Irene Tessaro

Readiness to Change Smoking Behavior in a Community Health Center Population

This study examines predictors of readiness to change smoking behavior in a sample of smokers who receive care at a community health center that serves a predominantly low income African American population. Prior to initiating interventions we conducted a telephone survey with a random sample of 1318 adult users who had visited the center in the last 18 months; 379 (28.8%) were current smokers (40.3% of males, 23.9% of females, 42.7% of Whites, and 25.3%, of African Americans). Multiple logistic regression analysis showed nine factors significantly associated with readiness to change smoking behavior: male gender; a previous quit attempt; a perception of risk of lung cancer from smoking; greater desire to quit smoking; a perception that smoking bothers others; doctor advice to stop smoking at last health visit; records kept for scheduling doctor appointments; thinking that losing a pleasure would not be a problem if quit smoking; and poorer self-reported health status. These findings provide direction for developing interventions for similar low income, high risk populations. The results indicate that it may be useful to heighten awareness of the risks of smoking and to assure that smokers receive clear quit smoking messages from their providers. Women need special attention since they are less ready to quit than men.

CANCER PREVENTION KNOWLEDGE, ATTITUDES, AND CLINICAL PRACTICE OF NURSE PRACTITIONERS IN LOCAL PUBLIC HEALTH DEPARTMENTS IN NORTH CAROLINA

This study discusses the findings from a survey of the knowledge, attitudes, and clinical practice regarding cancer prevention and early detection of 101 nurse practitioners (NPs) working in the 87 county public health departments in North Carolina. Results show that nurse practitioners provide breast and cervical cancer screening services for most women over age 40 but are less likely to provide other types of cancer prevention, such as smoking cessation counseling or education about diet and cancer. NPs tended to rate their clinical skills in providing cancer screening as excellent but rate their skills in educating clients about cancer risk lower. Most NPs were interested in practice related to cancer control, especially learning more about the latest recommendations on cancer. However, in this study they indicated the least interest in learning more about smoking cessation methods or cancer prevention issues for men. These findings suggest that NPs in public health need further education and skills training related to cancer control, in addition to breast and cervical cancer screening.

Self-Reported and Clinical Measurement of Three Chronic Disease Risks among Low-Income Women in West Virginia

BACKGROUND This study assessed the validity of several self-reported cardiovascular risk factors among low-income women aged 40-64 years in West Virginia. METHODS A cross-sectional survey was conducted of 733 women participating in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to examine agreement between self-report and clinical screenings in the prevalence of risk factors related to coronary heart disease (CHD). Women participating in the study were interviewed face-to-face before administration of clinical screenings that assessed height, weight, Quetelets index, high blood pressure (systolic > or =140 mm Hg or diastolic > or =90 mm Hg), and elevated total cholesterol concentrations (> or =200 mg/dL and > or =240 mg/dL). RESULTS The overall results showed high sensitivity and specificity for each of the risk factors examined; for overweight/obesity, the sensitivity was 96% and specificity was 93%; for cholesterol > or =240 mg/dL, sensitivity was 85% and specificity was 67%; for hypertension, sensitivity was 77% and specificity was 86%. Using a threshold value of > or =240 mg/dL for hypercholesterolemia led to higher sensitivity but a lower specificity than for a value of > or =200 mg/dL. CONCLUSIONS This study found that among low-income women at higher risk for cardiovascular disease (CVD), self-reported values for high body mass index (BMI), hypercholesterolemia, and hypertension were well correlated with clinical measures, as indicated by high sensitivity values. Thus, self-reported values can be used for surveillance, targeted screenings, and health promotion activities, including lifestyle changes.

Factors Associated with Control of Hypertension, Hypercholesterolemia, and Diabetes Among Low-Income Women in West Virginia

BACKGROUND Adequate control of cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes, requires management. Low-income women living in rural areas with limited health services may experience special challenges in managing chronic conditions. METHODS In 2008, we conducted an analysis of the baseline, cross-sectional survey of 733 uninsured, low-income, rural women aged 40-64 years participating in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to characterize prevalence, treatment, and control of hypertension, hypercholesterolemia, and diabetes. Data were collected from 2004 to 2007. RESULTS About 56% of the women had hypertension (38% of which was untreated or uncontrolled), 45% had hypercholesterolemia (31% of which was untreated or uncontrolled), and 19% had diabetes (26% of which was untreated or uncontrolled). Multivariable analyses showed that those with a regular physician were less likely than those without a physician to have uncontrolled hypertension (adjusted odds ratio [AOR] 0.34, 95% CI 0.13-0.88) and hypercholesterolemia (AOR 0.14, 95% CI 0.04-0.47). Education level was also a significant predictor for uncontrolled hypertension, and physical activity level (measured by total metabolic equivalent [MET] hours) significantly predicted uncontrolled hypercholesterolemia (AOR 1.01, 95% CI 1.001-1.02). For diabetes, race/ethnicity was the main predictor; white women were less likely than other groups to have untreated or uncontrolled diabetes. CONCLUSIONS High proportions of women in the WV-WISEWOMAN project had uncontrolled hypertension, hypercholesterolemia, and diabetes at baseline. These study results should be used to inform programs seeking to increase access to health services in order to reduce consequences of uncontrolled chronic conditions.

Changes in public health nurses' knowledge and perception of counseling and clinical skills for breast and cervical cancer control.

This study discusses the findings from two surveys of 459 nurses working in public health about their knowledge and perception of counseling and clinical skills related to breast and cervical cancer control. The first survey was conducted in 1993 before professional education efforts with the Breast and Cervical Cancer Control Program (BCCCP) began in North Carolina. The second survey was carried out in 1996. The results show a significant increase from 1993 to 1996 in recognition of increasing age, nulliparity, late childbearing, and family history as risk factors for breast cancer, and for smoking and early age at first sexual intercourse as risk factors for cervical cancer. Nurses’ skills were more likely to be rated as excellent or very good in 1996 as compared with ratings in 1993 for educating women about mammography, performing a clinical breast examination, teaching breast self-examination by demonstration, performing a Papanicolaou (Pap) smear and bimanual examination, and counseling women about abnormal Pap tests. Nurses who took a BCCCP-sponsored adult physical assessment course were more likely to know correct risk factors for breast and cervical cancer, and to show improvement in teaching breast self-examination, performing a Pap smear, and counseling women about abnormal Pap tests.

Impact of National Cancer Institute revised mammography screening guidelines on women 40–49

I n December 1993, the National Cancer Institute (NCI) announced that it would no longer recommend routine mammography screening for all women in their 40s and replaced its screening guidelines with a statement of evidence regarding mammography. The statement of evidence specifies the benefits of mammography screening for women of different ages and, rather than providing a specific screening guideline for women in their 4Os, advises women under age 50 to talk with their doctors about their risk for breast cancer and make their own informed decisions about mammography. The NC1 based its decision, in part, on the results of the International Workshop on Screening for Breast Cancer-a review of eight international randomized trials on the effectiveness of mammography screening for reducing mortality in women of different ages. The results of the workshop indicated that mammography screening reduced mortality in women age 50-70 by up to 30% but found no significant reduction in mortality for women age 40-49 5-8 years after screening had begun.’ The publication of the workshop results and the corresponding change in NC1 screening guidelines received extensive meo 1996 by The Jacobs Institute dia coverage and sparked considerable controversy and debate among medical Of Women’s Hea1th experts and health organizations, many of whom disagreed with the guideline PubLished by Elsevier Science Inc. 1049-3867/96/

An evaluation of professional education efforts for breast and cervical cancer in public health nurses.

15.00 change. I’11 SlO49-3867(96)00036-9

Cancer screening practices among women in a community health center population.

This article describes training programs instituted in 1992 by the North Carolina Breast and Cervical Cancer Control Program (BCCCP) to improve skills of public health nurses in breast and cervical cancer education and clinical services. Public health nurses traditionally serve as primary health care providers in medically underserved communities and are the main providers of BCCCP services. The training programs were evaluated by a statewide survey of public health nurses in 1996. The authors discuss the findings of this survey, its limitations, and the goals it has led the authors to set for improving the education program in the future.