Risk factors for breast cancer in a population with high incidence rates.

BackgroundThis report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates.MethodsEligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews.ResultsIn multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over.ConclusionsDespite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis

Physician Counseling on Colorectal Cancer Screening and Receipt of Screening among Latino Patients

BACKGROUND: Latinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors. OBJECTIVE: We assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients. DESIGN: This was a cross-sectional telephone survey. PARTICIPANTS: The participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year. MAIN MEASURES: We developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients’ barriers to CRC screening, were responsive to patients’ concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines. KEY RESULTS: Of 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p < 0.001), and explanations (p < 0.05) and encouragement (p < 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48). CONCLUSIONS: Among primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11606-014-3126-0) contains supplementary material, which is available to authorized users

The patient-reported Clinicians' Cultural Sensitivity Survey: a field test among older Latino primary care patients.

BackgroundPatient-reported measures of clinicians' cultural sensitivity are important to assess comprehensively quality of care among ethnically diverse patients and may help address persistent health inequities.ObjectiveCreate a patient-reported, multidimensional survey of clinicians' cultural sensitivity to cultural factors affecting quality of care.DesignUsing a comprehensive conceptual framework, items were written and field-tested in a cross-sectional telephone survey. Multitrait scaling and factor analyses were used to develop measures.Setting and participantsLatino patients age ≥50 from primary care practices in California.Main variables studiedThirty-five items hypothesized to assess clinicians' sensitivity.Main outcomes measuresValidity and reliability of cultural sensitivity measures.ResultsTwenty-nine of 35 items measuring 14 constructs were retained. Eleven measures assessed sensitivity issues relevant to all participants: complementary and alternative medicine, mind-body connections, causal attributions, preventive care, family involvement, modesty, prescription medications, spirituality, physician discrimination due to education, physician discrimination due to race/ethnicity and staff discrimination due to race/ethnicity. Three measures were group specific: two to limited English proficient patients (sensitivity to language needs and discrimination due to language) and one to immigrants (sensitivity to immigrant status). Twelve multi-item scales demonstrated adequate reliability (alpha ≥0.68 except for Spanish discrimination due to education) and evidence of construct validity (item-scale correlations for all scales &gt;0.40 except for sensitivity to immigrant status). Two single-item measures demonstrated sufficient construct validity to retain for further development.Discussion and conclusionsThe Clinicians' Cultural Sensitivity Survey can be used to assess the quality of care of older Latino patients

The patient-reported Clinicians' Cultural Sensitivity Survey: a field test among older Latino primary care patients.

BackgroundPatient-reported measures of clinicians' cultural sensitivity are important to assess comprehensively quality of care among ethnically diverse patients and may help address persistent health inequities.ObjectiveCreate a patient-reported, multidimensional survey of clinicians' cultural sensitivity to cultural factors affecting quality of care.DesignUsing a comprehensive conceptual framework, items were written and field-tested in a cross-sectional telephone survey. Multitrait scaling and factor analyses were used to develop measures.Setting and participantsLatino patients age ≥50 from primary care practices in California.Main variables studiedThirty-five items hypothesized to assess clinicians' sensitivity.Main outcomes measuresValidity and reliability of cultural sensitivity measures.ResultsTwenty-nine of 35 items measuring 14 constructs were retained. Eleven measures assessed sensitivity issues relevant to all participants: complementary and alternative medicine, mind-body connections, causal attributions, preventive care, family involvement, modesty, prescription medications, spirituality, physician discrimination due to education, physician discrimination due to race/ethnicity and staff discrimination due to race/ethnicity. Three measures were group specific: two to limited English proficient patients (sensitivity to language needs and discrimination due to language) and one to immigrants (sensitivity to immigrant status). Twelve multi-item scales demonstrated adequate reliability (alpha ≥0.68 except for Spanish discrimination due to education) and evidence of construct validity (item-scale correlations for all scales &gt;0.40 except for sensitivity to immigrant status). Two single-item measures demonstrated sufficient construct validity to retain for further development.Discussion and conclusionsThe Clinicians' Cultural Sensitivity Survey can be used to assess the quality of care of older Latino patients

Physician counseling on colorectal cancer screening and receipt of screening among Latino patients.

BackgroundLatinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors.ObjectiveWe assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients.DesignThis was a cross-sectional telephone survey.ParticipantsThe participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year.Main measuresWe developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients' barriers to CRC screening, were responsive to patients' concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines.Key resultsOf 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p &lt; 0.001), and explanations (p &lt; 0.05) and encouragement (p &lt; 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48).ConclusionsAmong primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening

Risk factors for breast cancer in a population with high incidence rates.

BackgroundThis report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates.MethodsEligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews.ResultsIn multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over.ConclusionsDespite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis