Lerman C, Rimer B K, Daly M, Lustbader E, Sands C, Balshem A, Masny A, Engstrom P
Lombardi Cancer Research Center, Georgetown University School of Medicine, Washington, DC 20007.
Cancer Epidemiol Biomarkers Prev. 1994 Apr-May;3(3):271-6.
This study sought to identify factors that facilitate or hinder participation in a breast cancer health promotion trial among high-risk women. The subjects were 271 women ages 35 years and older who had a family history of breast cancer in at least one first-degree relative. All subjects were eligible for participation in a randomized trial which compares breast cancer risk counseling with general health counseling. Structured telephone interviews evaluated demographic characteristics, risk factors, risk perceptions, breast cancer concerns, and past screening practices. The results showed that education level was a key determinant of the importance of these factors in participation. Logistic regression modeling indicated that women with a high school education or less were most likely to participate if: (a) their relatives' diagnoses had greatly increased their perceptions of their personal risks [OR (OR) = 4.1], particularly if they perceived that risk to be very high (OR for interaction = 6.4); and (b) if they were ages 40-49 years versus 35-39 or 50 + years (OR = 2.6). By contrast, among women with education beyond high school, participation was predicted by (a) marital status (OR = 2.6), (b) employment (OR = 0.03 for employed), (c) number of affected relatives (OR = 0.07 for 1 versus 2 first-degree relatives), and (d) previous biopsy (OR = 0.42). These findings suggest that recruitment strategies that tailor messages to women's educational levels might be most effective.
本研究旨在确定促进或阻碍高危女性参与乳腺癌健康促进试验的因素。研究对象为271名年龄在35岁及以上、至少有一位一级亲属患有乳腺癌家族史的女性。所有受试者均有资格参与一项随机试验，该试验将乳腺癌风险咨询与一般健康咨询进行比较。通过结构化电话访谈评估人口统计学特征、风险因素、风险认知、对乳腺癌的担忧以及过去的筛查行为。结果表明，教育水平是这些因素在参与度方面重要性的关键决定因素。逻辑回归模型显示，高中及以下学历的女性如果符合以下条件则最有可能参与：(a) 亲属的诊断极大地增加了她们对自身个人风险的认知 [比值比（OR）= 4.1]，特别是当她们认为风险非常高时（交互作用的OR = 6.4）；以及 (b) 她们年龄在40 - 49岁之间，而不是35 - 39岁或50岁及以上（OR = 2.6）。相比之下，在高中学历以上的女性中，参与度可由以下因素预测：(a) 婚姻状况（OR = 2.6），(b) 就业情况（就业者的OR = 0.03），(c) 受影响亲属的数量（1位一级亲属与2位一级亲属相比的OR = 0.07），以及 (d) 既往活检情况（OR = 0.42）。这些发现表明，根据女性教育水平量身定制信息的招募策略可能最为有效。
