Publications (41) View all
-
Article: Adaptation of an Evidence-Based Intervention for Appalachian Women: New STEPS (Strength Through Education, Physical fitness and Support) for Breast Health.
[show abstract] [hide abstract]
ABSTRACT: Appalachia is characterized by a high prevalence of individual-level risks for breast cancer, including physical inactivity and postmenopausal obesity. The availability of local, evidence-based programs to improve physical fitness is limited. We adapted an evidence-based intervention, StrongWomen, to improve physical fitness and increase breast cancer knowledge among women 40 years and older in Appalachian Pennsylvania. Utilizing a multi-site, community-based design, we tested the adapted 12-week, supervised program-New STEPS (Strength Through Education, Physical fitness and Support)-among 139 women. The completion rate was 67.6 %. Pre/post scores improved for each of six fitness assessments (P < 0.01). We found differences in overall fitness by study site (P < 0.001), but no differences by age (P = 0.13) or by previous breast cancer diagnosis (P = 0.73). New STEPS is an adapted, evidence-based program that can improve physical fitness and breast cancer awareness among women in Appalachian Pennsylvania. New STEPS may help fill a void in local fitness programs for Appalachian women at risk for breast cancer or breast cancer recurrence.Journal of Cancer Education 01/2013; · 0.76 Impact Factor -
Article: Barriers to CRC screening among Latino adults in Pennsylvania: ACCN results.
[show abstract] [hide abstract]
ABSTRACT: To describe knowledge of and barriers to colorectal cancer (CRC) screening by sex and geography among Latino adults in Pennsylvania. Eighty-two Latinos >50 years old engaged in one of 8 focus groups. Focus groups consisted of 4 components. Focus group data were audiotaped, transcribed, and grouped into thematic units using content analysis. We found significant differences in the reported barriers to CRC screenings by sex and geography. Identified barriers were placed into 5 domains: (1) physical environment, (2) structural, (3) sociocultural, (4) individual level, and (5) physician related. A targeted approach for CRC screening among Latinos may be better than the nontargeted approach.American journal of health behavior 03/2012; 36(2):153-67. · 1.31 Impact Factor -
Article: A pilot study for using fecal immunochemical testing to increase colorectal cancer screening in Appalachia, 2008-2009.
[show abstract] [hide abstract]
ABSTRACT: The Appalachian region of the United States has disproportionately high colorectal cancer (CRC) death rates and low screening rates. The purpose of this pilot study was to assess acceptability of a take-home fecal immunochemical test (FIT) and the effect of follow-up telephone counseling for increasing CRC screening in rural Appalachia. We used a prospective, single-group, multiple-site design, with centralized laboratory reports of screening adherence and baseline and 3-month questionnaires. Successive patients, aged 50 or older, at average CRC risk and due for screening were enrolled during a routine visit to 3 primary care practices in rural Appalachian Pennsylvania and received a free take-home FIT and educational brochure. Those who had not returned the test 2 weeks later were referred for telephone counseling. Of 232 patients approached, 200 (86.2%) agreed to participate. Of these, 145 (72.5%) completed the FIT as recommended (adherent) and 55 (27.5%) were referred for telephone counseling (nonadherent), of whom 23 (41.8%) became adherent after 1 to 2 counseling sessions, an 11.5 percentage-point increase in screening after telephone counseling and 84% FIT adherence overall. Lack of CRC-related knowledge and perceived CRC risk were the screening barriers most highly associated with nonadherence. Although not statistically significant, the rate of conversion to screening adherence was higher among participants who received telephone counseling compared to an answering machine reminder. If confirmed in future randomized trials, provider-recommended take-home FIT and follow-up telephone counseling may be methods to increase CRC screening in Appalachia.Preventing chronic disease 03/2012; 9:E77. · 1.82 Impact Factor -
Article: Breast cancer mortality in Appalachia: reversing patterns of disparity over time.
[show abstract] [hide abstract]
ABSTRACT: Breast cancer death rates in the U.S. have decreased in recent decades, however areas such as Appalachia with fewer cancer care resources may not have experienced comparable mortality declines. This study examines trends in breast cancer mortality rate disparities in Appalachian states and the continental U.S. using data from SEER mortality files 1969-2007 and the Area Resource File. Overall breast cancer mortality rates decreased significantly, with a smaller decline in Appalachian counties (17.5%) compared with non-Appalachian counties in Appalachian states (30.5%), and compared with non-Appalachia U.S. counties (28.3%). After accounting for poverty, rural/urban status, education, health care resources, and proportion White in the population, residence in Appalachian counties except for those in the Northern subregion was significantly associated with smaller reduction in breast cancer mortality rates. Lower levels of education, physician density, and percent White in the population were also associated with smaller reductions in breast cancer mortality.Journal of Health Care for the Poor and Underserved 01/2012; 23(2):715-25. · 1.10 Impact Factor -
Article: Impact of a community-based intervention on serving and intake of vegetables among low-income, rural Appalachian families.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the effectiveness of a community-based intervention promoting the serving and eating of deep-orange, cruciferous, and dark-green leafy vegetables. Randomized, parallel-group, community-based intervention with a baseline/postintervention/3-month follow-up design. Low-income food preparers (n = 50) and their partners (n = 50) in rural Appalachia Pennsylvania. Experimental food preparers attended 8 weekly interactive lessons; control food preparers received 8 weekly mailings that included similar recipes and handouts. Target vegetable intake and frequency of serving by experimental and control treatment groups and by high and low meal diary scores, a measure of recipe acceptability. Linear mixed-model analysis with repeated measures. No significant differences resulted between the original experimental and control treatment groups. When grouped by high and low meal diary scores, more experimental families had high scores than in controls. High scores were associated with significant changes in frequency of serving and intake of the target vegetables. Meal diary use may foster food preparer negotiation with partners and children to become involved in vegetable dish evaluation. Tools to help the trained food preparer draw family members into recipe evaluation, such as the meal diary, are useful and needed.Journal of nutrition education and behavior 01/2012; 44(1):36-45. · 1.36 Impact Factor
