RESUMEN
BACKGROUND: The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES: To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN: Randomized trial. SUBJECTS: Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES: The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS: Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS: UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.
Asunto(s)
Alcoholismo/complicaciones , Alcoholismo/diagnóstico , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/diagnóstico , Continuidad de la Atención al Paciente/organización & administración , Trastorno Depresivo/complicaciones , Trastorno Depresivo/diagnóstico , Evaluación Geriátrica , Psiquiatría Geriátrica/organización & administración , Hospitales de Veteranos/estadística & datos numéricos , Tamizaje Masivo/organización & administración , Servicios de Salud Mental/organización & administración , Grupo de Atención al Paciente/organización & administración , United States Department of Veterans Affairs/estadística & datos numéricos , Anciano , Alcoholismo/terapia , Análisis de Varianza , Trastornos de Ansiedad/terapia , Comorbilidad , Análisis Costo-Beneficio , Trastorno Depresivo/terapia , Femenino , Estudios de Seguimiento , Estado de Salud , Hospitales de Veteranos/economía , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , Estados Unidos , United States Department of Veterans Affairs/economía , VeteranosRESUMEN
The success of cervical cancer control programs depends on regular screening with the Pap smear test and prompt and appropriate treatment of early neoplastic lesions. Recognizing the potentially grave consequences of lack of follow-up for abnormal Pap smears, numerous intervention studies have tested the impact of a variety of strategies to increase return for follow-up. The majority of these studies were evaluated under controlled experimental conditions. Despite the encouraging findings of these trials, the next step in the research continuum requires that the effectiveness of these interventions be demonstrated in real world settings before full implementation is initiated. We report the results of an evaluation study assessing the combined effectiveness of three intervention modalities found effective in prior randomized studies: a tracking follow-up protocol, transportation incentives, and financial incentives. This study used a before-after, nonequivalent control group design to assess the impact of a multifaceted intervention that included a computerized tracking protocol with transportation and financial incentives. The study was implemented at two major hospitals, two comprehensive health centers (CHC), and nine public health centers (PHC) under the jurisdiction of the Los Angeles County Department of Health Services. One hospital, one CHC, and the four PHC located in the catchment area of the CHC were selected as experimental sites. The control sites - one hospital, one CHC, and five PHC - provided usual care. All women with an abnormal Pap smear at the intervention and control sites were included in the study. The study consisted of a 1-year period of baseline data collection (September 1989-August 1990), followed by a 2(1/2)-year intervention period (September 1990-February 1993). During the intervention period, the intervention protocol was implemented at the experimental sites, and the control sites provided usual care. Overall, we found that the rates of receipt of follow-up care were consistent with those found in similar studies. In contrast to results obtained in these prior randomized trials, we did not find strong and consistent evidence for intervention effects. Significant findings emerged only at the CHC and hospital levels and only for selected years. Results underscore the importance of testing interventions in real world conditions before large-scale implementation is initiated. In addition, this study highlights the challenge of detecting intervention effects in large-scale studies because of the greater measurement difficulties in field studies as compared with controlled experiments.
Asunto(s)
Tamizaje Masivo , Cooperación del Paciente , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Servicios de Salud Comunitaria/estadística & datos numéricos , Estudios Controlados Antes y Después , Femenino , Financiación Personal , Humanos , Sistemas de Registros Médicos Computarizados , Persona de Mediana Edad , Prueba de Papanicolaou , Transportes , Neoplasias del Cuello Uterino/terapia , Frotis VaginalRESUMEN
Formidable barriers hinder use of standard data collection methods among deaf youth. Culturally and linguistically sensitive data collection strategies are needed to identify the unmet health and programming needs of this population. Unfortunately, researchers often fail to describe the issues involved in developing such targeted methods. The authors describe development of a culturally appropriate data collection instrument for a study of tobacco-related knowledge, attitudes, and practices among deaf youth. The instrument uses interactive multimedia technology to administer a questionnaire translated into the primary languages used by the Deaf. The procedures taken to accommodate this technology to these languages and to Deaf culture are described. This process yielded useful insights with respect to data collection not only among the Deaf, but among other frequently overlooked and underserved populations as well.
Asunto(s)
Sordera , Nicotiana , Plantas Tóxicas , Encuestas y Cuestionarios , Tabaquismo/prevención & control , Adolescente , Niño , Cognición , Humanos , Lectura de los Labios , Lengua de SignosRESUMEN
BACKGROUND: Little is known about cancer-screening practices of various Asian subgroups, and even less is known about factors that may predict screening in these populations. DESIGN: Two independent surveys were conducted with 218 Filipino and 229 Korean female immigrants, aged 50 years and older, residing in Los Angeles. RESULTS: In these convenience samples, 48% of Filipino and 41% of Korean women reported receipt of a Pap smear within the past 2 years; 41% of Filipino and 25% of Korean women reported receipt of a mammogram and a clinical breast exam within the past 2 years; and 25% of Filipino and 38% of Korean women reported colorectal cancer screening (blood stool test within the past 12 months or sigmoidoscopy/colonoscopy within the past 5 years). Only 14% of Filipino and 10% of Korean women were adherent to cancer-screening guidelines for all three sites. These differences in screening rates were statistically significant in multivariate analyses of the combined sample, controlling for all demographic characteristics, including age, percent of lifetime in the United States, education, marital status, health insurance, employment, and ethnicity. The two variables that were most consistently independently associated with adherence to cancer screening in both samples were higher percentage of lifetime spent in the United States and ever having had a checkup when no symptoms were present. CONCLUSIONS: These two variables-percent of lifetime in the United States and ever having had a checkup when no symptoms were present-can alert a physician that cancer-screening tests may be overdue among Korean and Filipino immigrants in the United States. Future research should identify predictors of cancer screening among other Asian immigrant groups and U.S.-born Asian women to assist in targeting intervention efforts.
Asunto(s)
Neoplasias de la Mama/prevención & control , Neoplasias Colorrectales/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud , Neoplasias del Cuello Uterino/prevención & control , Aculturación , Anciano , Anciano de 80 o más Años , Asiático/estadística & datos numéricos , Femenino , Humanos , Corea (Geográfico)/etnología , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Filipinas/etnología , Factores Socioeconómicos , Estados UnidosRESUMEN
Face-to-face interviews were conducted with 211 Filipino-American adolescents and young adults residing in Los Angeles County to assess AIDS related knowledge, attitudes and behaviors. Among both sexually active and never sexually active respondents, HIV knowledge and self-efficacy with respect to condom use were generally high, and the majority held peer norms that were supportive of condom use. More than half of sexually active respondents reported condom use at last intercourse. Knowledge of HIV transmission, demographic variables, barriers to condom use, peer norms, and being comfortable asking a steady partner to routinely use condoms were not related to condom use at last intercourse. Higher self-efficacy (odds ratio 2.4, P<.06) and carrying condoms (odds ratio 1.9, P<.08) were the only two variables that approached statistical significance in their relationship to condom use at last intercourse. Findings suggest that variables that are related to AIDS risk behavior among non-Asian populations may not explain condom use among Filipinos. Therefore, future studies should identify determinants of AIDS risk behavior among Filipinos and other Asian American populations as a first step towards developing culturally relevant AIDS prevention programs for these groups.
Asunto(s)
Condones/estadística & datos numéricos , Conducta Anticonceptiva/etnología , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Femenino , Infecciones por VIH/transmisión , Humanos , Los Angeles , Masculino , Grupo Paritario , Filipinas/etnología , Asunción de Riesgos , Autoeficacia , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Evidence indicates that although first-degree relatives of breast cancer cases are at increased risk of developing the disease themselves, they may be underutilizing screening mammography. Therefore, interventions to increase the use of mammography in this group are urgently needed. METHODS: A randomized two-group design was used to evaluate an intervention to increase mammography use among women (N = 901) with at least one first-degree relative with breast cancer. A statewide cancer registry was used to obtain a random sample of breast cancer cases who identified eligible relatives. The mailed intervention consisted of personalized risk notification and other theoretically driven materials tailored for high-risk women. RESULTS: An overall significant intervention effect was observed (8% intervention group advantage) in mammography at post-test. There was an interaction of the intervention with age such that there was no effect among women <50 years of age and a fairly large (20% advantage) effect among women 50+ and 65+. Health insurance, education, and having had a mammogram in the year before baseline assessment were positive predictors of mammography at post-test. Perceived risk, calculated risk, and relationship to index cancer case were not associated with mammography receipt. CONCLUSION: The intervention was successful in increasing mammography rates among high-risk women 50+ years of age. Further work is needed to determine why it was ineffective among younger women.
Asunto(s)
Neoplasias de la Mama/prevención & control , Predisposición Genética a la Enfermedad , Educación en Salud/métodos , Aceptación de la Atención de Salud , Medición de Riesgo , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/genética , California , Femenino , Humanos , Modelos Logísticos , Mamografía/estadística & datos numéricos , Persona de Mediana Edad , Oportunidad Relativa , Servicios Postales , Sistema de RegistrosRESUMEN
BACKGROUND AND OBJECTIVES: Young blacks and Hispanics are an emerging risk group for contracting HIV. The goal of this study was to assess the most salient correlates of condom use for young Hispanics and blacks in Los Angeles county sexually transmitted diseases (STD) clinics as a first step toward designing a short clinic-based intervention. STUDY DESIGN: Face-to-face interviews were conducted with 376 patients younger than the age of 27 years at six STD clinics operated by the Los Angeles County Department of Health Services. Assessment included several attitudinal variables and AIDS risk behaviors. RESULTS: Condom use at last intercourse ranged from 40% among Hispanic females to 48% among black males. Among females, condom users were more likely to report high self-efficacy regarding condom use, peer norms supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. Among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The most important correlate of condom use among males and females was the frequency of carrying condoms. CONCLUSIONS: Our findings suggest that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may have the potential to increase condom use. The efficacy of these intervention strategies should be explored in future studies.
PIP: This study identifies the most salient correlates of condom use for young Hispanic and Black patients in Los Angeles county sexually transmitted disease (STD) clinics. A total of 376 patients aged under 27 years were interviewed from April to December 1995 at six STD clinics. The questionnaire used was developed to measure AIDS-related attitudes and behavior and included 1) self-efficacy with respect to condom use; 2) perceived peer norms regarding condom use; 3) sexual communication; 4) expected partner reactions; and 5) barriers to condom use. The study revealed that condom use during last intercourse ranged from 40% among Hispanic females to 48% among Black males. Female condom users were more likely to report high self-efficacy regarding condom use, peer norm supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. On the other hand, among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The frequency of carrying condoms was the most important correlate of condom use among males and females. This study suggests that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may increase condom use.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Condones/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Asunción de Riesgos , Enfermedades de Transmisión Sexual/etnología , Enfermedades de Transmisión Sexual/prevención & control , Adulto , Femenino , Humanos , Entrevistas como Asunto , Los Angeles/epidemiología , Masculino , Factores Sexuales , Encuestas y CuestionariosRESUMEN
The purpose of this study was to assess mammography utilization among Korean-American women and to identify their knowledge, attitudes and barriers related to screening. Face-to-face interviews were conducted in the Korean language with a convenience sample of 229 predominantly low-income Korean women 50 years and older residing in Los Angeles. Forty-nine percent had ever had a mammogram, 24% had had a screening mammogram in the past 12 months, and 36% had had one in the past two years. Variables positively related to "ever had a screening mammogram" included: having health insurance; income > or = $25,000; having received a physician's recommendation to obtain a mammogram; holding positive group norms; longer duration of residency in the U.S.; and greater acculturation. Variables negatively related to screening included: concerns about finding cancer; taking time to get a mammogram; transportation; embarrassment; and discomfort requesting the procedure from the physician. Strategies to increase mammography utilization among Korean-American women are discussed.
Asunto(s)
Neoplasias de la Mama/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Mamografía/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Anciano , Neoplasias de la Mama/etnología , Intervalos de Confianza , Femenino , Humanos , Corea (Geográfico)/etnología , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Muestreo , Encuestas y Cuestionarios , Estados UnidosRESUMEN
To determine the effect of the 1994 controversy about mammography screening guidelines on physicians' practices, the authors surveyed primary care physicians at a university medical center in 1995. The 44-item survey elicited information about screening practices for women in four age groups, at the time of the study and five years earlier. High screening rates were maintained for the noncontroversial 50+ age group, but baseline mammography was still being ordered for 30-39-year-olds. Women 40-49 years old as well as older women were being screened less often in 1995.
Asunto(s)
Actitud del Personal de Salud , Mamografía , Tamizaje Masivo , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Centros Médicos Académicos , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Los Angeles , Masculino , Persona de Mediana Edad , Médicos de Familia , Factores de TiempoRESUMEN
Face-to-face interviews were conducted with a convenience sample of 218 Filipino and 229 Korean women residing in Los Angeles County. This paper describes the women's knowledge and misconceptions regarding breast cancer risk factors, their utilization of traditional and westernized preventive health care, and the relationship of these variables to mammography utilization. Sixty-six percent of Filipino women and 49% of Korean women ever had a mammogram. Both Filipino- and Korean-American women share many of the same misconceptions about breast cancer risk factors. More instructive, however, is that these beliefs do not affect mammography utilization. Acculturation and modesty were associated with mammography utilization in both groups. Use of traditional medicine was negatively related and use of westernized preventive health care was positively related to mammography screening only among Filipino women. Practicing health care professionals should use these findings as they develop culturally sensitive breast cancer control programs.
Asunto(s)
Asiático , Neoplasias de la Mama/prevención & control , Mamografía , Aculturación , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , California , Femenino , Humanos , Corea (Geográfico)/etnología , Medicina Tradicional , Persona de Mediana Edad , Filipinas/etnología , Factores de Riesgo , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To test the acceptability of mobile mammography among community-dwelling older women and to identify factors predictive of mobile mammography acceptance. DESIGN: Case series. SETTING: Twelve community meal sites sponsored by the City of Los Angeles Area on Aging. PARTICIPANTS: Two hundred fifty-five volunteers aged 60 to 84 years who attended community meal sites. INTERVENTION: On-site mammography offered to women who had not had a mammogram within the last year. MEASUREMENTS: Mammography acceptance rates, reasons for accepting or declining the mammogram, and breast cancer knowledge, beliefs, and intentions. MAIN RESULTS: One hundred seven of the 255 (42%) women were ineligible because they had received mammograms within the last year. Of the 148 women eligible, 57% accepted the mammograms and 43% declined; moreover, 20 of the 42 (48%) women who had not had a mammogram within the last 5 years or who never had a mammogram also accepted on-site mammography in the mobile van. Variables identified as predictive of mammogram acceptance included Asian American status, not being an HMO member, being married, a reported willingness to accept a screening mammogram if recommended by a physician, and previous mammogram screening history. CONCLUSION: Mobile mammography is acceptable to many older community-dwelling women. Although mobile mammography does not eliminate all barriers that inhibit a woman from receiving a mammogram, it may substantially increase screening for some groups.
Asunto(s)
Mamografía/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Unidades Móviles de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Actividades Cotidianas , Negro o Afroamericano , Anciano , Anciano de 80 o más Años , Asiático , Neoplasias de la Mama/prevención & control , Distribución de Chi-Cuadrado , Femenino , Humanos , Modelos Logísticos , Los Angeles , Matrimonio , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Vigilancia de la Población , Factores Socioeconómicos , Encuestas y Cuestionarios , Población BlancaRESUMEN
This study assessed mammography screening rates and related attitudes and intervention preferences in Filipino-American women, a group that has been neglected in cancer control research. Face-to-face interviews were conducted in English and Tagalog with a convenience sample of 218 Filipino women 50 years and older residing in Los Angeles. Sixty-six % had ever had a screening mammogram, 42% had had one in the past 12 months, and 54% in the past 2 years. These rates are about 20% lower than those found among African-American and white women in the 1994 California Behavioral Risk Factor Survey. Women who had received a doctor's recommendation to obtain a mammogram, women stating that they were very likely to obtain a mammogram if a physician recommended it, and women who felt very comfortable requesting a mammogram from a physician were more likely to have been screened. Women who had friends and relatives who had obtained mammograms those stating that their friends and relatives would be very supportive of their getting a mammogram, and those who felt that it was very worthwhile to obtain a mammogram were also more likely to have been screened. The following variables were negatively related to the outcome: concern over cost, the attitude that mammograms are only needed in the presence of symptoms, perceived inconvenience of taking the time and difficulties getting to the mammography facility, and embarrassment. Implications for interventions to increase breast cancer screening are discussed.
Asunto(s)
Asiático , Neoplasias de la Mama/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Mamografía/estadística & datos numéricos , Tamizaje Masivo/psicología , Anciano , Neoplasias de la Mama/etnología , Neoplasias de la Mama/psicología , Femenino , Humanos , Modelos Logísticos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Análisis Multivariante , Filipinas/etnologíaRESUMEN
While African American physicians can play a key role in encouraging black patients who smoke to quit, little is known about the views and activities of these physicians with respect to antitobacco programming. In the process of developing a protocol for encouraging physicians' smoking cessation intervention, 96 African-American physicians completed a survey indicating their knowledge, attitudes, and practices relating to stop smoking counseling. Few physicians reported patient help-seeking behavior and 47.9% cited lack of patient motivation as a key barrier to intervention. Only 46.8% believed that it is possible to accomplish a lot of cessation help in a few minutes time, and 34.4% believed that setting up and maintaining an office protocol would require a great deal of effort. Explaining health risks (71.9%) and enrolling patients in programs (66.6%) were perceived as keys to patient cessation; fewer than half of the physicians surveyed discuss specific strategies for quitting with their patients. Physicians indicated a willingness to offer more counseling in the future and were open to a range of strategies for learning more about effective approaches. Our findings support the need for dissemination of such information, particularly among specialists, to support antitobacco efforts among African-American physicians.
Asunto(s)
Negro o Afroamericano , Pautas de la Práctica en Medicina , Cese del Hábito de Fumar , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad RelativaRESUMEN
Data from a population-based longitudinal study were used to compare cross-sectional versus prospective predictors of screening mammography. Although the results of the two analyses were not dramatically different, some important differences emerged. More attitudinal variables were related to future behavior compared with past behavior. Using purely cross-sectional data from this study to design an intervention would result in potentially important variables being deemphasized or omitted, which could have a significant impact on the strength of the intervention. Our findings strongly suggest that it may be unwise to generalize cross-sectionally obtained data to a longitudinal situation.
Asunto(s)
Estudios Transversales , Mamografía/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Estudios Prospectivos , Anciano , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Persona de Mediana EdadRESUMEN
BACKGROUND: This paper describes the results of an AIDS knowledge, attitudes, and behaviors survey of a random sample of heterosexual California adults. METHODS: The study was conducted from August 1990 until February 1991 and consisted of telephone interviews conducted in English and Spanish, with a household probability sample of 3,545 California adults, undersampling those age 44 and older. RESULTS: Approximately one-third of the sample believed that HIV/AIDS is contracted by donating blood, and 20% believed the infection could result from insect bites. Tolerance toward HIV-infected persons was highest among young, male, white, employed individuals with higher levels of education and income. Twenty-seven percent of males and 14% of females were categorized as high risk based on the presence of at least 1 of 7 risk factors. High-risk respondents tended to be male, young, employed, never married, U.S. born, and English speaking. Compared to low-risk respondents, they were less likely to use condoms and more likely to use alcohol and drugs in conjunction with sex. Most common sources of AIDS information were television, newspapers, and magazines. CONCLUSIONS: More strenuous efforts are needed to reach young adults, especially those beyond college age, with AIDS prevention messages. Creative messages via popular media venues should be explored.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Conocimientos, Actitudes y Práctica en Salud , Asunción de Riesgos , Conducta Sexual , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Anciano , California , Femenino , Conductas Relacionadas con la Salud , Educación en Salud , Humanos , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Factores de Riesgo , Muestreo , Encuestas y CuestionariosRESUMEN
This paper examines adherence to a referral for a screening mammogram among an ethnically diverse sample of 576 female county health department patients age 50 and over. Data were obtained by interview approximately one year after the referral for a screening mammogram. Overall, approximately 80% of the sample were adherent to the referral. Medical record validation of self-reports of mammography receipt verified receipt of a mammogram for 82% of those reporting one. In logistic regression analysis, determinants of adherence included: transportation barriers, fear of immigration authorities, perceived control over getting breast cancer, self-rated health status, age, and perceived quality of provider-patient communication. The most prevalent concerns about mammography were concern over finding cancer, treatment for breast cancer, and removal of a breast. Reporting of these concerns was not significantly related to adherence. Also reported are barriers to health care experienced by this population over the past 12 months. The high adherence rate found in this study emphasizes the importance of provider referral in the delivery of screening mammography, and invalidates assumptions that women of lower education and lower income are less likely to adhere to provider recommendations.
Asunto(s)
Mamografía/estadística & datos numéricos , Aceptación de la Atención de Salud , Derivación y Consulta , Anciano , Actitud Frente a la Salud , Femenino , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Modelos Logísticos , Los Angeles , Persona de Mediana Edad , Análisis Multivariante , Sistemas Recordatorios , Factores SocioeconómicosRESUMEN
This paper describes the prevalence of anal sex among heterosexual adults in California and investigates the relationship of anal sex to other risk behaviors associated with AIDS and STDs. The study consisted of telephone interviews with a household probability sample of 3,545 California adults undersampling those age 44 and older. Seven percent of the sexually active respondents, 8% of males, and 6% of females reported having anal sex at least once a month during the year prior to the survey. Of these, most engage in this activity one to five times per month, and about 60% report never using condoms. Younger respondents and those who were not married were more likely to report anal intercourse. Respondents who had anal sex were more likely to report standard AIDS risks and lifestyle risks associated with STDs, and to engage in recreational use of drugs and alcohol. Both anal sex and condom use during anal intercourse were poorly predicted by these demographic and risk variables. It is concluded that a non-trivial proportion of California heterosexual adults engages in anal sex regularly, most without condoms, and those who have anal sex are more likely to have other risk behaviors associated with AIDS and STDs. These results suggest that anal sex must be addressed specifically in clinical and educational programs designed to reduce the spread of AIDS.
Asunto(s)
Infecciones por VIH/transmisión , Asunción de Riesgos , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , California , Condones/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Conducta Sexual/psicología , Parejas Sexuales , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Of all age groups, teenagers have the highest rates of sexually transmitted diseases. Therefore, it is particularly important to target interventions at this group. Teenagers attending STD clinics are at particularly high risk since behaviours that lead to an STD can also result in the transmission of HIV. The goal of this study was to collect information concerning the prevalence and correlates of high-risk behaviours in this population as a first step in the design of an effective intervention programme. METHODOLOGY: Face-to-face interviews were conducted with patients attending five STD clinics operated by the Los Angeles County Department of Health Services. RESULTS: In the exclusively heterosexual teenage subgroup (N = 100, 55% Hispanic, 28% African-American, 10% White), males became sexually active at a younger age than females (14 years vs 14.9 years, p < 0.02), had more partners in the last 12 months (4.1 vs 2.0, p < 0.003), more "steady" partners (2.2 vs 1.4, p < 0.02) and more life time partners (14.1 vs. 4.1, p < 0.001). Only 10.0% of males and 3.8% of females reported consistent condom use with steady partners and 36% of both male and female respondents with non-steady partners. The decision to use condoms during vaginal sex was most likely made by the respondent, whereas the decision not to use condoms was most likely a joint decision. CONCLUSIONS: An intervention aimed at improving sexual communication regarding condom use could increase this behaviour among many adolescents, since only few teenagers in our sample perceived condom use as unpleasant.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Conducta del Adolescente , Asunción de Riesgos , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Consumo de Bebidas Alcohólicas , Coito , Condones , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Los Angeles , Masculino , Factores Sexuales , Enfermedades de Transmisión Sexual/complicaciones , Trastornos Relacionados con SustanciasRESUMEN
Low income, older, minority women are at high risk for underutilization of screening mammography. One strategy for increasing utilization is to conduct interventions targeting local and state health departments where a majority of these women seek health care. A prerequisite for conducting effective screening programs is to obtain current and accurate information on baseline screening rates to understand the nature and scope of the problem and to plan appropriate intervention strategies. The sample consisted of 3240 women who were 50+ years of age from 2 hospitals and 2 comprehensive health centers operated by the Los Angeles County Department of Health Services. Reviews of medical records indicated that only 21% of the sample had received a mammogram in the 12 months prior to the clinic visit on which they were sampled and 23% of the sample received a mammogram in the following 9 months. Approximately 5% of the total sample received a repeat mammogram in the 21-month period over which they were tracked. Prospective independent predictors of screening were age, number of visits to primary care clinics, number of visits to specialty care clinics, and history of breast abnormalities. The results underscore the importance of implementing programs to increase mammography implementing programs to increase mammography screening within public facilities serving low income multiethnic women. An important finding is that a large number of older women are seen in specialty clinics, which represents an untapped resource for increasing screening in this population. Innovative interventions targeting such specialty clinics could substantially contribute to increasing screening rates. A comprehensive approach targeting system, physician, and patient barriers is recommended.