title: The role of personal health concerns and knowledge of the health effects of hormone replacement therapy (HRT) on the ever use of HRT by menopausal women, aged 50-54 years.
abstract: Previous studies of factors important in a woman's decision to use hormone replacement therapy (HRT) infrequently have simultaneously considered the effects of personal concern for chronic medical disorders that begin at the time of the menopause (such as osteoporosis and heart disease) and knowledge of the beneficial and adverse effects of HRT on these conditions (increased risk of uterine and breast cancers). Moreover, few studies have been performed in broad-based populations that have included black women. This study was undertaken to determine the cross-sectional association of concern for chronic medical disorders that begin at the time of the menopause and knowledge of the effects of HRT on these disorders on the ever use of HRT in a biracial cohort of postmenopausal women. Two hundred eight-eight women, aged 50-54 years, who were members of an HMO, who reported their last menstrual period to be more than 1 year ago, and who were aware of HRT, were examined by questionnaire. Of the cohort, 21.2% were black. Concern for chronic medical disorders that begin at the time of the menopause was modest (approximately 50%). Knowledge of the effects of HRT on breast cancer, uterine cancer, and heart disease was low (approximately 30%). Only for osteoporosis was knowledge high (approximately 65%). On adjusted analysis, concern for heart disease was weakly associated with ever use of HRT, but only for white women. The factors most strongly associated with initiating HRT were a doctor's recommendation to use HRT and satisfaction with a doctor's counseling. Having menopausal symptoms was associated with ever use of HRT in black women. Black women were only 30% as likely as white women to ever use HRT after adjustment for baseline differences.
  
  
  CONCLUSIONS
  In this study, personal concerns for medical conditions that begin at the time of the menopause and knowledge of the effects of HRT on these conditions were low. Only personal concern for heart disease among white women was independently, but weakly, associated with ever use of HRT. Black women were less likely than white women to ever use HRT, even after adjustment for baseline differences between them.
authors.affiliation: Massachusetts Cancer Registry, Bureau of Health Statistics, Research, and Evaluation, Massachusetts Department of Public Health, Boston, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: MacDougall
authors.forename: J I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: C G
authors.initials: CG
authors.lastname: Helmick
mesh_terms: D001294:Attitude to Health; D001943:Breast Neoplasms / Q000139:chemically induced; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations; D006331:Heart Diseases / Q000517:prevention & control; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008593:Menopause / Q000208:ethnology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D014594:Uterine Neoplasms / Q000139:chemically induced