Keiko Honda

Cancer and Mental Disorders in a National Community Sample: Findings from the National Comorbidity Survey

Objective: To determine the association between cancer (past 12 months) and mental disorders (past 12 months) among community-dwelling adults. Methods: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative household sample of adults aged 15–54 years in the United States. Multiple logistic regression analyses were used to determine the association between cancer and mental disorders, adjusting for differences in sociodemographic characteristics. Results: Cancer was significantly associated with increased rates of major depression [odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.4–8.8], drug dependence (OR = 3.6, 95% CI = 1.3–9.8), simple phobia (OR = 2.5, 95% CI = 1.0–6.2) and agoraphobia (OR = 3.3, 95% CI = 1.0–10.4). These associations persisted after adjusting for major sociodemographic factors, and sex plays a significant role in the association between cancer diagnosis and mental disorder, with cancer diagnosis having a stronger influence on major depression and drug dependence in men than in women. Conclusions: Clinicians and community health workers working with cancer survivors need to be not only alert for signs of clinical depression but also of co-occurring drug dependence and certain anxiety disorders so that appropriate referrals to mental health professionals can be made.

Factors Underlying Variation in Receipt of Physician Advice on Diet and Exercise: Applications of the Behavioral Model of Health Care Utilization:

Purpose. To identify factors associated with receipt of physician advice on diet and exercise, including patient sociodemographic characteristics, health-related needs, and health care access, using Andersens model of health care utilization. Design. A cross-sectional analysis was performed using data from the 2000 National Health Interview Survey (NHIS). Setting. NHIS data were collected through personal household interviews by Census interviewers. The overall response rate for the 2000 NHIS adult sample was 82.6%. Subjects. Subjects were a representative sample of the American civilian, noninstitutionalized population aged 18 and older. After eliminating missing data and respondents who reported they did not see a doctor in the past 12 months, sample sizes for physician advice on diet and exercise were n = 26,255 and n = 26,158, respectively. Measures. Using the 2000 NHIS, the prevalence of receipt of physician advice on diet and exercise was assessed. Multiple logistic regression analyses were performed to examine the associations between receipt of physician advice on diet and exercise and potential predictors, adjusting for all covariates. Results. By self-report, 21.3% and 24.5% of respondents received physician advice on diet and exercise, respectively. Being middle-aged (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI], 1.0–1.29 for diet; AOR = 1.55, 95% CI = 1.33–1.79 for exercise) and having a baccalaureate degree or higher (AOR = 1.78, 95% CI = 1.52–2.08 for diet; AOR = 1.75, 95% CI = 1.47–2.07) were associated with a higher likelihood of receiving physician advice on diet and exercise. African-Americans (AOR = .78, 95% CI = .67–.92) and foreign-born immigrants (AOR = .57, 95% CI = .38–.86) were less likely to receive physician advice on exercise. The prevalence of physician advice was higher for persons who chose hospital outpatient departments as a usual source for care (AOR = 2.36, 95% CI = 1.66–3.36 for diet; AOR = 2.39, 95% CI = 1.68–3.4 for exercise) than for adults with other types of usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12–6.57 for diet; AOR = 2.63, 95% CI = 2.04–3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02–2.66 for diet; AOR = 3.01, 95% CI = 2.46–3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise. Conclusions. Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important predictors of who obtains such advice.

Factors Associated with Colorectal Cancer Screening among the US Urban Japanese Population

OBJECTIVES The author examined the prevalence and predictors of colorectal cancer screening among the urban Japanese population of the United States. METHODS A sample of Japanese residents of major US metropolitan areas completed a self-administered mailed survey. RESULTS Physician recommendation, acculturation, and perceived psychological costs were consistent predictors of screening for colorectal cancer. Gender and marital status were related to screening via fecal occult blood testing; age, susceptibility, and health insurance were related to sigmoidoscopy/colonoscopy screening. CONCLUSIONS Colorectal cancer screening among the urban Japanese population could be increased with interventions seeking to promote physician recommendations for screening, alleviate perceived psychological costs among patients, and improve physician-patient communication.

Cognitive Mediators Linking Social Support Networks to Colorectal Cancer Screening Adherence

This paper argues that normative considerations are more important than attitudinal factors in engaging colorectal cancer screening, and tests a model explaining how unique cultural expressions of social networks influence screening adherence. Structural equation modeling was used to understand colorectal cancer screening in a population-based sample of 341 Japanese Americans aged 50 and over. The model accounted for 25% of the variance in screening adherence. Adherence was most strongly associated with family/friend subjective norms about colorectal cancer screening use. Emotional family support, but not the size of the networks, was indirectly related to adherence via increased family/friend subjective norms, while emotional friend support was directly related to adherence. While usual source of care was directly associated with adherence, better provider-patient communication was directly and indirectly associated with adherence via increased perceived benefits. The findings of this study support strengthening informal support networks to enhance adherence among Japanese Americans at risk.

Modeling Pathways to Affective Barriers on Colorectal Cancer Screening Among Japanese Americans

The study aimed to identify the mechanisms through which colorectal cancer (CRC)-specific affective barriers, including fear of finding CRC, embarrassment, and concerns for screening discomfort, can be reduced to guide the development of interventions aimed at the secondary prevention of CRC. A model explaining these affective barriers was developed and tested among a random sample of 305 asymptomatic Japanese Americans using a path analysis. The model suggested that affective barriers could be reduced by increasing CRC-related knowledge, which could be enhanced by acculturation, social support, and physician recommendation. Interventions that focus on increasing CRC-related knowledge could reduce affective barriers to CRC screening for this population when taking the enhancement of communication skills and interpersonal interactions into account.