Mobile Technology, Cancer Prevention, and Health Status Among Diverse, Low-Income Adults
ABSTRACT Abstract Purpose . Characterize mobile technology ownership, use, and relationship to self-reported cancer prevention behaviors and health status in a diverse, low-income sample of callers to 2-1-1. Design . Secondary analyses of cross-sectional survey data from a larger trial collected from June 2010 to December 2012. Setting . United Way Missouri 2-1-1 serves 99 of 114 counties and received 166,000 calls in 2011. Subjects . The respondents (baseline, n = 1898; 4 month, n = 1242) were predominantly female, non-Hispanic Black, younger than 50 years, with high-school education or less and annual income <$20,000. Measures . Cell phone ownership and use and its relationship to cancer prevention services and health status were assessed via telephone-based survey, using items adapted from previous research and the Behavioral Risk Factor Surveillance System. Smartphone ownership and use were also assessed. Analysis . Descriptive statistics and bivariate and multivariate associations between cell phone ownership and prevention and health status are reported. Results . Three-fourths (74%) of study participants owned a cell phone and 23% owned a smartphone. Text messaging was the most popular use. Ownership was significantly associated with good to excellent health status and presence of smoke-free home policies in multivariate models. Conclusion . Cell phone ownership is growing and has potential to deliver health information to low-income populations. With 16 million calls annually, the national 2-1-1 system may be a promising model and platform.
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ABSTRACT: Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need with state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers' (N=1,408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared with state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers than for state and national rates, and callers were receptive to referrals. 2-1-1 could be a key partner in efforts to reduce cancer disparities.Journal of Health Care for the Poor and Underserved 01/2012; 23(2):752-67. DOI:10.1353/hpu.2012.0061 · 1.10 Impact Factor
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ABSTRACT: Background: Callers to 2-1-1 have greater need for and lesser use of cancer control services than other Americans. Integrating cancer risk assessment and referrals to preventive services into 2-1-1 systems is both feasible and acceptable to callers. Purpose: To determine whether callers will act on these referrals. Methods: In a randomized trial, 2-1-1 callers (n=1200) received standard service and those with at least one cancer risk factor or need for screening were assigned to receive verbal referrals only, verbal referrals + a tailored reminder mailed to their home, or verbal referrals + a telephone health coach/navigator. All data were collected from June 2010 to March 2012 and analyzed in March and April 2012. Results: At 1-month follow-up, callers in the navigator condition were more likely to report having contacted a cancer control referral than those receiving tailored reminders or verbal referrals only (34% vs 24% vs 18%, respectively; n=772, p<0.0001). Compared to verbal referrals only, navigators were particularly effective in getting 2-1-1 callers to contact providers for mammograms (OR=2.10, 95% CI=1.04, 4.22); Paps (OR=2.98, 95% CI=1.18, 7.54); and smoking cessation (OR=2.07, 95% CI=1.14, 3.74). Conclusions: Given the extensive reach of 2-1-1s and the elevated risk profıle of their callers, even modest response rates could have meaningful impact on population health if proactive health referrals were implemented nationally.American Journal of Preventive Medicine 12/2012; 43(6):S425-S434. DOI:10.1016/j.amepre.2012.09.004 · 4.53 Impact Factor
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ABSTRACT: Previous studies may have underestimated the contribution of health behaviors to social inequalities in mortality because health behaviors were assessed only at the baseline of the study. To examine the role of health behaviors in the association between socioeconomic position and mortality and compare whether their contribution differs when assessed at only 1 point in time with that assessed longitudinally through the follow-up period. Established in 1985, the British Whitehall II longitudinal cohort study includes 10 308 civil servants, aged 35 to 55 years, living in London, England. Analyses are based on 9590 men and women followed up for mortality until April 30, 2009. Socioeconomic position was derived from civil service employment grade (high, intermediate, and low) at baseline. Smoking, alcohol consumption, diet, and physical activity were assessed 4 times during the follow-up period. All-cause and cause-specific mortality. A total of 654 participants died during the follow-up period. In the analyses adjusted for sex and year of birth, those with the lowest socioeconomic position had 1.60 times higher risk of death from all causes than those with the highest socioeconomic position (a rate difference of 1.94/1000 person-years). This association was attenuated by 42% (95% confidence interval [CI], 21%-94%) when health behaviors assessed at baseline were entered into the model and by 72% (95% CI, 42%-154%) when they were entered as time-dependent covariates. The corresponding attenuations were 29% (95% CI, 11%-54%) and 45% (95% CI, 24%-79%) for cardiovascular mortality and 61% (95% CI, 16%-425%) and 94% (95% CI, 35%-595%) for noncancer and noncardiovascular mortality. The difference between the baseline only and repeated assessments of health behaviors was mostly due to an increased explanatory power of diet (from 7% to 17% for all-cause mortality, respectively), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality). The role of smoking, the strongest mediator in these analyses, did not change when using baseline or repeat assessments (from 32% to 35% for all-cause mortality). In a civil service population in London, England, there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly.JAMA The Journal of the American Medical Association 03/2010; 303(12):1159-66. DOI:10.1001/jama.2010.297 · 35.29 Impact Factor