and observed by oncologists, Asian American women are less likely to be assertive and are mostly reliant on physicians to make treatment decisions. However, many patients expressed a desire to be actively involved in the decision-making process.
Conclusion
Findings provide preliminary insight into patient-physician communication and identify several aspects of patient-physician communication that need to be improved for Asian American breast cancer patients. Proper patient education with linguistically and culturally appropriate information and tools may help improve communication and decision-making processes for Asian American women with breast cancer.
doi:10.5455/jbh.20120403024919
PMCID: PMC3566873  PMID: 24496377
Asian American; breast cancer; patient-physician communication; language barrier; cultural difference; treatment decision making
7.  Informational Needs of Head and Neck Cancer Patients 
Health and technology  2012;2(1):57-62.
Treatment for head and neck squamous cell carcinoma (HNSCC) can lead to considerable functional impairment. As a result, HNSCC patients experience significant decrements in quality of life, high levels of emotional distress, deteriorations in interpersonal relations, and increased social isolation. Studies suggest that HNSCC patients may have extensive informational and psychosocial needs that are not being adequately addressed. However, few programs have been developed to address the needs of HNSCC patients. Therefore, we conducted a pilot study of HNSCC patients to: 1) characterize patients' informational needs; and 2) describe preferred formats and time points for receiving such information. The majority of participants desired additional information regarding treatment options, managing changes in swallowing and speaking, and staying healthy after treatment. Overall, patients with early-stage disease reported more informational needs compared to patients with advanced disease. Female patients were more likely to desire information about coping with emotional stress and anxiety than male patients. Younger patients (29–49 years) were more interested in receiving information about sexuality after cancer compared to their older (50+) counterparts. Although information was requested throughout the cancer trajectory, most patients preferred to receive such information at diagnosis or within 1–3 months post-treatment. The majority of patients reported having computer and Internet access, and they were most receptive to receiving information delivered via the Internet, from a DVD, or from pamphlets and booklets. The relatively high percentage of patients with computer and Internet access reflects a growing trend in the United States and supports the feasibility of disseminating health information to this patient population via Internet-based programs.
doi:10.1007/s12553-012-0020-9
PMCID: PMC3327509  PMID: 22518350
Head and neck cancer; informational needs; Treatment side effects; Internet
8.  Socioeconomic position and lower dietary moderation among Chinese immigrant women in the United States 
Public Health Nutrition  2011;15(3):415-423.
Objective
To examine associations of education and occupation, as indicators of socioeconomic position (SEP), with dietary intake and diet quality in a sample of Chinese immigrant women.
Design
Cross-sectional. Data collection included four days of dietary recalls and information on education and current occupation for participants and their spouses.
Setting
Philadelphia, PA, USA.
Subjects
423 Chinese immigrant women recruited 10/05-4/08.
Results
In multivariate models, both higher education level and occupation category were significantly associated with higher energy density and intake of energy and sugar. Education was additionally associated with intake of sugar-sweetened beverages (p=0.01) and lower dietary moderation (p=0.01). With joint categorization based on both education and occupation, we observed significant trends indicating higher energy density (p=0.004) and higher intake of energy (p=0.001) and sugar (p=0.04), but less dietary moderation (p=0.02) with higher SEP.
Conclusions
In this sample of US Chinese immigrants, higher SEP as indicated by education level and occupation category was associated with differences in dietary intake, and with less dietary moderation. While higher SEP is typically linked to healthier diet in higher income nations, in these immigrants the association of SEP with diet follows the pattern of their country of origin – a lower-income country undergoing the nutrition transition.
doi:10.1017/S1368980011001820
PMCID: PMC3340423  PMID: 21806866
9.  Psychological functioning of caregivers for head and neck cancer patients 
Oral Oncology  2011;48(1):18-25.
SUMMARY
Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.
doi:10.1016/j.oraloncology.2011.11.012
PMCID: PMC3357183  PMID: 22154127
Caregiving; Psychological health; Emotional distress; Anxiety; Depression; Head and neck cancer
10.  Correlates of Cervical Cancer Screening among Vietnamese American Women 
Objective. Vietnamese American women are at the greatest risk for cervical cancer but have the lowest cervical cancer screening rates. This study was to determine whether demographic and acculturation, healthcare access, and knowledge and beliefs are associated with a prior history of cervical cancer screening among Vietnamese women. Methods. Vietnamese women (n = 1450) from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey participated in the study and completed baseline assessments. Logistic regression analyses were performed. Results. Overall levels of knowledge about cervical cancer screening and human papillomavirus (HPV) are low. Factors in knowledge, attitude, and beliefs domains were significantly associated with Pap test behavior. In multivariate analyses, physician recommendation for screening and having health insurance were positively associated with prior screening. Conclusion. Understanding the factors that are associated with cervical cancer screening will inform the development of culturally appropriate intervention strategies that would potentially lead to increasing cervical cancer screening rates among Vietnamese women.
doi:10.1155/2012/617234
PMCID: PMC3449126  PMID: 23008526
11.  Stress Is Associated with Unfavorable Patterns of Dietary Intake among Female Chinese Immigrants 
Background
Chinese immigrants experience increased risk for weight gain and chronic disease after US migration. Whether psychosocial stress affects their eating behavior is unknown.
Purpose
To examine psychosocial stress and dietary intake among 426 Chinese immigrant women in the Philadelphia region.
Methods
Participants completed 4 days of dietary recalls and questionnaires assessing positive and negative life events in the past year and migration-related stressors.
Results
In hierarchical linear regression models, positive life events were associated with higher energy intake (β=21.1, p=0.04). Migration-related stress was associated with lower total gram (β=−11.3, p<0.0001) and grain (β=−0.18, p=0.03) intake overall, and higher energy density (β=0.002, p=0.04) and % energy from fat (β=0.06, p=0.05).
Conclusions
Migration-related stress did not increase overall intake in terms of energy and total grams, but selectively increased fat intake and energy density. Such dietary habits may have implications for future chronic disease risk in this immigrant population.
doi:10.1007/s12160-010-9259-4
PMCID: PMC3098912  PMID: 21384248
stress; Asian; dietary intake; acculturation
12.  Overcoming Barriers to Cervical Cancer Screening Among Asian American Women 
Significant disparities in cervical cancer incidence and mortality exist among ethnic minority women, and in particular, among Asian American women. These disparities have been attributed primarily to differences in screening rates across ethnic/racial groups. Asian American women have one of the lowest rates of screening compared to other ethnic/racial groups. Yet Asian Americans, who comprise one of the fastest growing populations in the United States, have received the least attention in cancer control research. Studies suggest that various factors, including lack of knowledge, psychosocial and cultural beliefs, and access barriers, are associated with cervical cancer screening behaviors among Asian American women. Indeed, the few interventions that have been developed for Asian American women demonstrate that targeting these factors can yield significant increases in screening rates. It is important to note, however, that the effectiveness of educational interventions is often attenuated if access barriers are not adequately addressed. Hence, interventions that include key essential components, such as the use of community individuals as lay health workers, culturally-tailored and linguistically-appropriate educational materials, and navigation assistance to overcome access barriers, are more likely to be successful in enhancing screening rates. As the benefits of community-based cervical cancer prevention programs become more apparent, it will be essential to identify effective approaches for disseminating such programs more broadly. In conclusion, community-based cervical cancer screening programs have demonstrated promise in addressing existing cervical cancer disparities by increasing awareness and knowledge and promoting recommended screening behaviors. These findings will be instrumental in guiding future community-based programs to reduce cervical cancer health disparities among Asian American women.
PMCID: PMC3115728  PMID: 21687826
cervical cancer; screening; Asian Americans; disparities; cancer prevention; community-based; psychosocial beliefs; access barriers
13.  Enhanced Psychosocial Well-Being Following Participation in a Mindfulness-Based Stress Reduction Program is Associated with Increased Natural Killer Cell Activity 
Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity.
Objective
To examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program.
Design
A single-group, pre-test post-test design was utilized.
Setting
The intervention was conducted at an academic health center.
Subjects
This pilot study involved twenty-four participants (aged 28–72 years). Inclusion criteria were: ≥18 years of age, English-speaking, no known autoimmune disorder.
Intervention
The intervention was an 8-week MBSR program.
Outcome Measures
Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey (MOS) Short-Form Health Survey (SF-36), respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP).
Results
Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity.
Conclusion
Positive improvement in psychological well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.
doi:10.1089/acm.2009.0018
PMCID: PMC2921566  PMID: 20455784
mindfulness-based stress reduction; psychosocial functioning; natural killer cell activity; C-reactive protein
14.  Enhanced Psychosocial Well-Being Following Participation in a Mindfulness-Based Stress Reduction Program Is Associated with Increased Natural Killer Cell Activity 
Abstract
Background
Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity.
Objectives
The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program.
Design
A single-group, pretest/post-test design was utilized.
Setting
The intervention was conducted at an academic health center.
Subjects
This pilot study involved 24 participants (aged 28–72 years). Inclusion criteria were as follows: ≥18 years of age, English-speaking, and no known autoimmune disorder.
Intervention
The intervention was an 8-week MBSR program.
Outcome measures
Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey Short-Form Health Survey, respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP).
Results
Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity.
Conclusions
Positive improvement in psychologic well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.
doi:10.1089/acm.2009.0018
PMCID: PMC2921566  PMID: 20455784
15.  Evidence-Based Intervention to Reduce Access Barriers to Cervical Cancer Screening Among Underserved Chinese American Women 
Journal of Women's Health  2010;19(3):463-469.
Abstract
Objective
The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City.
Methods
Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff.
Results
In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01–1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10–0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02–0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05).
Conclusions
Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.
doi:10.1089/jwh.2009.1422
PMCID: PMC2867551  PMID: 20156089
16.  Behavioral correlates of HPV vaccine acceptability in the 2007 Health Information National Trends Survey (HINTS) 
The development of a prophylactic vaccine to prevent infection with oncogenic subtypes of human papillomavirus (HPV) is an important step in reducing cervical cancer incidence and mortality. However, national data indicate that only 37% of 13–17 year old females have initiated the vaccine series. Prior studies have examined demographic, medical history, and psychosocial variables associated with parental HPV vaccine acceptability, although few have investigated behavioral correlates of vaccine acceptability. The primary purpose of the current study is to report on national acceptability of the HPV vaccine among U.S. adults with female children in the household and to investigate health behavior correlates of vaccine acceptability. Data were drawn from the 2007 Health Information National Trends Survey (HINTS). The study sample was comprised of 1,383 adults who reported having a female child under the age of 18 in their household (52% female, 59% white, M age = 40 years). More than half (58%) reported that they would have a daughter get the HPV vaccine, 25% were not sure, and 18% would not have a daughter vaccinated. Behavioral factors significantly associated with lower acceptance of the HPV vaccine included lack of physical activity in the past month (p = .002), past year use of complementary or alternative therapies (p = .021), and no history of smoking (p = .005). These results suggest that behavioral health factors may be associated with vaccine acceptability and further our understanding of how behavioral patterns may contribute to uptake of new cancer prevention strategies.
doi:10.1158/1055-9965.EPI-09-0918
PMCID: PMC2820128  PMID: 20142234
HPV vaccine; health behaviors; cervical cancer prevention
17.  Adolescent Diet and Subsequent Serum Hormones, Breast Density and Bone Mineral Density in Young Women: Results of the Dietary Intervention Study in Children (DISC) Follow-Up Study 
Background
Adolescent diet is hypothesized to influence breast cancer risk. We evaluated the long-term effects of an intervention to lower fat intake among adolescent girls on biomarkers that are related to breast cancer risk in adults.
Methods
A follow-up study was conducted of 230 girls who participated in the Dietary Intervention Study in Children (DISC), in which healthy, prepubertal 8-10 year olds were randomly assigned to usual care or to a behavioral intervention that promoted a reduced fat diet. Participants were 25-29 years old at follow-up visits. All tests of statistical significance are two-sided.
Results
In analyses that did not take account of diet at the time of the follow-up visit, the only statistically significant treatment group difference was higher bone mineral content (BMC) in intervention group participants compared to usual care group participants; their mean BMCs were 2,444g and 2,377g, respectively. After adjustment for current diet, the intervention group also had statistically significantly higher bone mineral density and luteal phase serum estradiol concentrations. Serum progesterone concentrations and breast density did not differ by treatment group in unadjusted or adjusted analyses.
Conclusion
Results do not support the hypothesis that consumption of a lower fat diet during adolescence reduces breast cancer risk via effects on subsequent serum estradiol and progesterone levels, breast density or BMD.
Impact
Additional research is needed to clarify the association of adolescent diet with breast cancer risk and to determine if the results reported here are specific to the DISC intervention or more broadly applicable.
doi:10.1158/1055-9965.EPI-09-1259
PMCID: PMC2883023  PMID: 20501774
18.  Family cohesion moderates the relation between free testosterone and delinquent behaviors in adolescent boys and girls 
Purpose
This study examined the associations of free testosterone and family environment with delinquent and aggressive behaviors among adolescent boys and girls with elevated low-density lipoprotein (LDL)-cholesterol levels.
Methods
Participants were 164 boys and 180 girls (ages 11–14 years). The female parent provided ratings of family cohesion and child aggressive and delinquent behaviors. Tanner ratings of pubertal development were obtained during physical examination, and a blood sample was drawn for assessment of serum levels of free testosterone.
Results
Hierarchical regression analyses revealed significant two-way interactions of free testosterone and family cohesion on delinquent behaviors among adolescent boys and girls. Specifically, under conditions of low family cohesion, free testosterone was positively associated with delinquent behaviors among boys, whereas no association between free testosterone and delinquent behavior was observed in families with high cohesion. In contrast, free testosterone was negatively associated with delinquent behaviors among adolescent girls in low cohesion families. For girls, family cohesion was negatively associated with aggressive behaviors; for boys, LDL-C was positively associated with aggressive behaviors.
Conclusions
Child gender and family environment factors appear to modify the associations between free testosterone and delinquent behaviors in adolescent boys and girls.
doi:10.1016/j.jadohealth.2008.11.018
PMCID: PMC2687526  PMID: 19465324
testosterone; delinquent behaviors; aggression; family cohesion
19.  A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer 
Gynecologic oncology  2009;112(3):594-600.
Objective
The primary objective of the study was to prospectively assess quality of life (QOL) among women at increased risk of ovarian cancer who are undergoing risk-reducing salpingo-oophorectomy (RRSO) or serial screening.
Methods
Women at increased risk of ovarian cancer who were undergoing RRSO were recruited into the study. At-risk women undergoing serial screening for early detection of ovarian cancer served as a comparison group. Participants completed measures of QOL, sexual functioning, body image, depressive symptoms, and a symptom checklist at baseline (prior to surgery for women obtaining RRSO), and then at 1-month, 6-months, and 12-months post baseline.
Results
Women who underwent surgery reported poorer physical functioning, more physical role limitations, greater pain, less vitality, poorer social functioning, and greater discomfort and less satisfaction with sexual activities at 1-month assessment compared to baseline. In contrast, women undergoing screening experienced no significant decrements in QOL or sexual functioning at 1-month assessment. Most QOL deficits observed in the surgical group were no longer apparent by 6-month assessment. Women in the surgery group were more likely to report hot flashes and vaginal dryness, but over time, symptoms of vaginal discomfort decreased to a greater extent in women who had RRSO compared to women undergoing screening. No differences in body image or depressive symptoms were observed between the two groups at any time point.
Conclusions
Short-term deficits in physical functioning and other specific domains of QOL were observed following RRSO, but most women recovered baseline functioning by 6- and 12-month assessments. Issues regarding the potential impact of surgery on short-term sexual functioning should be considered and weighed carefully, particularly among younger women.
doi:10.1016/j.ygyno.2008.11.039
PMCID: PMC2697574  PMID: 19141360
quality of life; ovarian cancer; prophylactic surgery; screening
20.  Perceived stress is associated with impaired T-cell response to HPV16 in women with cervical dysplasia 
Background
Infection with high-risk subtypes of human papillomavirus (HPV) is a central factor in the development of cervical neoplasia. Cell-mediated immunity against HPV16 plays an important role in the resolution of HPV infection and in controlling cervical disease progression. Research suggests that stress is associated with cervical disease progression, but few studies have examined the biological mechanisms that may be driving this association.
Purpose
This study examines whether stress is associated with immune response to HPV16 among women with cervical dysplasia.
Methods
Seventy-four women presenting for colposcopy completed measures of health behaviors, stressful life events and perceived stress (Perceived Stress Scale). A blood sample was obtained to evaluate proliferative T-cell response to HPV16, and a cervical sample was obtained during gynecologic exam for HPV-typing.
Results
Over 55% tested positive for one or more HPV subtypes. Women who did not show proliferative responses to HPV (i.e. non-responders) were more likely to be HPV+ compared to women who had a response (i.e. responders). Consistent with study hypotheses, logistic regression revealed that higher levels of perceived stress were associated with a non-response to HPV16, controlling for relevant covariates. Stressful life events were not associated with T-cell response to HPV.
Conclusions
Higher levels of perceived stress are associated with impaired HPV-specific immune response in women with cervical dysplasia, suggesting a potential mechanism by which stress may influence cervical disease progression.
doi:10.1007/s12160-007-9007-6
PMCID: PMC2396791  PMID: 18347908
stress; human papillomavirus; cervical dysplasia; T-cell proliferative response

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