An educational intervention based on the extended parallel process model to improve attitude, behavioral intention, and early breast cancer diagnosis: a randomized trial

Vahideh Termeh Zonouzy,1 Shamsaddin Niknami,1 Fazlollah Ghofranipour,1 Ali Montazeri2 1Department of Health Education and Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; 2Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran Background: Breast cancer is an important public health problem worldwide. This study aimed to assess the effectiveness of an educational intervention based on fear appeals using the extended parallel process model (EPPM) to improve attitudes, intention, and early breast cancer diagnosis in Iranian women.Methods: This was a cluster-randomized trial conducted in Tehran, Iran. A sample of women 40 years old and above was recruited and assigned either to intervention group or to control group. The intervention group received two pamphlets containing fear appeals specially designed for this study using the EPPM. The control group received nothing. The primary outcomes were changes in attitude, behavioral intention, and early breast cancer diagnosis. Participants responded to a questionnaire before intervention and at 3 months follow-up assessments. Independent t-tests and paired t-tests were used for comparison.Result: In all, 600 women were entered into the study (277 in the intervention group and 323 in the control group). Of these, 162 were lost to follow-up assessment. Thus, the analysis was restricted to those for whom both baseline and follow-up information was available (n=438). The mean age of participants was 53.2 (SD=9.45) years, and the mean year education of participants was 9.4 (SD=4.12) years. There were no significant differences between two groups regarding demographic variables. However, comparing outcome variables (attitude, intention, and early breast cancer diagnosis) at baseline and follow-up assessments, we found that the intervention group showed significant improvements in attitude and intention (P=0.01 and P=0.001, respectively), but no significant improvement was observed for early breast cancer diagnosis (P=0.78). The control group did not show any changes.Conclusion: The findings showed that fear appeals could not influence early breast cancer diagnosis among women. However, significant changes were observed for attitude and behavioral intention. Keywords: EPPM, breast cancer screening, women’s health, Ira

Investigating human geographic origins using dual-isotope (87Sr/86Sr, $18O) assignment approaches

Substantial progress in the application of multiple isotope analyses has greatly improved the ability to identify nonlocal individuals amongst archaeological populations over the past decades. More recently the development of large scale models of spatial isotopic variation (isoscapes) has contributed to improved geographic assignments of human and animal origins. Persistent challenges remain, however, in the accurate identification of individual geographic origins from skeletal isotope data in studies of human (and animal) migration and provenance. In an attempt to develop and test more standardized and quantitative approaches to geographic assignment of individual origins using isotopic data two methods, combining87 Sr/86 Sr and ä18 O isoscapes, are examined for the Circum-Caribbean region: 1) an Interval approach using a defined range of fixed isotopic variation per location; and 2) a Likelihood assignment approach using univariate and bivariate probability density functions. These two methods are tested with enamel isotope data from a modern sample of known origin from Caracas, Venezuela and further explored with two archaeological samples of unknown origin recovered from Cuba and Trinidad. The results emphasize both the potential and limitation of the different approaches. Validation tests on the known origin sample exclude most areas of the Circum-Caribbean region and correctly highlight Caracas as a possible place of origin with both approaches. The positive validation results clearly demonstrate the overall efficacy of a dual-isotope approach to geoprovenance. The accuracy and precision of geographic assignments may be further improved by better understanding of the relationships between environmental and biological isotope variation; continued development and refinement of relevant isoscapes; and the eventual incorporation of a broader array of isotope proxy data

Mean number of motifs and evenness by period with one standard deviation.

<p>Mean number of motifs and evenness by period with one standard deviation.</p

Nation Building and Social Signaling in Southern Ontario: A.D. 1350–1650

<div><p>Pottery is a mainstay of archaeological analysis worldwide. Often, high proportions of the pottery recovered from a given site are decorated in some manner. In northern Iroquoia, late pre-contact pottery and early contact decoration commonly occur on collars—thick bands of clay that encircle a pot and extend several centimeters down from the lip. These decorations constitute signals that conveyed information about a pot’s user(s). In southern Ontario the period A.D. 1350 to 1650 witnessed substantial changes in socio-political and settlement systems that included population movement, coalescence of formerly separate communities into large villages and towns, waxing and waning of regional strife, the formation of nations, and finally the development of three confederacies that each occupied distinct, constricted areas. Social network analysis demonstrates that signaling practices changed to reflect these regional patterns. Networks become more consolidated through time ultimately resulting in a “small world” network with small degrees of separation between sites reflecting the integration of communities within and between the three confederacies.</p></div

Examples of collar decoration on Ontario Iroquoian pottery.

<p>Examples of collar decoration on Ontario Iroquoian pottery.</p

Networks of sequential periods.

<p>Networks of sequential periods.</p

Networks of sequential periods with sites in geographical position.

<p>Networks of sequential periods with sites in geographical position.</p

Selected Iroquoian site plans, ca. A.D. 1350–1650: a) Alexandra [25]; b) Robb [26]; c) Hope [27]; d) Over [28]; e) Baker [29]; f) Draper [30]; g) Keffer [31]; h) Kirche [32]; i) Mantle [33]; j) Benson [34]; k) Ball [35].

<p>Selected Iroquoian site plans, ca. A.D. 1350–1650: a) Alexandra [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref025" target="_blank">25</a>]; b) Robb [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref026" target="_blank">26</a>]; c) Hope [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref027" target="_blank">27</a>]; d) Over [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref028" target="_blank">28</a>]; e) Baker [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref029" target="_blank">29</a>]; f) Draper [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref030" target="_blank">30</a>]; g) Keffer [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref031" target="_blank">31</a>]; h) Kirche [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref032" target="_blank">32</a>]; i) Mantle [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref033" target="_blank">33</a>]; j) Benson [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref034" target="_blank">34</a>]; k) Ball [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156178#pone.0156178.ref035" target="_blank">35</a>].</p