Carolee Polek

Lesbians' Disclosure of Sexual Orientation and Satisfaction With Care

The overarching aim of this study was to explore demographic variables and their association with a womans disclosure of sexual orientation to a health care provider (HCP). This descriptive correlation study used a convenience sample of 96 women recruited at gay and lesbian community events held in Delaware. A self-report survey of 35 questions was used to obtain the data. None of the women identified themselves as exclusively heterosexual. The results indicate that a womans self-identified sexual orientation is significant in predicting whether she has shared her orientation with her HCP. The more a womans self-reported orientation moves toward the heterosexual end of the preference scale, the less likely she is to share her orientation with her HCP. Culturally competent care and a nondiscriminatory atmosphere will provide this population with the trust needed to enable open rapport with their HCPs.

Asian/Pacific Islander American women: age and death rates during hospitalization for breast cancer.

PURPOSE/OBJECTIVES To investigate whether differences in age and death rates exist between hospitalized Asian/Pacific Islander American (APIA) women and women of other racial groups. DESIGN Secondary data analysis of a national data set. SETTING The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data on women with breast cancer based on racial status. A total of 20,507 hospitalization records met the study criteria. SAMPLE All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization. METHODS Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups. FINDINGS Significant differences were found between APIA and Caucasian and Latino women. Significant differences based on race were found between subjects who had died during hospitalization. On average, APIA women were the youngest to die. CONCLUSIONS APIA women with breast cancer were among the youngest women being hospitalized and the youngest to die during hospitalization. IMPLICATIONS FOR NURSING Cultural awareness by nurses is critical when discussing methods for prevention and early detection of breast cancer with minority women. Targeting new immigrants is a priority for those who screen and educate women about detection and treatment of breast cancer.

Racial Disparities in Hospitalized Elderly Patients with Chronic Heart Failure

The purpose of this study was to examine the impact of race on length of hospital stay (LOS) and number of procedures on elderly persons hospitalized with chronic heart failure (CHF). Secondary data analysis was used to obtain data on 99,543 hospitalized Medicare patients with CHF age 65 years or older. MANOVA was utilized to examine the effects of race, age, and total hospital charges on LOS, number of procedures, and diagnosis. Asian American Pacific Islanders had significantly higher number of procedures and LOS compared to Whites. The combined dependent variables were significantly affected by race, F(9, 99,543) = 121.95, p = .000; the covariates of age, F(3, 99,543) = 720.65, p = .000; and total charges F(3, 99,543) = 38,962.95, p = .000. LOS accounted for 50% of the variance. Studies that examine cultural variables and their effect on LOS and number of procedures are needed.

Characterising emergency department high-frequency users in a rural hospital

Objective Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patients visits and discrete diagnoses. Design Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses. Results Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users. Conclusions These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.

Warfarin use post hospitalization: pilot comparative effectiveness of telephone follow-up.

Purpose This studys aims were to evaluate patient knowledge of safe warfarin practices early in treatment, and to pilot a nursing telephone follow‐up enhancement to a pharmacy‐facilitated discharge. Method Forty‐two randomized patients in either ”enhanced follow‐up“ or ”treatment as usual“ groups completed the study. Results Enhanced treatment resulted in significant improvement in warfarin knowledge (86% versus 71%). In critical safety related knowledge questions even larger improvements were present (˜96% compared to ˜77%). Discussion The hypothesis that non‐adherence generating rehospitalization is a function of poorer knowledge was not supported as there were no warfarin‐related readmissions during the study. Conclusion The study supports the use of enhanced follow up and the need for larger studies to delineate what patient knowledge prevents rehospitalization and cost effective educational efforts.

Drinks per day in women of Mexican origin: does birth place matter?

AbstractHistorically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of alcohol use and higher rates of abstinence compared with Mexican American women born in the U.S. and other racial groups in the U.S. As such, immigrant women’s alcohol use has received limited attention by the research community. Gaps in knowledge of their alcohol use patterns, changes in healthy drinking recommendation for women, and projections of population growth in both Mexican immigrant and Mexican American populations support the need for the study. Data from the Center for Disease Control’s National Health Interview Survey were used to explore alcohol use differences in women of Mexican origin born in and outside of the U.S. In addition, the relationship between years in the U.S. and drinks per day was explored in Mexican immigrant women. The results indicated that Mexican immigrant women who drink are drinking above recommended levels and the younger immigrant women are drinking more drinks per day than young Mexican American women. These changes point to the importance of developing culturally sensitive interventions for this expanding segment of the population.

Changing HPV vaccination rates in bisexual and lesbian women: HPV vaccination rates

Background Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. Methods Data were obtained from the Centers for Disease Control and Preventions National Health Interview Survey 2013–2014. This survey evaluated 5695 women—113 (2%) lesbian, 135 (2.4%) bisexual, and 5446 (95.6%) heterosexual women ages 18–26 in 2006—using logistic regression. A dependent variable of having had HPV vaccination and independent variable of sexual orientation was used. Results Significant differences were found in vaccine uptake based on sexual orientation. Bisexual women were most likely to be vaccinated, and differed significantly from heterosexual and lesbians which did not differ significantly from each other. The results suggest improvement in sexual minority rates but this finding is tempered by the low rates of vaccination in adult women. Implications The low vaccination rates in adult women and sexual minorities merit further study. The low rates may be a function of the transition from pediatric to adult care and/or practice barriers perceived by sexual minorities.BACKGROUND Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. METHODS Data were obtained from the Centers for Disease Control and Preventions National Health Interview Survey 2013-2014. This survey evaluated 5695 women-113 (2%) lesbian, 135 (2.4%) bisexual, and 5446 (95.6%) heterosexual women ages 18-26 in 2006-using logistic regression. A dependent variable of having had HPV vaccination and independent variable of sexual orientation was used. RESULTS Significant differences were found in vaccine uptake based on sexual orientation. Bisexual women were most likely to be vaccinated, and differed significantly from heterosexual and lesbians which did not differ significantly from each other. The results suggest improvement in sexual minority rates but this finding is tempered by the low rates of vaccination in adult women. IMPLICATIONS The low vaccination rates in adult women and sexual minorities merit further study. The low rates may be a function of the transition from pediatric to adult care and/or practice barriers perceived by sexual minorities.

Changing HPV vaccination rates in bisexual and lesbian women

Background Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. Methods Data were obtained from the Centers for Disease Control and Preventions National Health Interview Survey 2013–2014. This survey evaluated 5695 women—113 (2%) lesbian, 135 (2.4%) bisexual, and 5446 (95.6%) heterosexual women ages 18–26 in 2006—using logistic regression. A dependent variable of having had HPV vaccination and independent variable of sexual orientation was used. Results Significant differences were found in vaccine uptake based on sexual orientation. Bisexual women were most likely to be vaccinated, and differed significantly from heterosexual and lesbians which did not differ significantly from each other. The results suggest improvement in sexual minority rates but this finding is tempered by the low rates of vaccination in adult women. Implications The low vaccination rates in adult women and sexual minorities merit further study. The low rates may be a function of the transition from pediatric to adult care and/or practice barriers perceived by sexual minorities.BACKGROUND Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. METHODS Data were obtained from the Centers for Disease Control and Preventions National Health Interview Survey 2013-2014. This survey evaluated 5695 women-113 (2%) lesbian, 135 (2.4%) bisexual, and 5446 (95.6%) heterosexual women ages 18-26 in 2006-using logistic regression. A dependent variable of having had HPV vaccination and independent variable of sexual orientation was used. RESULTS Significant differences were found in vaccine uptake based on sexual orientation. Bisexual women were most likely to be vaccinated, and differed significantly from heterosexual and lesbians which did not differ significantly from each other. The results suggest improvement in sexual minority rates but this finding is tempered by the low rates of vaccination in adult women. IMPLICATIONS The low vaccination rates in adult women and sexual minorities merit further study. The low rates may be a function of the transition from pediatric to adult care and/or practice barriers perceived by sexual minorities.

Are changes in breast self‐exam recommendations and early misperceptions of breast cancer risk increasing women's future risks?

Objective Young women, high school age, are exposed to breast cancer messages targeting adult women that can result in misperceptions, increasing future risks. Changes in breast self-exam screening recommendations may reduce nurse practitioner (NP) time addressing breast health. This study characterized misperceived knowledge of breast cancer risk in younger women. Method A survey (338 high school students aged 14 to 19) was conducted to assess their perceptions of breast cancer etiologies and risk behaviors. Results Survey results indicated 20% to 50% of students had misperceptions about breast cancer risk, and the mean knowledge score for all items was 65.47%. There were no differences in students with familial breast cancer histories or those instructed in breast self-exam. Approximately 12% reported being fearful, avoiding public health messages, and approximately 20% thought breastfeeding increased breast cancer risk. Implications for practice The findings suggest that school-based programs are not addressing misperceptions related to breast health effectively. A National Cancer Institute survey found that NPs and other providers are the most trusted sources of health information. Given the low rates of breast cancer in young women and recommendations against teaching breast self-exam, it is important for NPs to be knowledgeable about common misperceptions and address them with their patients.Objective:Young women, high school age, are exposed to breast cancer messages targeting adult women that can result in misperceptions, increasing future risks. Changes in breast self‐exam screening recommendations may reduce nurse practitioner (NP) time addressing breast health. This study characterized misperceived knowledge of breast cancer risk in younger women. Method:A survey (338 high school students aged 14 to 19) was conducted to assess their perceptions of breast cancer etiologies and risk behaviors. Results:Survey results indicated 20% to 50% of students had misperceptions about breast cancer risk, and the mean knowledge score for all items was 65.47%. There were no differences in students with familial breast cancer histories or those instructed in breast self‐exam. Approximately 12% reported being fearful, avoiding public health messages, and approximately 20% thought breastfeeding increased breast cancer risk. Implications for practice:The findings suggest that school‐based programs are not addressing misperceptions related to breast health effectively. A National Cancer Institute survey found that NPs and other providers are the most trusted sources of health information. Given the low rates of breast cancer in young women and recommendations against teaching breast self‐exam, it is important for NPs to be knowledgeable about common misperceptions and address them with their patients.

In Asian americans, is having a family member diagnosed with cancer associated with fatalistic beliefs?

Objective: Cancer can evoke long-held cultural beliefs which either facilitate or impede efforts to expand the health literacy of families. Among these beliefs is fatalism which holds that controlling ones′ outcome is not possible, and that ones′ outcome is predestined. Some fatalistic beliefs are broadly held within the Asian American (AA) community and may be challenged or reinforced by the experience of having a family member diagnosed with cancer. This study evaluated the relationship between having a family member diagnosed with cancer and selected demographics in AAs on fatalistic beliefs. Methods: Data from 519 AA subjects from the Centers for Disease Control and Prevention Health Information Trends Survey were used to complete a secondary analysis. Descriptive statistics characterize fatalistic beliefs. Four models using four questions assessed fatalistic beliefs as dependent variables and independent variables of having or not having a family member diagnosed with cancer, completing college or not, sex, and age were assessed using ordinal regression. Results: All of the fatalistic beliefs examined were endorsed by large portions of the subjects. When considering the role of being exposed to having a family member with cancer, it was associated with an increase in the likelihood in a belief that one is likely to get cancer, and everything can cause cancer. Being exposed to a family member diagnosed with cancer was not significantly associated with believing, there was little one could do to control their cancer risk. This belief was broadly rejected. While the belief that there are so many different recommendations about preventing cancer, it is hard to know what to do, was broadly endorsed and not associated with having a family member diagnosed with cancer. Conclusions: The major practice implications within oncology nursing suggest the importance in assessing cancer health literacy and providing corrective knowledge in families with a member diagnosed with cancer. While recognizing the need for more knowledge, cancer diagnoses may represent a significant teachable moment for family members enhancing their health knowledge and supporting behavioral change. Two beliefs were contradictory and broadly held with the AA community, thus support will be needed for further public health research.