Rebecca J. Donatelle

Incentives in smoking cessation: Status of the field and implications for research and practice with pregnant smokers

We review the rationale and empirical evidence for the use of incentive and contingency management strategies for smoking cessation. Plausible theoretical rationales exist for the application of these strategies to smoking cessation, and a great deal of research with illicit drug users in laboratory or controlled treatment settings suggests such strategies can be effective. Contingency management methods have been effective in modifying smoking behavior in volunteers not seeking cessation assistance in highly controlled settings. Incentives have been used primarily as a component of worksite interventions, in community-wide quit-and-win programs, in quasiexperimental and experimental trials, and more recently with low-income pregnant women. Worksite studies have rarely been designed to isolate the impact of incentives. Nevertheless, they appear to be useful in these settings especially in increasing participation and increasing awareness about the deleterious effects of smoking. Quit-and-win programs are used widely in the United States and internationally and appear to attract many participants and produce modest quit rates. The quality of the evaluations of quit-and-win programs varies considerably, and none has employed rigorous control or comparison groups to sufficiently identify the effect of incentives. Recent controlled studies have yielded promising results with pregnant smokers, and larger trials are in progress. We discuss key methodological issues in mounting and evaluating incentive interventions, particularly during pregnancy, and discuss the practical and ethical issues arising from the use of incentives.

Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Findings from a Population-Based Survey

PURPOSE We sought to explore racial/ethnic disparities in the prevalence of gestational diabetes mellitus (GDM) in a population-based sample. METHODS Data from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), a stratified, random sample of postpartum women who delivered in Oregon in 2004 and 2005 (n = 3,883; weighted response rate, 75.2%) and linked birth certificates were analyzed. Hispanic, non-Hispanic Black, non-Hispanic American Indian, and non-Hispanic Asian/Pacific Islander (API) women were oversampled. We categorized women as having had GDM if they gave an affirmative answer on the birth certificate or the PRAMS survey. RESULTS Non-Hispanic API women had the highest prevalence of GDM (14.8%); this was true for women with both a normal and a high body mass index (BMI). Asian women were more likely to have had GDM than Pacific Islander women. On multivariate analysis, non-Hispanic APIs were significantly more likely to have a pregnancy complicated by GDM (adjusted odds ratio, 2.26; 95% confidence interval, 1.23-4.13) than non-Hispanic White women. CONCLUSION Non-Hispanic API women, especially Asian women with both normal and high BMI, have increased risk of GDM. Future research should examine the unique risk factors experienced by Asians and health practitioners should be vigilant in screening for GDM regardless of BMI.

Premature menopause and low back pain A population-based study

The association between premature menopause and low back pain was examined among 5325 women surveyed in the second National Health and Nutrition Examination survey. Nearly 49% of the women were postmenopausal. In a multiple logistic regression model that included age, postmenopausal women were approximately twice as likely to report low back pain compared to premenopausal women (odds ratio = 2.1; 95% confidence interval: 1.4-3.0). Among postmenopausal women, significant positive trends in low back pain were observed with decreasing age at menopause (P = 0.005) and increasing years since menopause (P = 0.004). The prevalence odds ratio for women who had their menopause before the age of 30 was 3.2 (1.8-5.4); and for women who had their menopause for 15 or more years the odds ratio was 3.0 (1.7-5.3). These findings suggest that premature menopause is associated with low back pain. Further studies appear warranted to confirm these findings, assess possible explanations, and examine the circumstances in which premature menopause occurs.

A process evaluation model for patient education programs for pregnant smokers

OBJECTIVE To describe and apply a process evaluation model (PEM) for patient education programs for pregnant smokers. METHODS The preparation of a process evaluation plan required each program to define its essential “new” patient assessment and intervention procedures for each episode (visit) of patient–staff contact. Following specification of these core implementation procedures (p) by each patient education program, the PEM, developed by the Smoke-Free Families (SFF) National Program Office, was applied. The PEM consists of five steps: (1) definition of the eligible patient sample (a); (2) documentation of patient exposure to each procedure (b); (3) computation of procedure exposure rate (b/a = c); (4) specification of a practice performance standard for each procedure (d); (5) computation of an implementation index (c/d = e) for each procedure. The aggregate of all indexes (e) divided by the number of procedures (Pn) produced a program implementation index (PII = Σe/Pn). PARTICIPANTS AND SETTINGS Data from four SFF studies that represent different settings were used to illustrate the application of the PEM. RESULTS All four projects encountered moderate to significant difficulty in program implementation. As the number and complexity of procedures increased, the implementation index decreased. From initial procedures that included patient recruitment, delivery of the intervention components, and conducting patient follow ups, a variety of problems were encountered and lessons learned. CONCLUSION This process evaluation provided specific insight about the difficulty of routine delivery of any new methods into diverse maternity care setting. The importance of pilot testing all procedures is emphasised. The application of the PEM to monitor program progress is recommended and revisions to improve program delivery are suggested.

Relationship Between Sexual Orientation and Quality of Life in Female Breast Cancer Survivors

BACKGROUND Some groups of breast cancer survivors bear a greater burden of diminished quality of life than others. Self-identified lesbians, or women who partner with other women in romantic and spousal relationships, are one group of women that has been hypothesized to experience and report poorer quality of life compared with heterosexual breast cancer survivors. METHODS A convenience sample of 204 breast cancer survivors (143 heterosexual and 61 self-identified lesbians) participated in this cross-sectional, online study by completing electronic surveys regarding their quality of life. RESULTS Multivariate linear regression indicated that quality of life was not related to sexual orientation (β=0.13, p=0.30). Quality of life scores were similar between heterosexual and self-identified lesbian breast cancer survivors. CONCLUSION Quality of life scores were similar between heterosexual and lesbian breast cancer survivors. Future survivorship research should include population-based sampling of lesbian breast cancer survivors for testing quality of life and reducing the healthy volunteer effect, and population-based methodologies should be made available to enhance researcher ability to study this rare population.

Breast cancer survivorship: the role of perceived discrimination and sexual orientation

Breast cancer disproportionately affects sexual minority women (SMW) compared to heterosexual women and a small but growing literature indicates that SMW may have diminished survivorship outcomes; outcomes that are measurably and importantly different from heterosexual breast cancer survivors. However, it remains unknown how sexual orientation influences breast cancer survivorship outcomes such as quality of life. One possible route of influence is SMW’s perceived discrimination in the health care setting. This cross-sectional study examines SMW perceptions of discrimination as one of the multiple facets of the breast cancer survivorship process. This study assessed SMW breast cancer survivor’s perceptions of discrimination during their breast cancer treatment experience and secondarily, examined the role of this perceived discrimination on SMW’s quality of life. Sixty-eight purposefully sampled sexual minority breast cancer survivors completed assessments of quality of life, perceived discrimination, perceived social support and perceived stress via an online survey. Statistical analyses point to perceived discrimination and perceived social support as important indicators for predicting SMW’s quality of life. Future research on SMW’s breast cancer survivorship should include measures of perceived discrimination.

Confirmatory Factor Analysis of the Cancer Locus of Control Scale

Perceptions of control after a cancer diagnosis may have psychological and physical health significance. The control constructs are critical components of the theory of cognitive adaptation. The Cancer Locus of Control scale reflected these theoretical components and was administered to 543 women with a history of breast cancer. Confirmatory factor analysis was conducted to assess the measurement factor structure of the Cancer Locus of Control. The results supported a three-factor model of the Cancer Locus of Control scale. Mean scores of beliefs in all three dimensions indicated generally high confidence in cancer control. It was concluded that use of this Cancer Locus of Control scale can provide adequate assessment of the three distinct control dimensions.