Leslie Hinyard

Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview

Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical explanations of narrative effects and research comparing narrative and nonnarrative approaches to persuasion, and makes recommendations for future research needs in narrative health communication.

Narrative communication in cancer prevention and control: a framework to guide research and application.

Narrative forms of communication—including entertainment education, journalism, literature, testimonials, and storytelling—are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.

Joint Association of Hyperuricemia and Reduced GFR on Cardiovascular Morbidity: A Historical Cohort Study Based on Laboratory and Claims Data From a National Insurance Provider

BACKGROUND Hyperuricemia is common in patients with chronic kidney disease (CKD). We assessed the relationship of increased serum uric acid levels with cardiovascular risk across levels of kidney function. STUDY DESIGN Historical cohort study. SETTING & PARTICIPANTS Study data were drawn from administrative records of a national private health insurer (2003-2006). We included all adult beneficiaries with concurrently measured serum creatinine and serum uric acid. Patients with acute kidney failure or undergoing renal replacement therapy at baseline were excluded. PREDICTORS Serum uric acid concentration and estimated glomerular filtration rate (eGFR). OUTCOMES & MEASUREMENTS Cardiovascular diagnoses (myocardial infarction, subacute coronary heart disease, heart failure, cerebrovascular disease, or peripheral arterial disease) ascertained from billing claims. Cox proportional hazard models were used to test the association of predictors with cardiovascular morbidity. Models were adjusted for sociodemographic characteristics, selected comorbid conditions, and laboratory results. RESULTS In 148,217 eligible patients, mean eGFR was 84 mL/min/1.73 m(2) and the prevalence of CKD stages 3-5 was 6.0%. Hyperuricemia (serum uric acid >7 mg/dL) was found in 15.6% of patients. The 40-month cumulative incidence of cardiovascular events (mean follow-up, 15.3 months) was 8.1%. Cardiovascular risk was associated independently with uric acid level, and this association was stronger in patients with lower eGFRs. LIMITATIONS Observational design, lack of information for mortality and potential confounders, single creatinine and uric acid assessment. CONCLUSIONS Serum uric acid concentration was an independent correlate of cardiovascular morbidity, and this association was stronger in patients with severely decreased eGFR. This investigation provides a rationale for further study of serum uric acid-lowering interventions on cardiovascular risk in the general population and patients with CKD.

The effect of marital status on breast cancer-related outcomes in women under 65: A SEER database analysis

BACKGROUND Marital status is strongly associated with improved health and longevity. Being married has been shown to be positively associated with survival in patients with multiple different types of malignancy; however, little is known about the relationship between marital status and breast cancer in younger women. The purpose of this study is to investigate the effect of marital status on diagnosis, and survival of women under the age of 65 with breast cancer. METHODS The SEER 18 regions database was used to identify women between the ages of 25-64 diagnosed with invasive breast cancer in the years 2004-2009. Logistic regression was used to predict later stage diagnosis by marital status and Cox proportional hazards models were used to compare breast cancer-related and all-cause survival by marital status classification. Models were stratified by AJCC stage. RESULTS After adjusting for age, race, and ER status, unmarried women were 1.18 times more likely to be diagnosed at a later stage than married women (95% CI 1.15, 1.20). In adjusted analysis unmarried women were more likely to die of breast cancer and more likely to die of all causes than married women across all AJCC stages. CONCLUSIONS Younger unmarried women with breast cancer may benefit from additional counseling, psychosocial support and case management at the time of diagnosis to ensure their overall outcomes are optimized.

Accuracy of Personal Breast Cancer Risk Estimation in Cancer-Free Women During Primary Care Visits

ABSTRACT To determine the accuracy of personal breast cancer risk estimation, interviews were conducted of 110 women between November 2004 and May 2005 during primary care visits. The average age of the women was 39 years. Considering their lifetime breast cancer risk, 49% of women perceived their risk to be low, 35% average, and 11% high. Compared to Gail-model lifetime risk scores, 62% of women were inaccurate and underestimated or overestimated risk. Factors affecting accuracy of risk prediction were race, family history of cancer, alcohol use and exercise. Our study highlights the need for personalized breast cancer education between an individual woman and her health care provider.

The Relationship Between Health-Related Quality of Life and Body Mass Index:

Obesity is a chronic, progressive, multifactorial medical condition. It is known that obesity is associated with cardiovascular disease, metabolic disorders, degenerative joint disorders, and decreased health-related quality of life (HRQoL). In addition, there are socio-economic, gender, age, and racial differences in the population distribution of obesity. The extent to which HRQoL is impaired by obesity independent of associated chronic disease and known demographic risk factors is less well understood by nurses. A secondary analysis of the National Health Measurement Study (NHMS) was conducted to illustrate this relationship. Regression analyses were used to assess the association between body mass index (BMI) and HRQol. BMI was categorized as normal, overweight, obese, and morbidly obese. HRQoL was measured using the EQ-5D and EQ-VAS. After adjusting for chronic health conditions and demographic factors, lower HRQoL was observed as BMI category increased for both the EQ-5D, F = 40.49, 15 df, p < .001, and EQ-VAS, F = 35.5, 15 df, p < .001.

Factors Associated with HPV Vaccination in Young Males

Human papilloma virus (HPV) affects both men and women; however, recommendations for HPV vaccination among men were not issued in the United States until 2011. The purpose of this study was to describe and compare characteristics of men who did and did not report receiving at least one dose of the HPV vaccine. Data from the ten states that completed the HPV vaccination module in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) were included in the study. Young men ages 18–26 were included (N = 1624). Categorical variables were compared between those who did and did not receive the HPV vaccine using Chi square. Logistic regression was used to examine the odds of HPV vaccination by the above factors. Only 16.5% of men reported at least one dose of HPV vaccine. Having health insurance, having a primary doctor, and receiving an HIV test were predictive of HPV vaccination. Men in Texas were more likely to report HPV vaccination than all other states. Overall, HPV vaccination is low in men. Targeted interventions for improving HPV vaccination rates in men are warranted, especially for those without health insurance or a routine source of care.

Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey

The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.

Her2 positivity and race predict higher mastectomy rates: a SEER database analysis

Given the difference in incidence of biologic subtype of breast cancer between black and white women, and the potential disparity in type of surgery in black and white women presenting with early stage breast cancer, this study aimed to examine the odds of mastectomy compared to lumpectomy by molecular subtype in black and white women with size T1 and T2 invasive breast cancer. Using the SEER database, breast operation choice for women over the age of 15 with T1 or T2 tumors between 2010 and 2012 were examined. Tumors were categorized according to the Breast Subtype variable in the SEER database and data were stratified by tumor size and race. Bivariate comparisons and logistic regression models adjusted for age were used. In women with T1 or T2 tumors, mastectomy rates were higher in women with Her2 positive tumors than in those with Her2 negative tumors. When Her2 results are the same among comparison groups, those women with HR positive tumors were less likely to undergo a mastectomy than those with HR negative tumors. In T1 tumors, the magnitude of the association was larger for white women than women of other races. Results suggest there are differences in surgical decision making based on breast cancer subtype in women with T1 or T2 tumors and that race may play a role for size T1 tumors. The strong association between Her2 positive tumors and higher mastectomy rates warrants further investigation.

Sociodemographic Factors Associated With Engagement in Diabetes Self-management Education Among People With Diabetes in the United States

Objective: Research outside the United States shows that certain subgroups of patients (eg, those who are older, male, of low socioeconomic status, and uninsured) are less likely than others to report receiving diabetes self-management education (DSME); however, less is known about DSME uptake in the United States. We examined sociodemographic, patient, and behavioral characteristics associated with DSME in a nationally representative sample. Methods: We analyzed data from the 2011-2013 Behavioral Risk Factor Surveillance System for 84 179 adults who self-identified receiving a diagnosis of diabetes. We constructed weighted, multivariate logistic regression models to examine the associations between DSME and sociodemographic characteristics (age, sex, race/ethnicity, marital status, education, and annual household income), patient characteristics (body mass index, having a regular provider, health insurance status, health status, and insulin use), and self-management behaviors (home foot examination, home blood glucose testing, and physical activity). Results: More than half (n = 45 557, 53.7% [weighted]) of respondents reported engaging in DSME. Compared with non-Hispanic white adults, non-Hispanic black adults were more likely to engage in DSME (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI], 1.07-1.29). Respondents were less likely to engage in DSME if they were male (aOR = 0.85; 95% CI, 0.80-0.91) or Hispanic (aOR = 0.81; 95% CI, 0.71-0.92), were a high school graduate (but no college; aOR = 0.71; 95% CI, 0.66-0.78) or less than a high school graduate (aOR = 0.51; 95% CI, 0.45-0.59), had an annual household income of