Individual Telephone Counseling Research Articles

Comparison of effectiveness of face to face and telephone-based counseling with EXPLISSIT approach on marital interaction and quality of life of women attending health centers of Tabriz city during Covid 19 epidemy: A Quasi-experimental study

Background. Quarantine and social distancing due to COVID 19 has led to anxiety, anger, stress, and anger in people and has had a negative impact on physical and mental health and the quality of marital relationships. Due to the lack of sufficient studies and also the fact that no study was found in the literature review that compared this approach over the phone and face-to-face, this study was conducted with the aim of comparing the effect of telephone and face-to-face counseling with the explicit approach on women's marital interactions. Methods. This quasi-experimental study was conducted in 2022 in the health centers of Tabriz city on women aged 18 to 40 with a sexual performance score of less than 28. The participants were assigned to two groups of face-to-face counseling and telephone counseling with a ratio of 1:1 using a computerized random number table with blocks of four and six. Counseling based on explicit approach was done in the face-to-face counseling group during three meetings of 60-90 minutes, and for the telephone counseling group, there were three individual telephone counseling sessions of 60-90 minutes. Pre-test questionnaires including sexual performance, quality of sexual life and marital satisfaction were completed before and eight weeks after the end of the intervention. Results. The mean (standard deviation) score of the quality of sexual life after the intervention was significantly increased in both face-to-face and telephone counseling groups compared to before the intervention. Also the mean (standard deviation) of the total score of sexual performance and marital satisfaction after the intervention in the face-to-face counseling group was significantly higher than that of the telephone counseling group. Conclusion. Using counseling based on ex-PLISSIT approach in both face-to-face and telephone counseling groups, are effective in sexual health. Therefore, during crises such as a pandemic, or other restrictions to hold face-to-face counseling sessions, telephone consultations are useful. Practical Implications. Counseling based on ex-PLISSIT approach is effective for sexual health.

Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients' Returning to Work (START): A Multi-center, Randomized Controlled Trial.

We developed a comprehensive return to work (RTW) intervention covering physical, psycho-social and practical issues for patients newly diagnosed and evaluated its efficacy in terms of RTW. A multi-center randomized controlled trial was done to evaluate the efficacy of the intervention conducted at two university-based cancer centers in Korea. The intervention program comprised educational material at diagnosis, a face-to-face educational session at completion of active treatment, and three individualized telephone counseling sessions. The control group received other education at enrollment. At 1-month post-intervention (T2), the intervention group was more likely to be working compared to the control group after controlling working status at diagnosis (65.4% vs. 55.9%, p=0.037). Among patients who did not work at baseline, the intervention group was 1.99-times more likely to be working at T2. The mean of knowledge score was higher in the intervention group compared to the control group (7.4 vs. 6.8, p=0.029). At the 1-year follow-up, the intervention group was 65% (95% confidence interval, 0.78 to 3.48) more likely to have higher odds for having work. The intervention improved work-related knowledge and was effective in facilitating cancer patients' RTW.

Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease.

Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised. To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease. Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach. Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence. Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.

Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities

Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99). This randomized clinical trial found that providing extended care for obesity management in rural communities via individual telephone counseling decreased weight regain and increased the proportion of participants who sustained clinically meaningful weight losses. ClinicalTrials.gov Identifier: NCT02054624.

Nurse practitioner interventions for smokers with chronic hepatitis C.

Smoking is a grossly overlooked risk factor for people with chronic hepatitis C with regard to disease progression. It is unclear whether current smoking cessation interventions are effective for this population. The purpose was to evaluate the effectiveness of a telephone counseling and nicotine replacement therapy (NRT) intervention for smokers with chronic hepatitis C to quit or reduce rates of smoking. A randomized controlled trial was conducted with participants randomized and stratified according to heaviness of smoking. Ninety-two eligible adults who smoked cigarettes and attended hepatology outpatient clinics were recruited. The intervention included NRT and telephone counseling compared with telephone counseling alone. Data collection occurred from December 2010 to November 2011. Data were collected at baseline, 6, and 12 weeks to assess smoking cessation. Change scores were analyzed using analysis of variance to examine the differences between smoking interventions. At 6 weeks, both control and intervention groups had quit or reduced the number of cigarettes smoked daily. However, over 12 weeks, the intervention group showed sustained quitting or reduced smoking, with 5.8 (confidence interval [CI]: 2.4, 9.3) fewer cigarettes smoked per day from baseline. The control group maintained an average reduction of 1.6 (CI: -1.9, 5.2) fewer cigarettes per day. Nicotine replacement therapy and individualized telephone counseling interventions increase the prospects of smoking cessation. Interventions such as these, introduced at routine clinic appointments in the outpatients' setting, by a nurse practitioner (hepatology) showed clinically important results for smoking cessation in this population.

Parents' Self-efficacy for Tobacco Exposure Protection and Smoking Abstinence Mediate Treatment Effects on Child Cotinine at 12-Month Follow-up: Mediation Results from the Kids Safe and Smokefree Trial.

Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations. Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer" [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers. Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways. Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking. Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements.

A secondary analysis of data from the OPTICARE randomized controlled trial investigating the effects of extended cardiac rehabilitation on functional capacity, fatigue, and participation in society

Objective: In this secondary analysis of data from the OPTICARE trial, we compared the effects of two behavioral interventions integrated into cardiac rehabilitation to standard rehabilitation with regard to functional capacity, fatigue, and participation in society. Design: This is a randomized controlled trial. Setting: This study was conducted in a cardiac rehabilitation setting. Subjects: A total of 740 patients with acute coronary syndrome were recruited for this study. Interventions: Patients were randomized to (1) three months of standard rehabilitation; (2) cardiac rehabilitation plus nine months after-care with face-to-face group lifestyle counseling; or (3) cardiac rehabilitation plus nine months after-care with individual lifestyle telephone counseling. Main measures: Functional capacity (6-minute walk test), fatigue (Fatigue Severity Scale), and participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) were measured at randomization, 3, 12, and 18 months. Results: Additional face-to-face sessions resulted at 12 months in 12.49 m more on the 6-minute walk test compared to standard rehabilitation (P = .041). This difference was no longer present at 18 months. Prevalence of fatigue decreased from 30.2% at baseline to 11.9% at 18 months compared to an improvement from 37.3% to 24.9% after standard rehabilitation (between-group difference: odds ratio = 0.47; P = .010). The additional improvements in functional capacity seemed to be mediated by increases in daily physical activity. No mediating effects were found for fatigue. No additional improvements were seen for participation in society. Additional telephonic sessions did not result in additional intervention effects. Conclusion: Extending cardiac rehabilitation with a face-to-face behavioral intervention resulted in additional long-term improvements in fatigue and small improvements in functional capacity up to 12 months. A telephonic behavioral intervention provided no additional benefits.

Design of the Rural LEAP randomized trial: An evaluation of extended-care programs for weight management delivered via group or individual telephone counseling

Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight.

Abstract A34: Understanding the Predictors of Smoking Cessation in a Culturally Tailored Smoking Cession Program Created for American Indians

Abstract The purpose of this study was to test the effectiveness of the All Nations Breath of Life program (ANBL); a 12-week culturally-tailored smoking cessation program designed for use in a heterogeneous urban and suburban American Indian (AI) population. Through this process we looked at the secondary outcome: predictors of successful smoking cessation. ANBL was developed, implemented, and tested using a community-based participatory research (CBPR) approach in which AI community members were involved in all phases of the research. Participants in ANBL (N=312) self-selected into the study. Participants self-identified as AI (tribal enrollment was not required). Additional inclusion criteria included being 18 years of age or older, cotinine verified current cigarette smoker, self-expressed interest in quitting smoking in the 30 days following the informed consent process. The vast majority of ANBL group sessions were located primarily in the Heartland/Midwest and surrounding areas. ANBL has five primary components, as follows: Group Support Sessions, Individual Telephone Counseling, Educational Curriculum, Pharmacotherapy, and Participant Incentives. The primary endpoint was salivary cotinine verified continuous abstinence at 6-months. Participants were asked to self-report smoking status, “Since your quit date in ANBL, have you ever smoked at least part of a cigarette?” Those participants answering “no” to this question were asked to provide saliva for cotinine verification. At program completion, 53.3% of program completers remained abstinent; using an intent-to-treat analysis labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline, 31.1% of retained participants quit smoking (p&amp;lt;0.0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% using an intent-to-treat analysis (p=0.002). Few items were found to be predictive of ability to quit at the primary endpoint. The most significant predictor of cessation was participation in one of the groups run in Mid-Missouri, all of which were run by one facilitator (OR=0.24, p=0.0005). An additional predictor of cessation included participants who had some form of home smoking rule (partial or full) (OR=0.35, p=0.0004). Other items that approached significance in relationship to quitting included use of traditional tobacco, which negatively impacted quit rates (OR=1.70, p=0.08), having higher self-confidence in one's ability to quit at baseline positively impacted quit rates (OR=2.20, p=0.16), and lack of use of other recreational tobacco products positively impacted quit rates (OR=2.42, p=0.07). Participants who had the longest history of smoking (greater than 20 years) were least likely to quit (OR=0.26; p=0.03). The data found will be incorporated into modifications to the program to assist other participants with successful cessation. Understanding the predictors of smoking cessation can ensure participant success in tailored smoking cession programs. Citation Format: Joseph A. Pacheco, Jordyn Gunville, Nazir Niaman, T. Edward Smith, Sean M. Daley, Won S. Choi, Christine M. Daley. Understanding the Predictors of Smoking Cessation in a Culturally Tailored Smoking Cession Program Created for American Indians. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A34.

Design of a comparative effectiveness evaluation of a culturally tailored versus standard community-based smoking cessation treatment program for LGBT smokers.

BackgroundSmoking prevalence rates among the lesbian, gay, bisexual, and transgender (LGBT) population are significantly higher than the general population. However, there is limited research on smoking cessation treatments in this group, particularly on culturally targeted interventions. Moreover, there are few interventions that address culturally specific psychosocial variables (e.g., minority stress) that may influence outcomes. This paper describes the protocol for a comparative effectiveness trial testing an evidence-based smoking cessation program, Courage to Quit, against a culturally tailored version for LGBT smokers, and examines the role of culturally specific psychosocial variables on cessation outcomes.Methods/DesignTo examine the effectiveness of a culturally targeted versus standard smoking cessation intervention, the study utilizes a 2-arm block, randomized, control trial (RCT) design. Adult LGBT participants (n = 400) are randomized to one of the two programs each consisting of a six-session group program delivered in a community center and an eight week supply of the transdermal nicotine patch. Four individualized telephone counseling sessions occur at weeks 2, 5, 7, and 9, at times of greatest risk for relapse. Study outcome measures are collected at baseline, and 1, 3, 6, and 12 months post quit date. Primary outcomes are expired air carbon monoxide verified 7-day point-prevalence quit rates at each measurement period. Secondary outcomes assess changes in cravings, withdrawal symptoms, smoking cessation self-efficacy, and treatment adherence. Additionally, study staff examines the role of culturally specific psychosocial variables on cessation outcomes using path analysis.DiscussionDetermining the efficacy of culturally specific versus standard evidence based approaches to smoking cessation is a critical issue facing the field today. This study provides a model for the development and implementation of a culturally tailored smoking cessation intervention for LGBT participants and addresses a gap in the field by examining the role of culturally psychosocial variables associated with cessation outcomes.Trial registrationU.S. National Institutes of Health Clinical Trials NCT01633567 Registered 30 May 2012.

Smoking habits in Hungary: analysis based on surveys of the past decade

Passing the amendments to the anti-smoking law in Hungary indicates a firm determination of the Department of Health to curb tobacco use. Professional steps were destined to follow policies and control measures. The Methodological Support Center for Smoking Cessation began operation at the National Korányi Institute of Tuberculosis and Pulmonology, Budapest, Hungary in 2012. The objective is to provide methodological assistance for evidence based smoking cessation support. The Center aspires to unite and direct the activities aimed at tobacco control, as well as initiate the drafting of appropriate medical guidelines. The Center works to ensure that information regarding smoking and personalized cessation support reaches wide range of Hungarian smokers through individual group and telephone counseling methods. Analysis of the results of national surveys conducted during the past decade on the adult population reveals that the proportion of daily smokers in Hungary has decreased to 28-29%. The proportion of men smokers (32-34%) indicates a more significant decrease, while the proportion of women smokers (24-25%) levels. Groups that are most affected by increased risk of smoking are people with low level of education, those facing economic hardship, the age groups of 17-34 and 35-64 years and women.

725 EFFECT OF INDIVIDUALIZED TELEPHONE COUNSELING ON HEART RATE, MEAN ARTERIAL PRESSURE, PULSE PRESSURE AND RESPIRATION RATE IN THE PATIENTS SCHEDULED FOR CORONARY ANGIOGRAPHY

Background and Objectives: The patients scheduled for coronary angiography often experienced anxiety and lack of information about coronary angiography. As a result, patients might show negative physical outcomes such as increased blood pressure, tachycardia or tachypnea. The purpose of the study was to demonstrate the effect of individualized telephone counseling on heart rate, mean arterial pressure, pulse pressure and respiration rate in patients scheduled for coronary angiography Method: We recruited the patients who were scheduled for coronary angiography. Experimental group received individualized telephone counseling by a specialized nurse before admission, while the control group took usual information. The counseling was provided one to three days before admission which took about 10 minutes. A total of 80 patients were enrolled for this study. Forty subjects were assigned to each group respectively. Results: The heart rate was not different between two groups. However, the mean arterial pressure, the pulse pressure and the respiration rate were higher in experimental group than in control group. Conclusion: The results of this study highlighted the effectiveness of individualized telephone counseling program for the patients waiting for elective coronary angiography.

Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings

BackgroundA major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. ObjectiveThis study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. DesignWe conducted a 1-year prospective randomized controlled clinical trial. Participants/settingThe study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. InterventionThe intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main outcome measuresProgram delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical analyses performedNonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. ResultsMedian weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control). ConclusionsBoth the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.

Telephone Counseling and Attendance in a National Mammography-Screening Program: A Randomized Controlled Trial

In Germany, a mammography-screening program (MSP) was implemented on a national level. It complies with all criteria of the European guidelines for quality assurance in screening mammography; however, the attendance rate is 54%, falling short of the target attendance rate of 70%. The aim of this study was to investigate whether additional telephone counseling improves attendance among nonresponders and the level of satisfaction with telephone counseling. In a prospective RCT, women identified as nonresponders in the MSP were randomized to a control group that received written reminders or to an intervention group that additionally received telephone counseling. In a follow-up, a subset of the intervention group was contacted by telephone regarding their satisfaction with telephone counseling. In 2008, a total of 5477 women aged 50-69 years who were eligible for the German MSP but had not participated up to 6 weeks after the first invitation were included in the study. Individual telephone counseling consisted of scripted calls from a trained counselor who provided information on MSP and answered the woman's questions. Report of mammography use provided by the screening unit 3 months after the reminder was sent. Analysis was conducted in 2009. Comparison of screening attendance revealed a significantly higher attendance rate in the intervention group compared with controls (29.7% vs 26.1%, p=0.0035). When only women for whom telephone numbers were available were analyzed, attendance was even better (35.5% vs 29.7%, p=0.0004). In the follow-up, 278 of 404 women were actually surveyed. Of those, 33% stated that telephone counseling had influenced their decision, 56% stated that they had undergone screening mammography, and 77% agreed that personal telephone counseling should be used routinely to encourage nonresponders to go for screening. Individual telephone counseling for nonresponders to a national program for breast cancer screening was well accepted by participants and effective. This study is registered at the Australian New Zealand Clinical Trials Registry ACTRN12611000645954.

Behavioral change in African American breast cancer survivors: results and challenges.

Abstract Abstract #1126 Background: African American breast cancer survivors have higher cancer mortality and greater prevalence of health risk behaviors than Caucasians. They are appropriate candidates for a behavioral intervention but few lifestyle change studies focus exclusively on this population.&amp;#x2028; Methods: 37 breast cancer survivors enrolled in a healthy living study that sought to implement a comprehensive lifestyle and breast care intervention to an African American target population. The 12-month intervention included behavioral change classes and individualized telephone counseling. Questionnaires and anthropometric measurement determined diet, exercise, cancer history and care, and psychosocial characteristics (quality of life on FACT-G; breast cancer and obesity awareness; self-efficacy). At entry subjects averaged: 60 yrs. Of age; 7 yrs. Post-breast cancer diagnosis; 190 lbs. Body weight; BMI = 32; 5.1 fruit/vegetable servings daily; 48% diagnosed at cancer stage I; 33% calories from fat in diet.&amp;#x2028; Results: 68% completed the 12-month study. Subjects who attended &amp;lt;2 of 8 class sessions had higher BMI at intake (p &amp;lt; .05). Oldest subjects were less likely to complete the study (p &amp;lt;.05). Behavioral changes at 4-months (after 8 classes) were: +3.5 hrs. weekly exercise; -2.37 % fat in diet; - 1 lb. weight. 12-month outcomes (after telephone counseling) were: average weight loss 1.44 lbs; small reduction in BMI; rise in moderate or more physical activity; improved cancer and obesity awareness; improved FACT-G scores (p = .07); reduced self efficacy for behavioral change (p &amp;lt; .05) as subjects realized the implications of improving eating and exercise habits. Neither length of time since cancer diagnosis nor age effected the extent of behavioral change.&amp;#x2028; Discussion: African American breast cancer survivors entered, and many completed, a intensive health behavior intervention. Overall, study completers improved their exercise behavior, food choices, and lost a modest amount of weight. Some early changes (4 months) were sustained over 12 months. Subjects with higher BMIs at entry provided the most challenge; they attended fewer class sessions and were less likely to lose weight. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1126.

Design of a Mediterranean Exchange List Diet Implemented by Telephone Counseling

A Greek-Mediterranean dietary pattern has two distinct aspects that differ relative to average intakes in the United States: a high intake of monounsaturated fats and a high intake of fruit and vegetables. The purpose of the study was to develop and test an exchange list Greek-Mediterranean diet that could be used in future clinical trials of breast cancer prevention. A total of 69 women, ages 25 to 59 years, were randomized to either continue their own usual diet or follow an intervention diet for 6 months during 2004 through 2005. Intervention goals were to decrease usual fat intakes by about half and to replace those fats with olive oil and other high–monounsaturated fatty acid foods; increase fruit and vegetable intakes to 7 to 9 servings/day, depending on energy intake; and consume at least one serving per day each of culinary herbs and allium vegetables. Registered dietitians provided exchange goals and individualized telephone counseling, and diets were self-selected using a Mediterranean exchange list developed specifically for this study. Changes in diet were assessed by 7-day food records. Results demonstrated that counseling using the Mediterranean exchange list was effective for large dietary changes relative to the nonintervention group. Repeated measures analysis of variance indicated a statistically significant 48% increase in dietary monounsaturated fat with no appreciable change in total fat intake, and a significant increase in fruit and vegetable intake from 4.0 to 8.6 servings/day ( P < 0.05).

Compliance to an Exchange‐list Mediterranean Diet

A Greek‐Mediterranean dietary pattern has great potential for cancer prevention. We developed an exchange list diet that would target key nutrient intakes of the Mediterranean eating pattern. The goals were to replace half of usual polyunsaturated fat intake with monounsaturated fats (MUFA) and to increase intakes of a wide variety of fruits and vegetables, including dark green vegetables, allium vegetables and herbs. A total of 69 women, ages 25–59, were enrolled in the study and randomized to the Mediterranean diet or not for 6 months. Subjects in the Mediterranean diet arm received individualized telephone counseling. Menus were provided as examples, but the diets were self‐selected. Compliance to the dietary goals was assessed by 7‐day food records and by levels of plasma fatty acids, lipids and carotenoids. The women were able to make large changes. Intake of MUFA increased by 48% without a change in overall fat intake. Fatty acids levels in plasma changed in the same direction as dietary fatty acids, but were smaller in magnitude. Intakes of carotenoids more than doubled in the Mediterranean diet arm, and plasma total carotenoids increased by 65%. A statistical model was developed to identify clustered outcome variables. This modified Mediterranean diet will be tested for its effects on markers of cancer risk in future studies.Supported by AICR grant #03B043.

Achieving substantial changes in eating behavior among women previously treated for breast cancer—an overview of the intervention

Objective To describe the intervention in a clinical trial examining the effect of a plant-based diet on breast cancer recurrence. To report baseline to 12-month dietary change and investigate whether cooking-class attendance influenced adherence to the study’s dietary targets. Design A descriptive analysis of baseline and 12-month dietary intake data and other variables from a subcohort of participants in the Women’s Healthy Eating and Living Study. Subjects/setting Seven hundred thirty-nine women (primarily non-Hispanic white and well educated) who had been treated for early stage breast cancer. All were intervention group participants and had adhered to the Women’s Healthy Eating and Living Study counseling and dietary assessment protocols. Mean age at study entry was 54 years, and mean body mass index was 26.7. Intervention Telephone counseling, complemented by an orientation meeting, cooking classes, and newsletters. Main outcome measures The change in intake of vegetables, vegetable juice, fruit, fiber, and fat between baseline and 12 months is reported, and the association between cooking classes attended and overall dietary adherence is examined. Statistical analyses performed Mean intake for vegetables, vegetable juice, fruit, fiber, and fat were calculated. Percentage of women meeting select Healthy People 2010 objectives were tabulated. Results Total daily vegetable, vegetable juice, fruit, and fiber intake increased significantly ( P<.01), while fat decreased significantly ( P<.01). The percentage of women meeting the Healthy People 2010 fruit and vegetable objectives increased substantially. Overall dietary adherence was associated with increased cooking-class attendance ( P for trend <.01). Conclusions A multimodal approach to dietary modification, based largely on individualized telephone counseling, can substantially change the overall dietary pattern of women previously treated for breast cancer.

Profile of an Abortion Counselor

The definition of who an abortion counselor is and what their training should be is very unclear. In 1973, 350 questionnaires were sent to 60 institutions in the San Francisco Bay Area that provided health care to women with the purpose of clarifying the definition of an abortion counselor. From this study emerged a profile of 100 people in the San Francisco Bay Area who are currently delivering family planning and abortion counseling services. The results are on the basis of 110 completed questionnaires from planned parenthood centers, abortion clinics, and family planning clinics. Results showed that 1) the counselors were similar to their clients in that they, too, were sexually active and of childbearing age, and 1/5 of them had had abortio ns themselves which was a factor in motivating them to enter the field of abortion counseling in the first place; 2) there was a wide variation in the educational and experiential backgrounds of the counselors; 3) 1/3 of the respondents were volunteers; and 4) 47% had completed a training course by Planned Parenthood/World Population. Initial training as well as on the job training was considered to be important by the counselors. During the day, they were occupied were interviewing, group and individual counseling, telephone counseling, and clerical work. They mostly dealt with their patients on a personal, informal level. Counselors complained of crowded conditions, lack of sufficient personnel, and poor follow-up. The author concludes that there is yet to be a definition of who an abortion counselor is, and asserts that if quality care is to be provided, established standards and quality training is needed.