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ABSTRACT: African American men bear disproportionate burden of prostate cancer (PCa) that can be reduced by early detection. A 15-minute culturally appropriate PCa education intervention developed to communicate effective, relevant, and balanced PCa screening information to low-income African American men was evaluated in men 42 years and older who had not been screened in one year. Of 539 men enrolled, 392 (72.7%) completed the six-month follow-up. Mean age was 54.4±8.9, 34.7% had no high school diploma, and 65.3% earned less than $25,000 annually. Barriers to screening included health insurance (41.4%), discomfort of digital rectal exam (32.1%), and fear of cancer diagnosis (29.9%). Mean knowledge score of 21 points increased from 13.27±3.51 to 14.95±4.14 (p<.001), and prostate-specific antigen screening from 22.1% to 62.8%. Men without high school diploma recorded the lowest post-intervention PCa knowledge and screening rate (47.7%), suggestive of the need for more than a single education session. Annual physicals with free prostate examination can maintain the positive trend observed.
Journal of Health Care for the Poor and Underserved 01/2013; 24(1):311-31. · 1.10 Impact Factor
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Kushal Patel,
Flora Ukoli,
Jianguo Liu,
Derrick Beech,
Katina Beard,
Byron Brown,
Maureen Sanderson,
Donna Kenerson,
Leslie Cooper,
Marie Canto,
Bill Blot,
Margaret Hargreaves
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ABSTRACT: The purpose of the study was to assess the impact of an educational intervention on prostate cancer screening behavior and knowledge. Participants were 104 African American men, 45 years and older, who had not been screened for prostate cancer with a prostate-specific antigen and/or digital rectal exam within the past year. All participants received an intervention delivered by trained lay community educators using a prostate cancer educational brochure developed in collaboration with the community, with structured interviews preintervention and 3 months postintervention. The main study outcomes included prostate-specific antigen screening rates during the 3-month interval and knowledge, barriers to screenings, and decisional conflict around screening. Compared with the 46 men who did not get screened, the 58 participants who got screened were more likely to have greater than a high school education, annual household incomes ≥$25,000, and a family history of non-prostate cancer (p < .05). Average knowledge scores increased, and barriers to screening scores decreased, from preintervention to postintervention only for participants who had been screened (p < .05). The results of this study demonstrate the feasibility and efficacy of an academic institution collaborating with the African American community to develop a successful prostate cancer educational intervention, an approach that can be expanded to other cancers and other chronic diseases.
Health Education & Behavior 04/2012; · 1.54 Impact Factor
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Kathryn L Braun,
Tung T Nguyen,
Sora Park Tanjasiri,
Janis Campbell,
Sue P Heiney,
Heather M Brandt,
Selina A Smith,
Daniel S Blumenthal,
Margaret Hargreaves,
Kathryn Coe,
Grace X Ma,
Donna Kenerson, Kushal Patel,
JoAnn Tsark,
James R Hébert
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ABSTRACT: We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR).
We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institute's 25 CNPs.
Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability.
Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
American Journal of Public Health 11/2011; 102(6):1195-203. · 3.93 Impact Factor
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ABSTRACT: This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for colorectal cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African Americans 50 years and older (n=460) were selected from the Meharry CNP community survey database. There were several predictors of colorectal cancer screening such as being married and having health insurance (P< .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and health insurance (P< .05). Educational interventions aimed at improving colorectal cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.
Journal of Community Health 11/2011; 37(3):673-9. · 1.28 Impact Factor
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ABSTRACT: To examine the relationship between smoking and weight status in adult women and whether this association differed by race.
The study sample consisted of 22,949 African American and 7831 white women enrolled in the Southern Community Cohort Study from 2002 to 2006.
Both African American and white current smokers had decreased odds of being overweight or obese compared to normal-weight nonsmokers, and the inverse trends between current smoking and BMI held for both groups.
A strong relationship exists between smoking and weight status, with patterns nearly identical for African Americans and white women.
American journal of health behavior 09/2011; 35(5):627-36. · 1.31 Impact Factor
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ABSTRACT: Objectives: To examine the relationship between smoking and weight status in adult women and whether this association differed by race. Methods: The study sample consisted of 22,949 African American and 7831 white women enrolled in the Southern Community Cohort Study from 2002 to 2006. Results: Both African American and white current smokers had decreased odds of being overweight or obese compared to normal-weight nonsmokers, and the inverse trends between current smoking and BMI held for both groups. Conclusion: A strong relationship exists between smoking and weight status, with patterns nearly identical for African Americans and white women.
American journal of health behavior 08/2011; 35(5):627-636. · 1.31 Impact Factor
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ABSTRACT: Heart disease and diabetes affect millions of individuals in the United States and are among the leading causes of mortality for all racial groups. They share common key risk factors including hypertension and high cholesterol. Community health screenings may play a vital role in identifying, preventing, and controlling these diseases and their associated risk factors. The data were part of the community health screening efforts by the Centers for Disease Control and Prevention-funded Nashville REACH 2010 project. Participants' demographic information and screening outcomes were recorded by project staff trained to conduct community health screenings. The study sample size consisted of 3543 participants. There were no racial differences in the likelihood of screening at-risk or positive for hypertension, diabetes, or high cholesterol. The majority of participants screened at-risk or positive for hypertension and high cholesterol. This study was successful in identifying new cases for these diseases and participants who were inadequately managing either of these health conditions. Given the high percentage of participants who screened at-risk or positive for these 3 health conditions, it will be beneficial for future research to understand the most effective methods of helping these individuals to receive appropriate medical services.
The Journal of ambulatory care management 03/2010; 33(2):155-62.
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ABSTRACT: This study examined demographic and lifestyle factors that influenced decisions to get screened for prostate cancer in low-income African Americans in three urban Tennessee cities. It also examined obstacles to getting screened. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American men 45 years and older (n=293) were selected from the Meharry CNP community survey database. Participants from Nashville, those who were older, obese, and who had health insurance were more likely to have been screened (p<.05). Additionally, there were associations between obstacles to screening (such as cost and transportation) and geographic region (p<.05). Educational interventions aimed at improving prostate cancer knowledge and screening rates should incorporate information about obstacles to and predictors of screening.
Journal of Health Care for the Poor and Underserved 01/2010; 21(1 Suppl):114-26. · 1.10 Impact Factor
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ABSTRACT: Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker).
The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 randomly selected participants.
Participants with diabetes were more likely to report being former smokers, after adjusting for sociodemographic characteristics, whereas having hypertension or high cholesterol was not associated significantly with smoking status. The likelihood of being a former smoker did not increase as number of diagnosed chronic diseases increased. Participants who were women, older (aged 65+), or single were significantly less likely to be former smokers. Participants with at least a college degree, those with incomes of 50,000+ US dollars, and those who were underweight or obese were more likely to be former smokers.
These findings were inconsistent with research that has suggested that having a chronic illness or experiencing a serious medical event increases the odds of smoking cessation. Supporting prior research, we found that being male, having a higher income, and being obese were associated with greater likelihood of being a former smoker.
Nicotine & Tobacco Research 07/2009; 11(8):933-9. · 2.58 Impact Factor
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ABSTRACT: African Americans bear a disproportionate burden of tobacco related morbidity and mortality despite smoking less than their Caucasian counterparts. Nashville's REACH 2010 initiative developed community partnerships to promote awareness, education and participatory programs to prevent and decrease smoking among residents of the northern geographic area of Nashville, TN, a majority African American community. A social-ecological model provided the framework for interventions used during a 5 year period that included: (a) community level strategies to increase awareness and knowledge about the effects of smoking; (b) individual level strategies to enlist and train community members to become advocates, lead smoking cessation classes and encourage current smokers in quit attempts; and (c) strategies directed to changing policy through education and partnership building. Smoking prevalence among residents was examined from 2001 through 2005 based on data from the Nashville CDC REACH 2010 Risk Factor Survey and the Tennessee CDC Behavioral Risk Factor Survey. Tests for linear trends indicated a significant decreasing trend (P < .02) of daily smoking and smoking uptake (P < .03) in North Nashville. In contrast to our community an increasing trend was observed in quitting smoking (P < .01). No trends were significant for African Americans in Tennessee. This study suggests that consistent, multiple and multi-level strategies targeted to an African American community may impact smokers who are not ready to quit but willing to reduce their level of smoking. This study underscores the importance of developing and implementing community wide campaigns to address the needs of African Americans.
Journal of Community Health 04/2009; 34(4):311-20. · 1.28 Impact Factor
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ABSTRACT: The objective of our study was to assess the psychometric properties of the Medical Outcomes Study's 12-Item Short Form Survey Instrument (SF-12) for use in a low-income African American community. The SF-12, a commonly used functional health status assessment, was developed based on responses of an ethnically homogeneous sample of whites. Our assessment addressed the appropriateness of the instrument for establishing baseline indicators for mental and physical health status as part of Nashville, Tennessee's, Racial and Ethnic Approaches to Community Health (REACH) 2010 initiative, a community-based participatory research study.
A cross-sectional random residential sample of 1721 African Americans responded to a telephone survey that included the SF-12 survey items and other indicators of mental and physical health status. The SF-12 was assessed by examining item-level characteristics, estimates of scale reliability (internal consistency), and construct validity.
Construct validity assessed by the method of extreme groups determined that SF-12 summary scores varied for individuals who differed in self-reported medical conditions. Convergent and discriminate validity assessed by multitrait analysis yielded satisfactory coefficients. Concurrent validity was also shown to be satisfactory, assessed by correlating SF-12 summary scores with independent measures of physical and mental health status.
The SF-12 appears to be a valid measure for assessing health status of low-income African Americans.
Preventing chronic disease 05/2008; 5(2):A44. · 1.82 Impact Factor
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ABSTRACT: This paper examines the rates of recent mammography use among African American and White women, the influence of demographic characteristics, socioeconomic status, health insurance coverage, and breast cancer risk factors on recent mammography use and reasons for not having a mammogram.
Cross-sectional data from the Southern Community Cohort Study were used to analyze mammography use among African American and White women.
Among 27,123 mostly low-income women age 42-79 in the Southern Community Cohort Study, the rate of recent (within the past 2 years) mammography use was 73% among African Americans and 68% among Whites. Health insurance coverage, age, household income, education, family history of breast cancer, hormone replacement therapy use, and post-menopausal status were positively associated with recent mammography, whereas consumption of 2 or more alcoholic drinks/day was negatively associated. These associations were observed in both African American and White women who had never [corrected] received a mammogram (Non-users) compared with recent mammography users, although some variation existed [corrected] Doctor has not recommended this test and cost were the two most commonly self-reported reasons for non-use.
Characteristics of non-users and past users identified may provide valuable information for maintaining the progress made and for further improving adherence to the screening guidelines.
Journal of Health Care for the Poor and Underserved 12/2007; 18(4 Suppl):102-17. · 1.10 Impact Factor
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ABSTRACT: To examine the association between religious fatalism and health care utilization, health behaviors, and chronic illness.
As part of Nashville's REACH 2010 project, residents (n=1273) participated in a random telephone survey that included health variables and the helpless inevitability subscale of the Religious Health Fatalism Questionnaire.
Religious health fatalism was higher among African Americans and older participants. Some hypotheses about the association between fatalism and health outcomes were confirmed.
Religious fatalism is only partially predictive of health behaviors and outcomes and may be a response to chronic illness rather than a contributor to unhealthy behaviors.
American journal of health behavior 31(6):563-72. · 1.31 Impact Factor
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ABSTRACT: Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P < .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P < .001); however, women experienced fewer problems related to utilization (P < .001). Of the covariates, income was significant (P < .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.
The Journal of ambulatory care management 30(2):142-9.
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ABSTRACT: To examine the relationships of religious involvement and affiliation with health behavior and conditions.
A survey (n = 3014) conducted for the Nashville REACH 2010 project included questions about religious affiliation and practice as well as health behaviors and conditions.
Bivariate analyses indicated negative associations between religious involvement and health, along with differences between religious affiliations/groups. This relationship changed, however, after controlling for demographic differences and individual differences in religious involvement.
Religious groups share not only beliefs, but also socioeconomic, ethnic, and cultural similarities that must be taken into account in research examining religion and health.
American journal of health behavior 32(6):714-24. · 1.31 Impact Factor
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ABSTRACT: Community-based participatory methods have emerged as a response to conventional approaches that have historically failed to make notable improvement in health status or reduce chronic disease among marginalized populations. The social-ecological model provides a framework to develop and implement strategies directed to affecting multiple levels (societal, community, organizational, and individual) of influence on health status. A systems approach can facilitate the identification of the complex interrelationships of factors at all levels that contribute to health disparities by making use of the unique knowledge, expertise, and resources of community partners. Community engagement in the planning, implementation, and evaluation of health initiatives builds community capacity to create sustainable changes at all levels to achieve and maintain optimal health for those who bear the greatest burden of disease.
The Journal of ambulatory care management 32(4):264-70.
