Myers, Balshem, Wolf, Ross, & Millner, 1993). There is some evidence that women may be less likely to be screened than men. For example, Borum (1996) found that 39% of female patients in a university clinic had an FOBT as compared to 59% of male patients. Efforts need to be made to encourage physicians to increase their use of CRC screening.
Blalock, DeVellis, Afifi, and Sandler (1990) and Hunter et al. (1990) also found that personal experience with cancers of relatives or friends increases participation in screening by FOBT and sigmoidoscopy. In addition, increasing age, not smoking, and higher education levels in populations who believe that cancer is curable are likely to be associated with greater participation in colorectal screening activities (Myers et al., 1990).
There have been no reported studies designed to increase colorectal cancer screening among women specifically, and few have been developed for men and women. Those few interventions tested to date suggest that the same approaches that have been successful for enhancing breast and cervical cancer screening are likely to be effective for colorectal cancer. These include such techniques as reminder letters, postcards, and telephone calls (Thompson, Michnich, Gray, Friedlander, & Gilson, 1986; Myers et al., 1991). Because physicians have not yet accepted colorectal cancer screening, physician education is essential. There is a real need to extend what is known about screening for women's cancers to colorectal cancer. In view of the fact that perhaps one third or more of colon cancer deaths could be avoided by regular screening, the need for intervention research is urgent.
Over the past decade, significant progress has been made in understanding women's health and particularly health promotion. Significant progress has been made in identifying barriers to participation in screening for breast and cervical cancer, and successful interventions have been developed. Major challenges for the future are to increase screening for these cancers among the women who have not yet been reached, including some ethnic minorities and women with low levels of education. In addition, almost nothing is known about women's barriers to colorectal screening or how to overcome them.
As the previous sections have demonstrated, too few women are exercising, and far too many are overweight. Far too little is known about how to prevent smoking among girls or how to help women stop smoking. Gender-appropriate interventions are needed that fit into women's increasingly busy lifestyles. Time-intensive, centralized interventions are not likely to be the answer for most women; brief programs and tailored methods that can be delivered by telephone or mail should be investigated further. Special attention in program design and evaluation should be paid to those groups of women who are most likely to be out of step with health promotion recommendations. These include minority women, poor women, and those with less education. Instrumental help in reducing access barriers may be needed.
Finally, there should be more attention to the efficacy of multiple risk factor or, at least, phased risk factor reduction programs. Health promotion behaviors do not exist in isolation, and it is important to determine whether and how health promotion synergy can be achieved by focusing on more than one risk factor. Similarly, both the benefits and risks of behaviors and interventions need to be considered not just for a single disease, such as cancer, but for cancer and heart disease, for example. As women live longer, health promotion behaviors are a critical part of not just living but living well.
Work on this chapter was supported by grants from the National Cancer Institute (lROlCA63782–03, lROlCA59734- 03,5ROlCA60141–02, 1P01CA72099) and the National Heart Lung and Blood Institute (5ROlHL48121–04).
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