[Show abstract][Hide abstract] ABSTRACT: This article reports on the association between ethnic identity and condom use among Black African men in the rural areas of the Eastern Cape Province, South Africa. Individual face-to-face structured interviews were conducted by trained community research assistants among 1,656 men who had undergone traditional initiation and male circumcision. Logistic regression analyses were used to explore the association between two components of ethnic identity (cultural affiliation and cultural alienation) and condom use. Overall, 49.2 % of the participants reported using condoms consistently and, of these users, 66.4 % used them correctly. Logistic regression adjusting for age, employment status, education level, and nation of origin showed that participants who expressed high as opposed to low cultural affiliation were significantly more likely to use condoms consistently and correctly when having sex, especially if they reported to have more than one sexual partner. Cultural alienation was negatively related with consistent condom use, whereas its association with correct use was unclear. The findings of this study suggest that positively emphasizing the ethnic identity of African black men may promote condom use.
Archives of Sexual Behavior 06/2014; · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Smokeless tobacco in South Africa is commonly used in the form of "snuff" or chewing tobacco. This paper reports its use among secondary school learners and provides evidence of its association with demographic characteristics, tobacco smoking, and socioeconomic status.
Data were derived from a nationally representative study conducted in 2008 among 10,270 grade 8-11 learners from 192 schools in South Africa. Data were collected in class using self-administered questionnaires. Multiple logistic regression analyses were used to examine correlates of past month smokeless tobacco use.
Nationally, 12.4% of learners used smokeless tobacco such as chewing tobacco or snuff in the month preceding the survey, with significantly higher rates among males (13.6%) than females (10.6%). Smokeless tobacco use differed between "race" groups, with African (12.8%) and Colored (11.7%) learners having the highest rates of past month use. Grade 8 learners (15.3%) reported significantly higher rates of use than grade 11 learners (9.1%). Current cigarette smokers (21.3%) reported a higher prevalence of smokeless tobacco use than noncurrent smokers (10.1%). Logistic regression of past month smokeless tobacco use showed significant associations with race, grade, school socioeconomic level, urbanicity, current cigarette smoking, and having first smoked a cigarette before the age of 10 years.
These findings provide evidence for policy makers and program developers to develop targeted and tailored interventions for young people regarding smokeless tobacco use.
Nicotine & Tobacco Research 04/2014; · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over 45% of American women 20-39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers18-39 years old by promoting stress management, healthy eating, and physical activity.Methods/design: Peer recruiters approached participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n = 350) or comparison group (n = 175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention.
If MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs and PSGTs will be disseminated in WIC, Extension, clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers. Also, our methodology can be adapted by researchers and community stakeholders to help other low-income populations prevent weight gain.Trial regestration: Clinical Trials Number: NCT01839708.
BMC Public Health 03/2014; 14(1):280. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Smokers who report quitting without prior planning have been shown to report longer abstinence compared with those who planned. Little is known about unplanned quitting (UQ) among U.S. smokers, minorities, or nondaily and light smokers.
Using an online panel, we recruited equal numbers of Black, White, and Latino nondaily, light daily, and moderate/heavy daily smokers. Of the 1,127 who reported a past year quit attempt, we queried whether it was planned and the maximum number of days abstinent.
Overall, 38% reported that their last quit attempt was unplanned. The impact of planned versus unplanned quitting interacted with smoking level and race. Among White moderate/heavy smokers, mean days abstinent was 99 for those who reported an unplanned quit attempt compared with 60 days for those who reported having planned, p = .02. Among Black moderate/heavy smokers, the mean days abstinent was higher among those whose last attempt was planned, 92 days, compared with 56 days among those whose last attempt was unplanned, p = .09. The pattern among Latinos resembled Whites but was not significant. Results remained after adjusting for confounds such as age, gender, education, income, time to first cigarette, and menthol use. There were no significant differences in abstinence by quit type for light or nondaily smokers.
Future studies are needed to elucidate why UQ appears to have differential effectiveness across racial/ethnic groups and different levels of cigarette use. Research examining the impact of UQ on long-term quitting, something not addressed here, is needed.
Nicotine & Tobacco Research 01/2014; · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
Test the impact of tailoring CRC screening messages for African Americans (AAs) using novel theoretical variables and to examine moderating effect of communication preferences.
Participants were randomized to receive two minimally tailored or two enhanced tailored print newsletters addressing CRC. The enhanced intervention was tailored on self-determination theory and other novel psychological constructs. Minimal tailoring only used information available in the patient's EHR. The primary outcome was CRC screening based on EHR. Participants were AA members aged 50-74 of an integrated health care delivery system not up to date on CRC screening.
We enrolled 881 participants. CRC screening participation rates at 1-year follow up were 20.5% and 21.5% in the minimally and enhanced tailored groups, respectively. Communication preferences moderated the impact of the intervention. Specifically, among those with an autonomous communication preference, screening rates in the minimally and enhanced tailored groups were 17.1% and 25.9%, respectively, while no intervention effect was evident among those with a directive preference.
Future research is needed to explore the impact of communication preference tailoring for other health behaviors and among other populations.
Patient Education and Counseling 01/2014; · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: The current study examined the effects of a Web-based tailored parenting intervention on increasing fruit and vegetable intake in African American families. Methods: Forty-seven African American parents (mean age, 41.32±7.30; 93.6% female) with an adolescent (mean age, 13.32±1.46; 59.6% female) participated in a Web-based autonomy-support parenting tailored intervention session to increase both parent and youth fruit and vegetable (F&V) intake. The session lasted 45-60 minutes and included three phases: a feedback phase; a Web-based information phase, and a goal-setting and action plan phase. Self-reported measures of parenting skills [based on autonomy (choice), support, and communication] and F&V intake (assessed as average daily intake) were assessed at baseline and at a 1-week follow-up session. Results: There was a significant increase in parents' self-reports of daily fruit intake from pretest to the 1-week follow-up. Parent and adolescent combined F&V intake also significantly increased from pretest to 1-week follow-up. Overall, parents reported that the program was easy to navigate and that they enjoyed participating in the Web-based online program. Conclusions: Current findings provide preliminary support for an autonomy-support parent tailored Web-based program for improving dietary intake in African American families.
[Show abstract][Hide abstract] ABSTRACT: Background. The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown.Objective. To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners. Methods. Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours. Results. Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period. Conclusion. These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 11/2013; 103(11):835-40. · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: According to the World Health Organization's 2008 GLOBOCAN report, 64% of global cancer deaths -- and 56% of cancer cases -- were registered in countries in Africa, Asia, or Latin America. So while cancer is unquestionably a global burden, its reach in the developing world points to the need for specialized study on cancer in these countries.
Cancer Epidemiology: Low- and Middle-Income Countries and Special Populations reviews the current status of cancer epidemiologic research and training -- rationale, requisite infrastructure, methodologic principles, and illustrative examples in low- and middle-income countries -- in order to facilitate future advances by trained health professionals. The result is a valuable resource for both program leaders and graduate and post-graduate students pursuing careers in international cancer epidemiologic research.
In addition to LMICs, addresses reports on specific studies conducted in Africa, Asia, Central and South America, and the Middle East, as well as studies in Australia, Europe, North America and in populations that migrate from LMICs to developed countries
Includes detailed training requirements and examples of curricula that will enable graduate and post-graduate students to pursue careers in international cancer epidemiologic research
Summarizes and reviews research studies that are in progress concerning major prevalent cancers of the breast, uterine cervix, lung and bronchus, upper aerodigestive tract, stomach, liver, colon, and HIV-associated cancers
For program leaders and graduate and post-graduate students pursuing careers in international cancer epidemiologic research
[Show abstract][Hide abstract] ABSTRACT: AIMS: To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. DESIGN: Two-group randomized controlled trial with 26-week follow-up. PARTICIPANTS AND SETTING: A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. INTERVENTION AND MEASUREMENTS: All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. FINDINGS: Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7 ± 11.9 for MI versus -13.5 ± 16.2 for standard care). CONCLUSIONS: Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U.S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities.Methods/design: The proposed study will evaluate the efficacy of an evidence-based and theoretically-driven Motivation And Problem Solving (MAPS) intervention, adapted and culturally-tailored for reducing cancer risk related to smoking, poor diet, and physical inactivity among high-risk Mexican-origin smokers who are overweight/obese (n = 400). Participants will be randomly assigned to one of two groups: Health Education (HE) or MAPS (HE + up to 18 MAPS counseling calls over 18 months). Primary outcomes are smoking status, servings of fruits and vegetables, and both self-reported and objectively measured physical activity. Outcome assessments will occur at baseline, 6 months, 12 months, and 18 months. DISCUSSION: The current study will contribute to a very limited evidence base on multiple risk factor intervention studies on Mexican-origin individuals and has the potential to inform both future research and practice related to reducing cancer risk disparities. An effective program targeting multiple cancer risk behaviors modeled after chronic care programs has the potential to make a large public health impact because of the dearth of evidence-based interventions for Latinos and the extended period of support that is provided in such a program.Trial registration: National Institutes of Health Clinical Trials Registry # http://www.clinicaltrials.gov/ct2/show/NCT01504919.
BMC Public Health 03/2013; 13(1):237. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Evidence-based health promotion programs that are disseminated in community settings can improve population health. However, little is known about how effective such programs are when they are implemented in communities. We examined community implementation of an evidence-based program, Body and Soul, to promote consumption of fruits and vegetables. METHODS: We randomly assigned 19 churches to 1 of 2 arms, a colon cancer screening intervention or Body and Soul. We conducted our study from 2008 through 2010. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to evaluate the program and collected data via participant surveys, on-site observations, and interviews with church coordinators and pastors. RESULTS: Members of 8 churches in Michigan and North Carolina participated in the Body and Soul program. Mean fruit and vegetable consumption increased from baseline (3.9 servings/d) to follow-up (+0.35, P = .04). The program reached 41.4% of the eligible congregation. Six of the 8 churches partially or fully completed at least 3 of the 4 program components. Six churches expressed intention to maintain the program. Church coordinators reported limited time and help to plan and implement activities, competing church events, and lack of motivation among congregation members as barriers to implementation. CONCLUSIONS: The RE-AIM framework provided an effective approach to evaluating the dissemination of an evidence-based program to promote health. Stronger emphasis should be placed on providing technical assistance as a way to improve other community-based translational efforts.
[Show abstract][Hide abstract] ABSTRACT: We used data from two telephone-administered health surveys to explore African Americans’ preferences for interviewer race. The first survey utilized African American interviewers to assess ethnic identity and aspects of healthy eating among 617 African American adults. In the second survey, interviewers of varying races queried 534 African American adults about their motivations to eat healthier. The motivation survey contained almost no racial content, whereas 40% of the ethnic identity survey assessed racial content. Using only ethnic identity survey data, we found that respondents with Afrocentric or Black American identity components were more likely to prefer African American interviewers than respondents with solely assimilated, bicultural, or multicultural identity components. Ethnic identity survey respondents were also more likely to prefer racially/ethnically matched interviewers than motivation survey respondents. Ethnic identity respondents with a college or graduate degree reported lower hypothetical comfort with a white interviewer than respondents with a high school education.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Although current clinical practice guidelines recommend Motivational Interviewing for use with smokers not ready to quit, the strength of evidence for its use is rated as not optimal. The purpose of the present study is to address key methodological limitations of previous studies by ensuring fidelity in the delivery of the Motivational Interviewing intervention, using an attention-matched control condition, and focusing on unmotivated smokers whom meta-analyses have indicated may benefit most from Motivational Interviewing. It is hypothesized that MI will be more effective at inducing quit attempts and smoking cessation at 6-month follow-up than brief advice to quit and an intensity-matched health education condition. METHODS: A sample of adult community resident smokers (N= 255) who report low motivation and readiness to quit are being randomized using a 2:2:1 treatment allocation to Motivational Interviewing, Health Education, or Brief Advice. Over 6 months, participants in Motivational Interviewing and Health Education receive 4 individual counseling sessions and participants in Brief Advice receive one brief in-person individual session at baseline. Rigorous monitoring and independent verification of fidelity will assure the counseling approaches are distinct and delivered as planned. Participants complete surveys at baseline, week 12 and 6-month follow-up to assess demographics, smoking characteristics, and smoking outcomes. Participants who decide to quit are provided with a self-help guide to quitting, help with a quit plan, and free pharmacotherapy. The primary outcome is self-report of one or more quit attempts lasting at least 24 hours between randomization and 6-month follow-up. The secondary outcome is biochemically confirmed 7-day point prevalence cessation at 6-month follow-up. Hypothesized mediators of the presumed treatment effect on quit attempts are greater perceived autonomy support and autonomous motivation. Use of pharmacotherapy is a hypothesized mediator of Motivational Interviewing's effect on cessation. DISCUSSION: This trial will provide the most rigorous evaluation to date of Motivational Interviewing's efficacy for encouraging unmotivated smokers to make a quit attempt. It will provide also provide effect-size estimates of MI's impact on smoking cessation to inform future clinical trials and inform the clinical practice guidelines. Trial registration ClinicalTrials.gov NCT01188018.
BMC Public Health 06/2012; 12(1):456. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: African Americans are disproportionately represented among those awaiting a transplant, but many are reluctant to donate their organs.
To test the effectiveness of using lay health advisors to increase organ donation among church members.
Churches were pair-matched by average estimated income and size and then randomized to 1 of 2 interventions: one addressing organ donation and the other addressing increasing consumption of fruits and vegetables.
Twenty-two African American churches in Southeast Michigan.
Church members were trained to serve as lay health advisors (called peer leaders).
Peer leaders conducted organ donation discussions with church groups and showed a DVD created for this program that was tailored to African American churches.
The primary outcome was verified registration in the state's donor registry. Participants also completed pre/post questionnaires regarding their attitudes about organ donation.
Once clustering, baseline value, and demographics were adjusted for, the intervention and comparison groups did not differ on any of the 3 attitude scales on the posttest. In logistic regression analysis, with baseline donation status, demographics, and church clustering controlled for, the odds of self-reported enrollment at 1-year posttest did not differ by condition (odds ratio, 1.23; 95% CI, 0.87-1.72). A total of 211 enrollments in the state registry from participating churches were verified. Of these, 163 were from intervention churches and 48 were from comparison churches.
Use of lay health advisors through black churches can increase minority enrollment in a donor registry even absent change in attitudes.
[Show abstract][Hide abstract] ABSTRACT: rgan transplants are often required for individuals with end-stage organ failure, most commonly for the kidney, liver, and heart. 1 Medical advances continue to make transplants safer and more effective. However, the rate of donation has not kept pace with the increas-ing number of Americans waiting for organs. More than 112 000 Americans are currently awaiting a trans-plant. 1 African Americans are disproportionately rep-resented among those awaiting a transplant because they have higher rates of hypertension, diabetes, and chronic kidney disease. Although African Americans comprise about 13% of the US population, 29% of the persons on the waiting list for an organ are African American. 1 Despite this need, a 2005 Gallup survey indicated that 61% of whites stated that they had signed their driver's license saying they were willing to donate their organs, but only 31% of blacks indicated that they had done so. Furthermore, 82.3% of whites were "very likely" or "somewhat likely" to report wanting their organs donated after their death compared with 64.1% of blacks, which is the lowest percentage among the 4 racial/ethnic groups for which data were reported. 2 The challenges to increasing organ and tissue dona-tion in the African American community include reli-gious beliefs about permissibility of donation, distrust of the medical system, lack of knowledge about the organ allocation process, and fear of premature dec-laration of death if a donor card had been signed. 3-7 Increasing donor designation through black churches: results of a randomized trial
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Smoking prevalence in homeless populations is strikingly high (∼70%); yet, little is known about effective smoking cessation interventions for this population. We conducted a community-based clinical trial, Power To Quit (PTQ), to assess the effects of motivational interviewing (MI) and nicotine patch (nicotine replacement therapy [NRT]) on smoking cessation among homeless smokers. This paper describes the smoking characteristics and comorbidities of smokers in the study. METHODS: Four hundred and thirty homeless adult smokers were randomized to either the intervention arm (NRT + MI) or the control arm (NRT + Brief Advice). Baseline assessment included demographic information, shelter status, smoking history, motivation to quit smoking, alcohol/other substance abuse, and psychiatric comorbidities. RESULTS: Of the 849 individuals who completed the eligibility survey, 578 (68.1%) were eligible and 430 (74.4% of eligibles) were enrolled. Participants were predominantly Black, male, and had mean age of 44.4 years (SD = 9.9), and the majority were unemployed (90.5%). Most participants reported sleeping in emergency shelters; nearly half had been homeless for more than a year. Nearly all the participants were daily smokers who smoked an average of 20 cigarettes/day. Nearly 40% had patient health questionnaire-9 depression scores in the moderate or worse range, and more than 80% screened positive for lifetime history of drug abuse or dependence.Conclusions:This study demonstrates the feasibility of enrolling a diverse sample of homeless smokers into a smoking cessation clinical trial. The uniqueness of the study sample enables investigators to examine the influence of nicotine dependence as well as psychiatric and substance abuse comorbidities on smoking cessation outcomes.
Nicotine & Tobacco Research 05/2012; · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: When using Motivational Interviewing (MI), once resistance or ambivalence are resolved and motivation is solidified, many practitioners struggle with how best to transition the discussion toward action planning, while still retaining the spirit and style of client centeredness, i.e., moving from the WHY phase to the HOW phase of counseling in a style that is MI-consistent. For many, there is a perception that the counseling style, skills, and strategies used to build motivation are distinct from those used in the action planning phase. The WHY to HOW transition does not, however, necessitate abandoning a client-centered style for a more overtly educational or directive style. Goal setting, action planning, provision of advice, and relapse prevention can be implemented from an autonomy supportive, MI consistent framework.
To this end, this article will present a new class of reflection, which we have termed "action reflections", that can be used to help bridge the WHY-HOW gap. Action reflections (AR) allow the clinician to maintain a tone and orientation that are consistent with MI, i.e. autonomy support; guiding versus directing, during the action phase of counseling. They differ from reflecting change talk as they focus not on the WHY of change, but the HOW, WHEN, or WHERE. Action Reflections (ARs) also differ from the more common type of reflections such as those that focus on client feelings, rolling with resistance, or acknowledging ambivalence as ARs usually contain a potential concrete step that the client has directly or obliquely mentioned. Like any type of reflection, ARs represent the clinician's best guess for what the client has said or, more apropos here, where the conversation might be heading.
This article describes the various types of ARs and provides examples of each to help clinicians incorporate them into their behavior change counseling.
Behavioural and Cognitive Psychotherapy 03/2012; 40(4):474-80. · 1.69 Impact Factor