Donald R. Harris

Changes in mammography use : economic, need, and service factors

OBJECTIVES The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.

Work-site nutrition intervention and employees' dietary habits: the Treatwell program

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.

Measuring the effect of a worksite-based nutrition intervention on food consumption

Although current dietary guidelines focus on a combination of specific nutrients and food items, most effective dietary interventions focus on patterns of dietary intake and take into account the relationships among nutritional factors. In a controlled nutrition intervention conducted at 16 workplaces, a self-administered health habits questionnaire (HHQ) including a 67-item version of a semiquantitative food frequency questionnaire (FFQ) was distributed prior to a 15-month intervention and again after it. Principal components analysis (PCA) was used to reduce this large set of highly correlated FFQ food items to a smaller set of maximally uncorrelated components (PCs). Of the eight discrete food-based eating patterns targeted in the Treatwell intervention, six were highly correlated ([r[ > or = 0.48) with at least one PC each. This indicates a high level of concordance between a priori intervention targets and actual behavior. Based on log-transformed preintervention FFQ measures, our results showed that a very high proportion (0.55) of the variance in the FFQ data was explained by the PCs. A significantly greater increase in consumption of total vegetables and a larger decrease in dietary intake of ground and processed meats were observed among intervention companies. A comparison PCA conducted on intervention and control companies after the intervention indicated that patterns of intake were very stable over time.

Impact of a worksite cancer prevention program on eating patterns of workers

Abstract Changes in the consumption of foods targeted by a cancer prevention intervention based on seven food-focused messages were measured in Treatwell, a randomized, controlled worksite nutrition intervention study aimed at reducing dietary fat and increasing dietary fiber. Changes in food intake of employees in five sites fully implementing the intervention were compared with those in eight control sites in order to assess the impact of the intervention on eating behavior. Food intake was measured using a semi-quantitative food frequency questionnaire (FFQ). Some messages addressed consumption of one food, and others three or four foods in a category. Fourteen foods representing the seven messages from the FFQ and summary questions were analyzed. The intervention messages were delivered to workers through activities such as classes on nutrition and weight management, taste tests, food demonstrations, and point-of-purchase nutrition education programs. A total of 1762 workers responded both to the baseline and the follow-up surveys. The reported change values represent the average of the mean worksite values, thereby assigning equal weight to each worksite, which served as the unit of analysis. Workers in companies where the full intervention was implemented decreased their use of margarine and butter as spreads (p

A work-site nutrition intervention: its effects on the consumption of cancer-related nutrients.

OBJECTIVES In a work-site nutrition intervention targeting fat and fiber, we examined the interventions effect on specific nutrients implicated in carcinogenesis, including trace metals, vitamins, and categories of fatty acids. The rationale was based on the association observed in a variety of epidemiologic studies between these nutrients and epithelial cancers. METHODS Data were taken from eight control companies and five intervention companies that fully implemented the Treatwell intervention. Analyses of variance were used preserving the studys nested design. RESULTS Significant intervention-related associations were observed for increased total vitamin A and carotene. Marginal intervention effects were observed for relative decreases in the percentage of calories from both saturated and monounsaturated fatty acids, a relatively smaller increase in the percentage of calories from polyunsaturated fatty acids, and an increase in the consumption of vitamin B6. CONCLUSIONS Results indicate a broader effect of the intervention than on fat and fiber only. Increased intake of carotene, the single most important of these other nutrients, is plausibly related to a variety of epithelial cancers.

Validity and reliability of psychosocial factors related to breast cancer screening

This research explored the construct validity of hypothesized survey items and data reduction procedures for selected psychosocial constructs which are frequently used in breast cancer screening research. Factor analysis was used to validate relationships between survey items and hypothesized constructs suggested by several theories of behavior change. These constructs included perceived barriers and benefits of breast cancer screening compliance behavior. Reliability analyses were then used to evaluate the consistency of the resultant scales applied across three data sets, resulting from surveys conducted by two different methods (telephone and in-person interview) over three time periods. These analyses found reliability coefficients ranging from .53 to .69.