Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening.

There is legitimate concern about whether cancer screening programs and other types of prevention and early detection programs are designed to reach those most in need of services. Previous research on barriers to screening has generally addressed screening for specific cancers. The purpose of this study was to evaluate and compare the types and strengths of barriers to both mammography and Pap smear screening experienced by three groups of women. Five hundred and twenty-two women, aged 52-69, who were members of a large health maintenance organization (HMO), completed a survey about cancer screening and associated barriers. Women with no mammogram in the preceding 2 years and with no Pap smear in 3 years were classified into a "safety net" program. We classified women as falling into both (Pap smear and mammography), one (Pap smear or mammography), or neither safety nets. Results consistently revealed that women needing both tests had more numerous and more intense barriers than other women to both types of screening. Factor analyses and descriptive analyses both showed that the types of barriers experienced were very similar for mammography and Pap smear screening. The discussion addresses intervention implications and the additional research needed on women who need both mammogram and Pap smear screening and who have much higher cancer risk than other women.

A brief smoking cessation intervention for women in low-income planned parenthood clinics.

OBJECTIVES: The purpose of this study was to evaluate a brief smoking cessation intervention for women 15 to 35 years of age attending Planned Parenthood clinics. METHODS: Female smokers (n = 1154) were randomly assigned either to advice only or to a brief intervention that involved a 9-minute video, 12 to 15 minutes of behavioral counseling, clinician advice to quit, and follow-up telephone calls. RESULTS: Seventy-six percent of those eligible participated. Results revealed a clear, short-term intervention effect at the 6-week follow-up (7-day self-reported abstinence: 10.2% vs 6.9% for advice only, P < .05) and a more ambiguous effect at 6 months (30-day biochemically validated abstinence: 6.4% vs 3.8%, NS). CONCLUSIONS: This brief, clinic-based intervention appears to be effective in reaching and enhancing cessation among female smokers, a traditionally underserved population.

Concern about weight gain associated with quitting smoking: prevalence and association with outcome in a sample of young female smokers.

This study investigated the relationship between weight gain concern and outcomes of a large-scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.

Recent patterns of hormone replacement therapy use in a large managed care organization.

Rates of hormone replacement therapy (HRT) in women have varied substantially over the last 25 years. Data on the impact of recent recommendations for widespread use to prevent cardiovascular disease and osteoporosis and factors that influence use are needed. We attempted to (1) describe recent trends in HRT use, (2) investigate the relationship between HRT use and prepaid drug benefit, and (3) detail prescribing frequencies by provider specialty. We conducted a cross-sectional analysis of annual HRT pharmacy dispensings from 1986 to 1995 in a large HMO to all female HMO members aged 45 years and older. HRT rates increased among all age categories, although the magnitude of change varied by age. Highest rates of use were found in those 50-59 years old. Although combined estrogen-progestin use increased, 57% of all estrogen users did not receive progestin in 1995. Unopposed estrogen use was largely limited to hysterectomized women. Women of all ages with no prepaid drug benefit as part of their HMO coverage had the lowest HRT rates. Internal medicine, obstetrics/gynecology, and family practice providers prescribed over 90% of HRT, and prescriber specialty varied with user age. HRT use increased in the HMO from 1986 to 1995, especially among younger women. In 1995, about half of women aged 50-64 years received one or more HRT dispensings. As the benefits, risks, and cost effectiveness of HRT depend on the duration of use, additional information on current use duration is needed. Combined estrogen-progestin use increased and appeared appropriate to hysterectomy status. Research is needed to determine if lower HRT use rates among women without a prepaid drug benefit indicate less prophylactic HRT use, particularly among younger women, for whom this lack of coverage was relatively common.

Reaching those most in need: participation in a Planned Parenthood smoking cessation program.

We evaluated the representativeness of women approached and enrolled in a brief smoking cessation intervention conducted in Planned Parenthood clinics. In this effectiveness study, regular clinic staff were trained to identify, offer participation, and counsel willing smoking clients as part of their clinic visit. Chart audits were conducted to determine the percent of clients who had smoking status identified, as well as the percent and characteristics of potentially eligible clients who were not approached. Baseline and non-participant questionnaires were analyzed to determine participation rate and characteristics of those participating versus those not participating. Smoking status was documented in 99% of charts. Seventy percent of eligible smokers were approached about study participation and 74% of those approached participated. There were no significant differences between those approached and those not approached or between those who participated versus those who did not on a host of sociodemographic variables. This project was able to approach and attract a representative sample of young, lower income women to participate in a brief, clinic-based smoking cessation program.

Does gender affect response to a brief clinic-based smoking intervention?

INTRODUCTION: Although recent reviews suggest few gender differences in smoking-cessation outcomes, it is important to establish whether gender differences exist in response to the brief interventions increasingly recommended as part of routine medical care. METHODS: We used data from an efficacious primary care-based smoking intervention to examine gender differences in smoking characteristics, use of intervention components, self-reported quitting activities, and cessation outcomes among all smokers randomized to receive clinician advice and nurse-assisted intervention (n = 1,978, 58% female). RESULTS: Although female and male smokers differed on a number of sociodemographic and smoking-related characteristics, they were equally likely to participate in each step of the recommended intervention. Female and male smokers were also equally likely to report quit attempts and cessation at 3, 12, and 3 and 12 months (combined long-term cessation endpoint). Similarly, no gender difference in relapse at 12 months was seen. Women attempting to quit used a greater number and variety of smoking-cessation strategies, suggesting that, although outcomes were similar, the processes of cessation may vary by gender. CONCLUSIONS: Since this brief intervention in primary care was equally efficacious and acceptable to female and male smokers, broader implementation in medical settings of this population-based approach to reducing tobacco use is warranted. Indeed, widespread implementation of smoking-cessation programs in medical settings may particularly benefit women, who are more likely than men to have contacts with the medical care system.

Smoking characteristics of female veterans.

Recent studies suggest that the prevalence of smoking among active duty military women is higher than that of active duty military men or civilians of either gender. No data have been published on cessation rates among female veterans. We wanted to report such rates in a group of female veterans at Pettis VAMC Preventive Medicine Clinic and to study predictive factors for smoking cessation and prevention. We identified female patients at Pettis VAMC Preventive Medicine Women's Clinic who had received services in the past 3 years or who enrolled as new patients during the study period; 529 received questionnaires by mail or at the clinic; 409 returned completed surveys. A high proportion (32.5%) of our sample of female veterans were current smokers, and 67% of female veteran smokers reported smoking at least one pack daily. More than one-third of ever-smokers began smoking during military service. Thirty-nine percent of the female veteran sample had CES-D scores of 16 or greater, and current smokers had significantly greater mean CES-D scores than former smokers. Twenty-three percent of current smokers had high nicotine dependence scores (> 7). The highest proportion of CES-D scores compatible with depressive symptoms (55%) was seen among current smokers who consumed a pack or more of cigarettes per day. Ever-smokers who screened as depressed were significantly less likely to have quit than those with lower CES-D scores; however, in multivariate models, CES-D scores were not significantly related to cessation. The prevalence of current, ever, and heavy smoking was high among this sample of female veterans attending a VAMC Preventive Medicine clinic. An unexpectedly high prevalence of screening scores compatible with depression was found among this sample, particularly among smokers. This warrants further investigation, particularly in light of the reported relationship between depression and smoking.