Alison Timm

Using cancer registry data for recruitment of sexual minority women: successes and limitations.

OBJECTIVE To identify and recruit an unknown and presumably small subgroup of survivors, that is, lesbian or bisexual women with breast cancer. METHODS This report describes our multistep approach to recruit a representative sample of heterosexual and sexual minority breast cancer survivors. We used census data to identify geographic areas with a greater prevalence of sexual minority women (SMW), that is, lesbian and bisexual women. We then obtained the breast cancer cases from a cancer registry for these geographic areas. In the absence of sexual orientation data in cancer registries, all potentially eligible women with breast cancer needed to be contacted by telephone to determine their sexual orientation. RESULTS Among the 1341 women screened who answered the question about sexual orientation, 6.3% were SMW. Overall, we processed 4143 cases to obtain completed data on 69 SMW and 257 heterosexual women with breast cancer. CONCLUSIONS Our findings suggest that it is resource intensive but feasible to recruit a representative sample of breast cancer survivors of different sexual orientations. Our findings can inform future studies that seek to recruit sexual minority populations from cancer registries about some of the limitations to this approach.

Comparing Sexual Minority Cancer Survivors Recruited Through a Cancer Registry to Convenience Methods of Recruitment

PURPOSE Sexual minority women, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, are not considered by cancer surveillance. This study assesses the representativeness of sexual minority breast cancer survivors, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, who were recruited into a convenience sample compared with a population-based registry sample of sexual minority breast cancer survivors. METHODS Long-term survivors of non-metastatic breast cancer who self-reported as sexual minority were recruited from a cancer registry and subsequently from the community using convenience recruitment methods. Sexual minority breast cancer survivors who screened eligible participated in a telephone survey about their quality of life and factors associated therewith. RESULTS Participants in the convenience sample were similar to the registry-based sample with respect to adjustment to cancer, physical health, trust in physician, coping, social support, and sexual minority experiences. Compared with the convenience sample, breast cancer survivors in the registry sample were more likely married, more educated, diagnosed more recently, at an earlier stage of cancer, and more likely treated with breast-conserving surgery; they differed on adjuvant therapies. DISCUSSION Because sexual minority breast cancer survivors who volunteered for the community-based sample shared most characteristics of the sample recruited from the cancer registry, we concluded that the community sample had comparable representational quality. In the absence of cancer surveillance of sexual minorities, thoughtful convenience recruitment methods provide good representational quality convenience samples.

The CHEER Study to Reduce BMI in Elementary School Students: A School-Based, Parent-Directed Study in Framingham, Massachusetts

Childhood obesity may be lessened by parent-focused interventions. A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham, Massachusetts. Parents were randomly assigned to either the Materials Group, which received mailed educational materials, or the Materials plus Personal Encounters Group, which received educational materials through interactions with community health workers (CHWs). Parents completed baseline and post-intervention surveys; children’s body mass index (BMI) percentiles were measured at baseline and post-intervention. There were no differences in the reduction of children’s BMI between groups. However, the mean BMI percentile for all children dropped from 94.1 to 90.6 (p = .005), while there was no change in BMI among a nonrandomized contemporaneous control group. Findings are limited by the lack of a true control group and small sample size. Results from this school nurse and CHW outreach program to parents are encouraging.

Smoking cessation counseling for parents during child hospitalization: a national survey of pediatric nurses.

OBJECTIVE Given the central role played by pediatric nurses in intake assessment, discharge planning, and education for families of hospitalized pediatric patients, a childs hospitalization may provide a unique opportunity for counseling parents about smoking. We sought to determine if hospital policies can support nurses in effectively counseling parents about smoking. DESIGN AND SAMPLE We conducted a national survey of pediatric staff nurses and administrators/educators who were members of the Society of Pediatric Nurses in 2008 (n=888) to explore counseling practices for tobacco control. MEASURES Questionnaires included data on demographics, personal and work environment characteristics, hospital policy characteristics, work attitudes and barriers and the main outcome--5As for smoking cessation counseling--Ask, Advise, Assess, Assist, and Arrange. RESULTS Overall, routine screening for household smokers was most common (43%), followed by advice to quit (25%), assessing willingness to quit (19%), assisting with a quit plan (6%), and arranging follow-up contact (3%). Nurses working in hospitals with admission assessments specifically asking about household members who smoke were 7 times more likely than those without such assessments to routinely ask about smoking (OR: 7.2, 95% CI: 4.9-10.5). CONCLUSION Future research should test the efficacy of developing comprehensive hospital-wide policies to deliver smoking cessation for parents during a childs hospitalization.

Applying the Female Sexual Functioning Index to Sexual Minority Women

BACKGROUND Available measurements of womens sexual function do not account for different sexual orientations; rather, instruments have been developed using heterosexual samples. The Female Sexual Functioning Index (FSFI) is a widely used instrument, applicable for sexually active or inactive women. We apply the FSFI to a sample of women who have or prefer women as sexual partners, defined as sexual minority women, and who vary with respect to their sexual activity. METHODS A modified version of the FSFI was used in a sample of sexual minority women. Statistical analyses focused on examining associations between FSFI responses of no sexual activity and womens characteristics. RESULTS Partner status and sexual frequency was significantly associated with reporting no sexual activity on the FSFI. A revised scoring of the FSFI allows for the use of this instrument among women who vary on sexual frequency and partner status, without biasing their scores towards sexual dysfunction. The desire subscale is independent of sexual frequency, partner status, and sexual orientation. CONCLUSIONS The modified wording of the FSFI and its revised scoring allow for the use of this instrument among sexual minority women. A separate reporting of the desire subscale will generate reliable and valid assessments of sexual minority womens sexual functioning.

Two Means of Sampling Sexual Minority Women: How Different Are the Samples of Women?

We compared 2 sampling approaches of sexual minority women in 1 limited geographic area to better understand the implications of these 2 sampling approaches. Sexual minority women identified through the Census did not differ on average age or the prevalence of raising children from those sampled using nonrandomized methods. Women in the convenience sample were better educated and lived in smaller households. Modeling the likelihood of disability in this population resulted in contradictory parameter estimates by sampling approach. The degree of variation observed both between sampling approaches and between different parameters suggests that the total population of sexual minority women is still unmeasured. Thoroughly constructed convenience samples will continue to be a useful sampling strategy to further research on this population.

Overweight and obesity in long-term breast cancer survivors: how does sexual orientation impact BMI?

In noncancer populations lesbians have greater odds of obesity compared with heterosexual women, suggesting a similar pattern among cancer survivors. Weight of cancer survivors is an important area of study because obesity is associated with an increased risk of recurrence and shorter survival. Sixty-nine lesbian and bisexual and 257 heterosexual survivors of breast cancer were recruited to participate in a one-time telephone survey. Multinomial logit models do not support disparities in obesity due to sexual orientation. Our findings in breast cancer survivors suggest that lesbians are more likely to improve their weight-related behaviors after cancer than heterosexual women.

Explanatory factors of sexual function in sexual minority women breast cancer survivors

BACKGROUND The sexual function of sexual minority women (women with female partners) who are breast cancer survivors is mostly unknown. Our objective is to identify explanatory factors of sexual function among sexual minority women with breast cancer and compare them with a control sample of sexual minority women without cancer. PATIENTS AND METHODS Using a conceptual framework that has previously been applied to heterosexual breast cancer survivors, we assessed the relationship of each explanatory factor to sexual function in sexual minority women. Using generalized estimating equations, we identified explanatory factors of sexual function and identified differences by case and control status. RESULTS Self-perception of greater sexual attractiveness and worse urogenital menopausal symptoms explain 44% of sexual function, after controlling for case and control status. Focusing only on partnered women, 45% of sexual function was explained by greater sexual attractiveness, postmenopausal status, and greater dyadic cohesion. CONCLUSIONS All of the relevant explanatory factors for sexual function among sexual minority survivors are modifiable as has been suggested for heterosexual survivors. Sexual minority survivors differ from heterosexual survivors in that health-related quality of life is less important as an explanatory factor. These findings can guide adaptation of interventions for sexual minority survivors.BACKGROUND The sexual function of sexual minority women (women with female partners) who are breast cancer survivors is mostly unknown. Our objective is to identify explanatory factors of sexual function among sexual minority women with breast cancer and compare them with a control sample of sexual minority women without cancer. PATIENTS AND METHODS Using a conceptual framework that has previously been applied to heterosexual breast cancer survivors, we assessed the relationship of each explanatory factor to sexual function in sexual minority women. Using generalized estimating equations, we identified explanatory factors of sexual function and identified differences by case and control status. RESULTS Self-perception of greater sexual attractiveness and worse urogenital menopausal symptoms explain 44% of sexual function, after controlling for case and control status. Focusing only on partnered women, 45% of sexual function was explained by greater sexual attractiveness, postmenopausal status, and greater dyadic cohesion. CONCLUSIONS All of the relevant explanatory factors for sexual function among sexual minority survivors are modifiable as has been suggested for heterosexual survivors. Sexual minority survivors differ from heterosexual survivors in that health-related quality of life is less important as an explanatory factor. These findings can guide adaptation of interventions for sexual minority survivors.