Susan Butler

Internet Use for Health Information Among College Students

Use of the Internet to retrieve health information is increasingly common. The authors surveyed 743 undergraduate students at 2 academic institutions to examine their Internet use, health-seeking behaviors, and attitudes related to the use of the Internet to obtain health information. Fifty-three percent of the respondents indicated that they would like to get health information online, and 28% reported that they would like to attend a health program online. Overall, 74% of the students reported having ever received health information online, and more than 40% reported that they frequently searched the Internet for information. They used various search engines and multiple Web sites to find health information. Issues related to the credibility of the information on health Web sites were crucial considerations for students. The study found differences in Internet use for health information by gender and by level of Internet experience.

Mother-child talk about past emotions: Relations of maternal language and child gender over time

Abstract Emotional understanding and expression is largely constructed in sociocul-tural contexts; thus examination of the ways in which parents talk about emotions with their young children is critical for understanding emotional socialisation. In this longitudinal research, 18 white, middle-class mothers and their preschool children discussed salient past events when the children were 40, 58, and 70 months of age. Analyses revealed that mothers talked more about emotions and talked about a greater variety of emotions with daughters than with sons. Mothers also focused more on negative emotions with daughters than with sons. Although there were no gender differences between girls and boys at the beginning of the study, by the last phase, girls talked more about emotion and about a greater variety of emotion than did boys and also initiated more emotion-related discussions than did boys. Results are discussed in relation to a growing body of evidence on gender and emotion across the life span.

A qualitative study of how families decide to adopt household smoking restrictions.

Household smoking bans reduce exposure to secondhand smoke in adult nonsmokers and children. To explore the process families go through in adopting voluntary household smoking restrictions, qualitative interviews were conducted with rural African American and White adults in 102 households. The study investigated how families decide to restrict smoking in the home, who has significant influence in the decision-making process, the kinds of disagreements families have about household smoking restrictions, and reasons some families never consider household smoking policies. These findings have implications for designing intervention strategies and messages to promote household smoking bans and help family members negotiate smoke-free homes.

Formative research on creating smoke-free homes in rural communities

The home is a significant place for exposure to secondhand smoke for children and non-smoking adults. This study explored factors that would convince families to adopt household smoking bans and actions to create and maintain smoke-free homes. Interviews were conducted with adults in 102 households in rural Georgia. Participating families had a young adolescent and included households with a mix of smokers and non-smokers and smoking ban status. Families reported they would consider a total ban to protect children from secondhand smoke and protect family members if they got sick. Few described difficulties in enforcement with over half of smokers accepting the rules. Situations that made it hard to enforce restrictions were if there was a visitor who smoked, a smoker who had cravings, and bad weather outside when the smoker desired to smoke. Smokers explained that family members could assist them in quitting by talking to them, not purchasing cigarettes for them, not smoking around them, and supporting them. Ideas for promoting smoke-free homes were having a no smoking sign, saying no to visitors who want to smoke, removing ashtrays, and creating a place outside for smokers. These findings can inform interventions designed to create and maintain smoke-free households.

What physicians think about the need for informed consent for communicating the risk of cancer from low-dose radiation

BackgroundThe National Institute of Environmental Health Sciences, a subsidiary of the Food and Drug Administration, has declared that X-ray radiation at low doses is a human carcinogen.ObjectiveThe purpose of our study was to determine if informed consent should be obtained for communicating the risk of radiation-induced cancer from radiation-based imaging.Materials and methodsInstitutional review board approval was obtained for the prospective survey of 456 physicians affiliated with three tertiary hospitals by means of a written questionnaire. Physicians were asked to state their subspecialty, number of years in practice, frequency of referral for CT scanning, level of awareness about the risk of radiation-induced cancer associated with CT, knowledge of whether such information is provided to patients undergoing CT, and opinions about the need for obtaining informed consent as well as who should provide information about the radiation-induced cancer risk to patients. Physicians were also asked to specify their preference among different formats of informed consent for communicating the potential risk of radiation-induced cancer. Statistical analyses were performed using the chi-squared test.ResultsMost physicians stated that informed consent should be obtained from patients undergoing radiation-based imaging (71.3%, 325/456) and the radiology department should provide information about the risk of radiation-induced cancer to these patients (54.6%, 249/456). The informed consent format that most physicians agreed with included modifications to the National Institute of Environmental Health Services report on cancer risk from low-dose radiation (20.2%, 92/456) or included information on the risk of cancer from background radiation compared to that from low-dose radiation (39.5%, 180/456).ConclusionMost physicians do not know if patients are informed about cancer risk from radiation-based imaging in their institutions. However, they believe that informed consent for communicating the risk of radiation-induced cancer should be obtained from patients undergoing radiation-based imaging.

The Effect of Race and Rural Residence on Prostate Cancer Treatment Choice Among Men in Georgia

OBJECTIVE To analyze differences for prostate cancer by race and in rural areas. METHODS We studied 516 men younger than 75 years old with incident prostate cancer during 2005-08 in 33 counties in Southwest Georgia (SWGA), a rural area of 700,000 (40% African American). Treatment data were abstracted from medical records, and interviews conducted with 314 men. We also compared treatments in SWGA vs. Atlanta in 2005. RESULTS External radiation plus brachytherapy was the most common treatment in SWGA (31%), followed by external radiation alone (27%), and surgery (18%). Patients in SWGA had higher odds of external radiation vs. surgery than men in Atlanta (OR 2.66, 95% CI 1.85-3.81). African Americans had higher odds of choosing treatment other than surgery, compared with whites (OR 2.04, 95% CI 1.57-2.63), more so in SWGA (OR 3.51, 95% CI 1.92-6.41) than Atlanta (OR 1.76, 95% CI 1.32-2.35) (P = .05). Poor communication with their physician was reported by 13% of men in SWGA, more among African Americans than whites (OR 3.95, 95% CI 1.52-10.30), and more among those who had no treatment vs. some treatment (OR 5.77, 95% CI 1.88-11.46). CONCLUSIONS In both rural and urban Georgia, white men with prostate cancer had surgery more frequently than African Americans, although data suggest this may be caused more by income differences than race. Rural patients as opposed to urban patients were more likely to receive external radiation and less likely to receive brachytherapy alone or surgery. Poor communication with a physician, particularly prevalent among African Americans, was associated with choosing no treatment in SWGA.

A Qualitative Study on Establishing and Enforcing Smoking Rules in Family Cars

With continued expansion of clean indoor air legislation, private spaces such as homes and cars are gaining increased attention as significant sources of secondhand smoke (SHS). This study examines the establishment and enforcement of smoking rules in family cars. Qualitative interviews (N = 136) were conducted with Black and White families in rural Georgia. Participating families had a young adolescent in the home and included households with all nonsmokers, a mix of smokers and nonsmokers, and all smokers. Common car smoking rules included no smoking allowed at any time, smoking allowed if a window is cracked, and no smoking allowed if children or nonsmokers are in the car. Major reasons for rules included protecting children and nonsmokers from SHS, aversion to the smell, and the stifling nature of SHS in cars. Damage to the vehicle from ashes and burns was another reason for smoking rules, particularly among families with smokers. Many families had never discussed car smoking rules. Families with car smoking rules were generally able to enforce them without difficulty, although smokers responded with a range of reactions from acceptance to anger. Families would consider a total ban if the smoker in their family quit or, for a few, if they purchased a new car. These findings have implications for designing intervention strategies to promote smoke-free cars and help family members to negotiate and enforce car smoking rules.

Cancer Outcomes Research in a Rural Area: A Multi-Institution Partnership Model

Whereas, most cancer research data come from high-profile academic centers, little is known about the outcomes of cancer care in rural communities. We summarize the experience of building a multi-institution partnership to develop a cancer outcomes research infrastructure in Southwest Georgia (SWGA), a primarily rural 33-county area with over 700,000 residents. The partnership includes eight institutions: the Emory University in Atlanta, the Centers for Disease Control and Prevention (CDC), the Georgia Comprehensive Center Registry (the Registry), the Southwest Georgia Cancer Coalition (the Coalition), and the four community cancer centers located within the SWGA region. The practical application of the partnership model, its organizational structure, and lessons learned are presented using two specific examples: a study evaluating treatment decisions and quality of life among prostate cancer patients, and a study of treatment discontinuation among prostate, breast, lung, and colorectal cancer patients. Our partnership model allowed us to (1) use the Coalition as a link between Atlanta-based researchers and local community; (2) collaborate with the area cancer centers on day-to-day study activities; (3) involve the Registry personnel and resources to identify eligible cancer cases and to perform data collection; and (4) raise community awareness and sense of study ownership through media announcements organized by the Coalition. All of the above activities were performed in consultation with the funding institution (CDC) and its project directors who oversee several other studies addressing similar research questions throughout the country. Our partnership model may provide a useful framework for cancer outcomes research projects in rural communities.