Use of structural equation modeling to examine the association between breast cancer risk perception and repeat screening mammography among United States women

Breast cancer is the second leading cause of cancer death in United States women, estimated to be diagnosed in 1 out of 8 women in their lifetime. Screening mammography detects breast cancer in its pre-clinical stages when treatment strategies have the greatest chance of success, and is currently the only population-wide prevention method proven to reduce the morbidity and mortality associated with breast cancer. Research has shown that the majority of women are not screened annually, with estimates ranging front 6% - 30% of eligible women receiving all available annual mammograms over a 5-year or greater time frame. Health behavior theorists believe that perception of risk/susceptibility to a disease influences preventive health behavior, in this case, screening mammography The purpose of this dissertation is to examine the association between breast cancer risk perception and repeat screening mammography using a structural equation modeling (SEM) framework. A series of SEM multivariate regressions were conducted using self-reported, nationally representative data from the 2005 National Health Interview Survey. Interaction contrasts were tested to measure the potential moderating effects of variables which have been shown to be predictive of mammography use (physician recommendation, economic barriers, structural barriers, race/ethnicity) on the association between breast cancer risk perception and repeat mammography, while controlling for the covariates of age, income, region, nativity, and educational level. Of the variables tested for moderation, results of the SEM analyses identify physician recommendation as the only moderator of the relationship between risk perception and repeat mammography, thus the potentially most effective point of intervention to increase mammography screening, and decrease the morbidity and mortality associated with breast cancer. These findings expand the role of the physician from recommendation to one of attenuating the effect of risk perception and increasing repeat screening. The long range application of the research is the use of the SEM methodology to identify specific points of intervention most likely to increase preventive behavior in population-wide research, allowing for the most effective use of intervention funds.^

Directionality based preventive link maintenance scheme for mobile ad hoc networks

The purpose of this study was to design a preventive scheme using directional antennas to improve the performance of mobile ad hoc networks. In this dissertation, a novel Directionality based Preventive Link Maintenance (DPLM) Scheme is proposed to characterize the performance gain [JaY06a, JaY06b, JCY06] by extending the life of link. In order to maintain the link and take preventive action, signal strength of data packets is measured. Moreover, location information or angle of arrival information is collected during communication and saved in the table. When measured signal strength is below orientation threshold , an orientation warning is generated towards the previous hop node. Once orientation warning is received by previous hop (adjacent) node, it verifies the correctness of orientation warning with few hello pings and initiates high quality directional link (a link above the threshold) and immediately switches to it, avoiding a link break altogether. The location information is utilized to create a directional link by orienting neighboring nodes antennas towards each other. We call this operation an orientation handoff, which is similar to soft-handoff in cellular networks. ^ Signal strength is the indicating factor, which represents the health of the link and helps to predict the link failure. In other words, link breakage happens due to node movement and subsequently reducing signal strength of receiving packets. DPLM scheme helps ad hoc networks to avoid or postpone costly operation of route rediscovery in on-demand routing protocols by taking above-mentioned preventive action. ^ This dissertation advocates close but simple collaboration between the routing, medium access control and physical layers. In order to extend the link, the Dynamic Source Routing (DSR) and IEEE 802.11 MAC protocols were modified to use the ability of directional antennas to transmit over longer distance. A directional antenna module is implemented in OPNET simulator with two separate modes of operations: omnidirectional and directional. The antenna module has been incorporated in wireless node model and simulations are performed to characterize the performance improvement of mobile ad hoc networks. Extensive simulations have shown that without affecting the behavior of the routing protocol noticeably, aggregate throughput, packet delivery ratio, end-to-end delay (latency), routing overhead, number of data packets dropped, and number of path breaks are improved considerably. We have done the analysis of the results in different scenarios to evaluate that the use of directional antennas with proposed DPLM scheme has been found promising to improve the performance of mobile ad hoc networks. ^

Knowledge, attitudes, and practices affecting health behaviors in the U.S. Army Special Operations Command population of Rangers

Malaria is a threat to United States military personnel operating in endemic areas, from which there have been hundreds of cases reported over the past decade. Each of these cases might have been avoided with proper adherence to malaria chemoprophylaxis medications. Military operations may detract from the strict 100% adherence required of these preventive medications. However, the reasons for non-adherence in military populations are not well understood. This behavior was investigated using a cross sectional study design on a convenience sample of U.S. Army Ranger volunteers (n=150) located at three military instillations. Theoretical support was based on components of the Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Social Cognitive Theory. ^ Data on knowledge, attitudes, and practices, as well as multiple environmental domains was collected using an original yet unvalidated questionnaire. The data was analyzed using bivariate Pearson correlations, binary logistic regression, and moderated logistic regressions employing a 0.05 criterion of statistical significance. Power analyses predicted 96-98% power for this analysis. ^ Multiple significant medium strength Pearson correlation coefficients were identified relative to the two dependent variables Take medications as directed and Intend to take the medications as directed the next time. Binary logistic regression analyses identified multiple variables that may predict behavioral intentions to adhere to these preventive medications, as a proxy for behavioral change. Moderated logistic regression analyses identified Command Support for adherence to these medications as a potential significant moderator that interacts with independent variables within three domains of the survey questionnaire. ^ The findings indicate that there may be potential significant beneficial effects, which may improve this behavior in this population of Rangers through 1) promoting affirmative interpersonal communications that emphasize adherence to these medications, 2) including malaria chemoprophylaxis medications in the mission planning process, and 3) military command support, in the form of including the importance of proper adherence to these medications in the unit safety briefings.^