Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention.
ABSTRACT: To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.
Project description:Scientific reports suggest that women at risk for familial breast cancer may benefit from prophylactic mastectomy. However, few data are available about how women decide upon this clinical option, and in particular, what role an objective risk assessment plays in this. The purpose of the present study is to assess whether this objective risk information provided in genetic counselling affects the intention for prophylactic mastectomy. Additionally, the (mediating) effects of breast cancer worry and perceived risk are investigated. A total of 241 women completed a questionnaire before and after receiving information about their familial lifetime breast cancer risk in a genetic counselling session. Path analysis showed that the objective risk information had a corrective effect on perceived risk (beta=0.38; P=0.0001), whereas the amount of breast cancer worry was not influenced by the counselling session. The objective risk information did not directly affect the intention for prophylactic mastectomy. The intention was influenced by perceived risk after counselling (beta=0.23; P=0.002), and by the precounselling levels of perceived risk (beta=0.27; P=0.00025) and breast cancer worry (beta=0.32; P=0.0001), that is, higher levels of perceived risk and breast cancer worry imply a stronger intention for prophylactic mastectomy. A personal history of breast cancer did not directly influence the intention for prophylactic mastectomy, but affected women who had undergone a mastectomy as surgical treatment were more positively inclined to have a prophylactic mastectomy than women who had had breast-conserving therapy. The impact of objective risk information on the intention for prophylactic mastectomy is limited and is mediated by perceived risk. Important determinants of the intention for prophylactic mastectomy were precounselling levels of breast cancer worry and perceived risk, suggesting that genetic counselling is only one event in the entire process of decision making. Therefore, interventions aimed at improving decision making on prophylactic mastectomy should explicitly address precounselling factors, such as personal beliefs and the psychological impact of the family medical history.
Project description:In the absence of routine ovarian cancer screening, promoting help-seeking in response to ovarian symptoms is a potential route to early diagnosis. The factors influencing women's anticipated time to presentation with potential ovarian cancer symptoms were examined.Cross-sectional questionnaires were completed by a sample of women at increased familial risk (n?=?283) and population risk (n?=?1043) for ovarian cancer. Measures included demographic characteristics, symptom knowledge, anticipated time to symptom presentation, and health beliefs (perceived susceptibility, worry, perceived threat, confidence in symptom detection, benefits and barriers to presentation). Structural equation modelling was used to identify determinants of anticipated time to symptomatic presentation in both groups.Associations between health beliefs and anticipated symptom presentation differed according to risk group. In increased risk women, high perceived susceptibility (r?=?.35***), ovarian cancer worry (r?=?.98**), perceived threat (r?=?-.18**), confidence (r?=?.16**) and perceiving more benefits than barriers to presentation (r?=?-.34**), were statistically significant in determining earlier anticipated presentation. The pattern was the same for population risk women, except ovarian cancer worry (r?=?.36) and perceived threat (r?=?-.03) were not statistically significant determinants.Associations between underlying health beliefs and anticipated presentation differed according to risk group. Women at population risk had higher symptom knowledge and anticipated presenting in shorter time frames than the increased risk sample. The cancer worry component of perceived threat was a unique predictor in the increased risk group. In increased risk women, the worry component of perceived threat may be more influential than susceptibility aspects in influencing early presentation behaviour, highlighting the need for ovarian symptom awareness interventions with tailored content to minimise cancer-related worry in this population.
Project description:BACKGROUND AND AIMS:Diabetes mellitus is a coronary heart disease (CHD) risk-equivalent for the outcome of peripheral vascular disease. The impact of diabetes with comorbid risk factors on the outcome of peripheral vascular disease remains unexplored. METHODS:We performed a cross-sectional analysis of participants in Lifeline Vascular Screening Inc. age 40-90 who were screened for peripheral vascular disease, defined as lower extremity peripheral artery disease (PAD, ABI <0.9) and/or carotid artery stenosis (CAS, internal CAS ?50%). CHD was defined as prior myocardial infarction or revascularization. Risk factors included hypertension, hyperlipidemia, smoking, obesity, sedentary lifestyle and family history of cardiovascular disease. RESULTS:Among 3,517,804 participants, PAD and CAS was identified in 4.4% and 3.7%, respectively. Diabetes was identified in 376,528 participants, 324,680 (86%) of whom did not have CHD. Among diabetic participants without CHD, prevalence of PAD increased with 1-2 (4.3%), 3-4 (7.3%), and ?5 (12.0%) comorbid risk factors (p trend < 0.0001). The pattern was similar for CAS (3.7%, 6.2%, 8.8%, p trend < 0.0001). Compared to participants without diabetes, those with diabetes and 1-2, 3-4 and ?5 risk factors had increasing odds of PAD and CAS after adjustment for age, sex and race/ethnicity (1.0, 95% CI 0.98-1.06; 1.8, 95% CI 1.8-1.89; 3.5, 95% CI 3.43-3.64, respectively, p trend < 0.0001). By comparison, in nondiabetic participants, CHD increased odds of PAD and CAS by 2-fold (2.06, 95% CI 2.02-2.1; 2.19, 95% CI 2.15-2.23 respectively). CONCLUSIONS:Diabetes, particularly with comorbid risk factors, confers increased odds of PAD and CAS, even in the absence of CHD. Counseling regarding screening and prevention for peripheral vascular disease among individuals with diabetes and multiple risk factors may be useful.
Project description:BACKGROUND AND AIM:Coronary heart disease (CHD) is a chronic complex disease caused by a combination of factors such as lifestyle behaviors and environmental and genetic factors. We conducted this study to evaluate the risk factors affecting the development of CHD in Xinjiang, and to obtain valuable information for formulating appropriate local public health policies. METHOD:We conducted a nested case-control study with 277 confirmed CHD cases and 554 matched controls. The association of the risk factors with the risk of CHD was assessed using the multivariate Cox proportional hazard model. Multiplicative interactions were evaluated by entering interaction terms in the Cox proportional hazard model. The additive interactions among the risk factors were assessed by the index of additive interaction. RESULTS:The risk of CHD increased with frequent high-fat food consumption, dyslipidemia, obesity, and family history of CHD after adjustment for drinking, smoking status, hypertension, diabetes, family history of hypertension, and family history of diabetes. We noted consistent interactions between family history of CHD and frequent high-fat food consumption, family history of CHD and obesity, frequent high-fat food consumption and obesity, frequent high-fat food consumption and dyslipidemia, and obesity and dyslipidemia. The risk of CHD events increased with the presence of the aforementioned interactions. CONCLUSIONS:Frequent high-fat food consumption, family history of CHD, dyslipidemia and obesity were independent risk factors for CHD, and their interactions are important for public health interventions in patients with CHD in Xinjiang.
Project description:BACKGROUND: It has been suggested that family history information may be effective in motivating people to adopt health promoting behaviour. The aim was to determine if diabetic familial risk information by using a web-based tool leads to improved self-reported risk-reducing behaviour among individuals with a diabetic family history, without causing false reassurance among those without a family history. METHODS: An online sample of 1,174 healthy adults aged 35-65 years with a BMI ? 25 was randomized into two groups receiving an online diabetes risk assessment. Both arms received general tailored diabetes prevention information, whilst the intervention arm also received familial risk information after completing a detailed family history questionnaire. Separate analysis was performed for four groups (family history group: 286 control versus 288 intervention group; no family history: 269 control versus 266 intervention group). Primary outcomes were self-reported behavioural outcomes: fat intake, physical activity, and attitudes towards diabetes testing. Secondary outcomes were illness and risk perceptions. RESULTS: For individuals at familial risk there was no overall intervention effect on risk-reducing behaviour after three months, except for a decrease in self-reported saturated fat intake among low-educated individuals (Beta (b) -1.01, 95% CI -2.01 to 0.00). Familial risk information resulted in a decrease of diabetes risk worries (b -0.21, -0.40 to -0.03). For individuals without family history no effect was found on risk-reducing behaviour and perceived risk. A detailed family history assessment resulted in a greater percentage of individuals reporting a familial risk for diabetes compared to a simple enquiry. CONCLUSIONS: Web-based familial risk information reduced worry related to diabetes risk and decreased saturated fat intake of those at greatest need of preventative care. However, the intervention was not effective for the total study population on improving risk-reducing behaviour. The emphasis on familial risk does not seem to result in false reassurance among individuals without family history. Additionally, a detailed family history questionnaire identifies more individuals at familial risk than a simple enquiry. TRIAL REGISTRATION: NTR1938.
Project description:Patients' beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor.In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions.Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%).Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.
Project description:We described and compared seniors' stroke-related health beliefs among four racial/ethnic communities to inform a culturally-tailored stroke prevention walking intervention. Specific attention was paid to how seniors combined pathophysiology-based biomedical beliefs with non-biomedical beliefs. We conducted twelve language-concordant, structured focus groups with African American, Chinese American, Korean American, and Latino seniors aged 60 years and older with a history of hypertension (n =?132) to assess stroke-related health beliefs. Participants were asked their beliefs about stroke mechanism and prevention strategies in addition to questions corresponding to four constructs from the Health Belief Model: perceived susceptibility, perceived severity, and benefits and barriers to walking for exercise. Using thematic analysis, we iteratively reviewed and coded focus group transcripts to identify recurrent themes within and between racial/ethnic groups. Participants across all four racial/ethnic groups believed that blockages in brain arteries caused strokes. Factors believed to increase susceptibility to stroke were often similar to biomedical risk factors across racial/ethnic groups, but participants also endorsed non-biomedical factors such as strong emotions. The majority of participants perceived stroke as a serious condition requiring urgent medical attention, fearing paralysis or death, but few mentioned severe disability as a stroke consequence. Participants largely believed stroke to be preventable through physical activity, dietary changes, and medication adherence. Perceived benefits of walking for exercise included improved physical health, decreased bodily pain, and ease of participation. Perceived barriers to walking included limited mobility due to chronic medical conditions, increased bodily pain, and low motivation. While seniors' stroke-related health beliefs were often similar to biomedical beliefs across racial/ethnic groups, we also identified several non-biomedical beliefs that were shared across groups. These non-biomedical beliefs regarding perceived stroke susceptibility and severity may warrant further discussion in stroke education interventions. Patterns in non-biomedical beliefs that vary between groups may reflect cultural differences. Stroke education could potentially increase cultural relevancy and impact by addressing such differences in health beliefs as well as perceived benefits and barriers to walking for exercise that vary between different racial/ethnic groups.
Project description:Family history of coronary heart disease (CHD) as well as genetic predisposition to CHD assessed by a genetic risk score (GRS) are predictors of CHD risk. It is, however, uncertain to what extent these risk predictors are mediated by major metabolic pathways.Total effects of self-reported family history and a 50-variant GRS (GRS50), as well as effects mediated by apolipoprotein B and A-I (apoB, apoA-I), blood pressure, and diabetes mellitus, on incidence of CHD were estimated in 23 595 participants of the Malmö Diet and Cancer study (a prospective, population-based study). During a median follow-up of 14.4 years, 2213 participants experienced a first CHD event. Family history of CHD and GRS50 (highest versus other quintiles) were associated with incident CHD, with hazard ratios of 1.52 (95% CI: 1.39-1.65) and 1.53 (95% CI: 1.39-1.68), respectively, after adjusting for age, sex, and smoking status. Small proportions of the family history effect were mediated by metabolic risk factors: 8.3% (95% CI: 5.8-11.7%) by the apoB pathway, 1.7% (95% CI: 0.2-3.4%) by apoA-I, 8.5% (95% CI: 5.9-12.0%) by blood pressure, and 1.5% (95% CI: -0.8% to 3.8%) by diabetes mellitus. Similarly, small proportions of GRS50 were mediated: 8.1% (95% CI: 5.5-11.8%) by apoB, 1.2% (95% CI: 0.5-3.0%) by apoA-I, 4.2% (95% CI: 1.3-7.5%) by blood pressure, and -0.9% (95% CI: -3.7% to 1.6%) by diabetes mellitus.A fraction of the CHD risk associated with family history or with GRS50 is mediated through elevated blood lipids and hypertension, but not through diabetes mellitus. However, a major part (?80%) of the genetic effect operates independently of established metabolic risk factor pathways.
Project description:Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.Retrospective cohort study.A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents' family.Mean baseline age was 66.2 years; 994 (16.7%) had DM and 3,023 (53.4%) hypertension. Overall, 173 (3.1%) suffered incident strokes, 129 (2.3%) had incident MI, and 465 (8.2%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 % CI 1.07-1.67), hypertension (1.31, 95% CI 1.07-1.61) and perceived constraints in the third (1.55, 95% CI 1.12-2.15) and fourth quartiles (1.61, 95% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95% CI 1.41-2.64).Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.
Project description:BACKGROUND:To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. OBJECTIVES:The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. METHODS:Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. RESULTS:Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). DISCUSSION:Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.