Orna Baron-Epel

General subjective health status or age-related subjective health status: does it make a difference?

This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.

Predictors of Sun Protection Behaviors and Severe Sunburn in an International Online Study

Background: The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors. Methods: Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries. Results: Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (β = −0.44/β = −0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (β = −0.16/β = −0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. Conclusions: Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn. Impact: Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection. Cancer Epidemiol Biomarkers Prev; 19(9); 2199–210. ©2010 AACR.

Perceptions of Breast Cancer Among Arab Israeli Women

ABSTRACT The incidence of breast cancer is increasing among Arab Israeli women, yet few Arab women over the age 50 take advantage of free mammography available to them. In this study we attempted to identify social and cultural aspects of the Arab Israeli womans life that may reduce screening attendance for early detection of breast cancer. This qualitative study consisted of 6 focus groups. The fundamental theme identified as a barrier to prevention behavior was the role of the Arab woman in society expressed as marrying, having children and being totally committed to her family. In this model, without these roles her life is purposeless and her place in society is lost. The women perceived the chain of events that begins with screening for breast cancer as possibly resulting in cancer diagnosis and having breast cancer will lead to an inability to fulfill female roles. This feedback mechanism inherent in the chain of events may be the cause of the low rates of compliance in performing early detection and mammography. Interventions aimed at increasing the rate of Arab womens performance of mammography should take these issues into consideration.

Can subjective and objective socioeconomic status explain minority health disparities in Israel

Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35-65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected. Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.

Fatalism and Mammography in a Multicultural Population

Purpose/Objectives: To assess levels of fatalistic beliefs and their association with mammography use in four population groups in Israel.Design: Telephone survey.Setting: Maccabi Healthcare Services in Israel.Sample: A random sample of 1,550 Arabic and Jewish women.Methods: A random telephone survey was performed during May and June 2007. Womens fatalistic beliefs were measured. Information from claims records regarding mammography use was obtained for each woman.Main Research Variables: Levels of fatalistic beliefs and mammography use.Findings: Fatalistic beliefs included general beliefs that God or fate (external force) was the cause of cancer and related to cancer survivorship. The higher-educated women reported less fatalistic beliefs. Arab women reported more fatalistic beliefs compared to the other women. Mammography use was associated with fatalistic beliefs that external forces were the cause of cancer among Arab and immigrant women but not among veteran Jewish and ultraorthodox women. Fatalistic beliefs about cancer survivorship were not associated with mammography in any of the population groups. Levels of fatalism and education may explain the difference in rates of mammography among Arab and Jewish women.Conclusions: High levels of fatalism may inhibit women from having a mammogram, particularly Arab and immigrant women in Israel. However, this is not a generalizable result for all population groups and all types of fatalism.Implications for Nursing: Interventions to decrease fatalism in Arabs and immigrants may increase compliance with mammography. Nurses may achieve this by developing tailored messages for women who believe that external forces are the cause of cancer.

Attitudes and Beliefs Associated With Mammography in a Multiethnic Population in Israel

This article highlights beliefs, attitudes, and barriers that are associated with mammography use in four distinct cultural and ethnic groups in Israel: veteran, ultra-orthodox, and immigrant Jewish and Arab women. A random telephone survey of 1,550 women was performed. Information from claims records concerning mammography use was obtained for each woman from Maccabi Health Services. Of the barriers studied, no one barrier was associated with mammography performance in all population groups. However, the combined measure was associated with mammography use in all groups. Subjective norms, fatalism, fear of breast cancer, and perceived effectiveness were associated with mammography in some of the population groups but not in others. Each population seems to have a unique set of variables predicting mammography use. It is not possible to generalize from one population to another and it implies that information concerning beliefs and attitudes should be studied in each subpopulation before planning interventions.

Reducing disparities in mammography-use in a multicultural population in Israel

BackgroundIn the past mammography-use has been reported to be low in Israel compared to other western countries. The objectives of this study were (1) to assess the increase in mammography-use during the years 2002 to 2007 in four population groups in Maccabi Healthcare Services (MHS), Israel: non-immigrant non-ultraorthodox, ultraorthodox, and immigrant Jewish women and Arab women; (2) to assess ethnic and socioeconomic disparities in mammography-use.MethodsA random telephone survey of 1,550 women receiving healthcare services from MHS was performed during May-June 2007. Information from MHS claims-records database regarding mammography-use was obtained for each woman for the period 2002 to 2007. Since mammography-use serves as a quality assurance measure for primary care, MHS sent mail and telephone invitations for mammography to all women since the end of 2004.ResultsAt the beginning of the follow-up period (2002) mammography-use among Jewish non-immigrant non-ultraorthodox and ultraorthodox women was higher than among Arab and Jewish immigrant women. During the 5 year follow-up these disparities decreased significantly. In 2007, mammography-use by Arab women was only slightly lower compared to all groups of Jewish women. In 2007, after adjustment for socioeconomic factors there was only a borderline significant difference between Jewish and Arab women. The socioeconomic variables were not associated with mammography-use in 2002 and 2007 in any of the groups except for marital status in immigrant women in 2002.ConclusionThe interventions implemented by MHS may have increased mammography-use in all population groups, decreasing disparities between the groups, however the differences between Jewish and Arab women have not been completely eliminated and indicate a need for further targeted interventions. No significant socioeconomic disparities in mammography-use were observed.

Prediction of survival: a comparison between two subjective health measures in an elderly population

A large amount of evidence shows that the subjective evaluation of health is a predictor of survival in many different populations. Subjective health (SH) is measured using different types of measures such as a general evaluation of health or a comparative evaluation of health. The aim of this study was to compare the prediction of survival by two measures of SH (a general measure and an age-related measure) and evaluate the association with other variables in an elderly population. The baseline survey was conducted during 1994, covering 1138 men and women aged over 70. The survival status was ascertained 7 years later. After adjustment for age, sex, education, marital status, perceived socioeconomic status and presence of diseases the two SH measures were found to be predictors of mortality, but only in men. In men, there was no significant difference between the two types of SH measures in their prediction of mortality. Also in men, when there was only one or no disease, being married had a protective effect compared with not being married when both types of SH measures were used. In elderly women, the association between the two types of SH and survival diminished after adjusting for the various variables. However, the general SH measure may be the preferable measure to use when needed. Education in women was associated with mortality only via the age-related SH measure.

Validity of self-reported mammography in a multicultural population in Israel

OBJECTIVE To validate self-reported mammography against claims records in women aged 52-74 living in Israel and belonging to the Jewish (non-orthodox pre-1989 native or former Soviet Union immigrant or ultra-orthodox) or Arab populations. METHODS In a spring 2007 random telephone survey, 1550 women receiving healthcare at Maccabi Health Services were asked whether they had had a mammography during the previous 2 years. The same information was obtained from claims records and treated as the gold standard. RESULTS Self-reported mammography and claims records disagreed for 17.4%. Compared to the other populations, Arab women tended to report more often that they had obtained a mammogram when it was not registered in the claims data (specificity=47.3%, 95% CI%=38.4, 56.3). Ultra-orthodox women more often failed to report having had the mammogram while the claims records indicated they had had (sensitivity=90.3%, 95% CI%=86.1, 93.6). CONCLUSION Agreement between self-reported mammography and claims records depends on cultural and socioeconomic factors.

Breast cancer trends in Israeli Jewish and Arab women, 1996-2007.

Breast cancer is the most common malignancy in Israeli Jewish and Arab women. The main objective of this study was to reexamine the trends in breast cancer incidence, mortality, and survival in Israel in 1996 through 2007, as well as the use of mammography. Data were obtained from the Israel National Cancer Registry, the Central Bureau of Statistics, and National Health Surveys. Incidence and mortality rates per 100 000 are age adjusted to the world standard population. Time trends are presented using the joinpoint regression analysis. The relative survival was calculated for the diagnosis years 1996–2003. Data on mammography performance were obtained from the Knowledge, Attitudes and Practices surveys carried out in 2002–2008. From 1996 through 2007, the incidence of in-situ breast cancer increased in both subpopulations whereas the incidence of invasive breast cancer decreased by 3% for Jewish women and increased by 98% for Arab women (P value for ‘between-populations’ differences <0.001). Reports on having had a mammogram in the last 2 years increased by 16% in Jewish women and by 17% in Arab women in 2002 through 2008 (P=0.880). Breast cancer mortality rates decreased significantly from 24.7 in 1996 to 19.0 in 2007 in Jewish women, but remained stable in Arab women (P=0.041). The 5-year relative survival increased in both subpopulations (P=0.420). The incidence of breast cancer has been stable in Jewish women, but had been increasing rapidly in Arab women throughout 1996–2007. The differences indicate an epidemiologic transition in the Arab minority in Israel. Efforts should focus not only on secondary but also on primary prevention strategies.