Jo Anne Earp

The Association of Race/Ethnicity, Socioeconomic Status, and Physician Recommendation for Mammography: Who Gets the Message About Breast Cancer Screening?

OBJECTIVES This study investigated the association between physician recommendation for mammography and race/ethnicity, socioeconomic status, and other characteristics in a rural population. METHODS In 1993 through 1994, we surveyed 1933 Black women and White women 52 years and older in 10 rural counties. RESULTS Fifty-three percent of the women reported a physician recommendation in the past year. White women reported recommendations significantly more often than did Black women (55% vs 45%; odds ratio = 1.49). Controlling for educational attainment and income eliminated the apparent racial/ethnic difference. After control for 5 personal, 4 health, and 3 access characteristics, recommendation for mammography was found to be more frequent among women who had access to the health care system (i.e., had a regular physician and health insurance). Recommendation was less frequent among women who were vulnerable (i.e., were older, had lower educational attainment, had lower annual family income). CONCLUSIONS Socioeconomic status, age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use.

Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions

Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to identify the ecological levels that health promotion programs target and then applied this system to 157 intervention articles from the past 20 years of Health Education & Behavior. Overall, articles were more likely to describe interventions focused on individual and interpersonal characteristics, rather than institutional, community, or policy factors. Interventions that focused on certain topics (nutrition and physical activity) or occurred in particular settings (schools) more successfully adopted a social ecological approach. Health education theory, research, and training may need to be enhanced to better foster successful efforts to modify social and political environments to improve health.

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

OBJECTIVES A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. METHODS A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. RESULTS The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = -1, 14) in community-wide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. CONCLUSIONS A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.

Measuring the use of mammography: two methods compared.

Population studies often estimate mammography use using womens self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.

Manual ability as a marker of dependency in geriatric women

Little is known about the factors responsible for the institutionalization of the elderly. This studys objective was to discover markers associated with nursing home placement. Fifty-six white ambulatory women over 63 yrs of age were selected from 3 settings encompassing a range of dependency: 20 women from nursing homes; 16 women who lived in their own homes but requiring social assistance and 20 totally independent women. Each woman was examined for factors that might be associated with her state of dependency: age, socioeconomic status, morale, education, strength of social network, number and type of medications, mental status, manual ability, medical problems and abnormalities on physical examination. The time required to perform any of 27 manual skills discriminated the 3 groups better than any other factor (P less than 0.0001). Three manual skills predicted group membership with 92% accuracy. Manual ability may be the best marker of dependency in elderly women and should be measured in studies concerned with geriatric health status.

Beyond the Measurement Trap A Reconstructed Conceptualization and Measurement of Woman Battering

Many areas of womens health, including battering, suffer from conceptual and methodological deficits. This article uses the “measurement trap” (Graham & Campbell, 1991), a set of conditions defined by lack of information resulting from a narrow conceptualization of the problem, poor existing data sources, inappropriate outcome indicators, and limited measurement techniques, as a framework for describing how current approaches to conceptualizing and measuring battering hamper research and program efforts in the field of domestic violence. We then describe an alternative conceptualization-and-measurement approach that is based on battered womens experiences. We argue that an experiential approach, which grounds measurement in womens lived experiences, improves our ability to conduct research that correctly identifies, monitors, and explains the epidemiology of this phenomenon and provides a solid basis for policy and program development.

Women's Experiences with Battering: A Conceptualization from Qualitative Research

Battering of women by their male partners affects an estimated 3 -4 million women each year in the United States. Prevalence studies indicate that between one-third and one-fifth of all women will be physically assaulted by a male partner. Battering generally consists of mens continuous use of physical, and often sexual, assaults along with verbally and emotionally abusive behaviors that may become more severe and damaging over time. In addition to assaulting their partners, batterers also threaten, intimidate, and humiliate them; isolate them from family and friends; restrict their access to money and other resources; threaten the safety of children and others in their families; and control their activities outside the home. Sex is also a weapon batterers use to gain power over their partners; this manifests itself as both rape and withholding sexual affection. Evidence is growing that the physical, psychological, and sexual violence battered women are subjected to contributes to the development of many serious health problems including injury, depression, anxiety, posttraumatic stress disorder, chronic pain, gastrointestinal disorders, substance abuse, suicide, and homicide.

A Population-Based Study of the Prevalence and Distinctiveness of Battering, Physical Assault, and Sexual Assault in Intimate Relationships

The types of violence subsumed under the term intimate partner violence include physical assault, sexual assault, psychological abuse, and battering. This study is the first to estimate the prevalence of intimate partner violence by type (battering, physical assaults, and sexual assaults) in a population-based sample of women aged 18 to 45. The authors describe the prevalence of partner violence by type as well as the demographic, health behavior, and health status correlates of intimate partner violence by type. Findings support the empirical distinction of battering and assault. Battering as measured by the Womens Experiences With Battering (WEB) Scale provided the most comprehensive measure of intimate partner violence.

Lay Health Advisors: A Strategy for Getting the Word out about Breast Cancer

Transforming natural helpers into lay health advisors (LHAs) is a complex undertaking. Using the North Carolina Breast Cancer Screening Program (NC-BCSP) as a case study, this article describes the steps involved in developing, implementing, and evaluating an LHA intervention, considering factors that make the LHA approach appropriate for the NC-BCSPs population, setting, and health focus. The authors review five phases of implementation (start-up, training, LHA activities, follow-up, resource mobilization) and discuss the NC-BCSPs evaluation strategies and tools in light of difficulties involved in assessing natural helping processes and impact. Program challenges related to resource needs, identification of natural helpers, and LHA monitoring and support also are considered. The authors describe ways in which one large group of older, rural, African American LHAs are helping establish countywide partnerships between health care providers, agencies, and local communities that support and sustain individual changes in health behavior.

Accuracy of women's self-report of their last Pap smear.

We compared interview data and physician records on when women last had a Pap smear in a sample of 98 rural Black women. We found 20 per cent of women could not accurately report on whether a Pap smear had been done within three years (sensitivity = 0.95, specificity = 0.47). Source of gynecological care and perceived barriers to obtaining a Pap smear but not education were associated with inaccurate reports. Self-report may be a misleading measure of Pap smear screening in comparable groups of women.