Sally W Vernon

University of Texas Health Science Center at Houston, Houston, Texas, United States

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Publications (236)845.31 Total impact

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    ABSTRACT: We tested the efficacy of a remote tailored intervention (TeleCARE) compared to a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers. Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N=232) or an educational brochure (N=249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained non-adherent. Rates of medically-verified colonoscopy at the 15-month follow-up were compared based on group assignment and within group stratification by cost barriers. In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically-verified colonoscopy [OR = 2.37; 95% confidence interval (CI) 1.59 to 3.52]. Cost was identified as a barrier in both groups (TeleCARE = 62.5%; educational brochure = 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR = 3.66; 95% CI= 1.85 to 7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR = 1.99; 95% CI = 1.12 to 3.52). TeleCARE increased colonoscopy regardless of cost barriers. Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent. Copyright © 2015, American Association for Cancer Research.
    Cancer Epidemiology Biomarkers & Prevention 06/2015; DOI:10.1158/1055-9965.EPI-15-0150 · 4.32 Impact Factor
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    ABSTRACT: A cancer diagnosis may provide a 'teachable moment' in cancer recovery. To better understand factors influencing lifestyle choices following diagnosis, we examined associations between time since diagnosis and symptom burden with recommended dietary (e.g., five or more fruit/vegetable servings/day), physical activity (e.g., >150 active min, 3-5 times/week), and smoking behaviors (i.e., eliminate tobacco use) in cancer survivors. We analyzed cross-sectional survey data collected from breast (n = 528), colorectal (n = 106), and prostate (n = 419) cancer survivors following active treatment at The University of Texas MD Anderson Cancer Center. Four regression models were tested for behaviors of interest. Additionally, we assessed symptom burden as a potential moderator and/or mediator between time since diagnosis and behaviors. Respondents were mostly female (55%) and non-Hispanic White (68%) with a mean age of 62.8 ± 11.4 years and mean time since diagnosis of 4.6 ± 3.1 years. In regression models, greater time since diagnosis predicted lower fruit and vegetable consumption (B = -0.05, p = 0.02) and more cigarette smoking (B = 0.06, p = 0.105). Greater symptom burden was a significant negative predictor for physical activity (B = -0.08, p < .001). We did not find evidence that symptom burden moderated or mediated the association between time since diagnosis and health behaviors. We assessed the prevalence of recommended behaviors in the context of other challenges that survivors face, including time since diagnosis and symptom burden. Our results provide indirect evidence that proximity to a cancer diagnosis may provide a teachable moment to improve dietary and smoking behaviors and that symptom burden may impede physical activity following diagnosis. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Psycho-Oncology 06/2015; DOI:10.1002/pon.3857 · 4.04 Impact Factor
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    ABSTRACT: Recent colorectal cancer screening studies focus on optimizing adherence. This study evaluated the cost effectiveness of interventions using electronic health records (EHRs); automated mailings; and stepped support increases to improve 2-year colorectal cancer screening adherence. Analyses were based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings ["automated"]; automated plus telephone assistance ["assisted"]; or automated and assisted plus nurse navigation to testing completion or refusal [navigated"]) were compared to usual care. Data were from August 2008 to November 2011, with analyses performed during 2012-2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over 2 years. Bootstrapping examined robustness of results. Intervention delivery cost per participant current for screening ranged from $21 (automated) to $27 (navigated). Inclusion of induced testing costs (e.g., screening colonoscopy) lowered expenditures for automated (ICER=-$159) and assisted (ICER=-$36) relative to usual care over 2 years. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost effective relative to less intensive interventions, with willingness to pay values of $600-$1,200 for an additional person current for screening yielding ≥80% probability of cost effectiveness. Two-year cost effectiveness of a stepped approach to colorectal cancer screening promotion based on EHR data is indicated, but longer-term cost effectiveness requires further study. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
    American journal of preventive medicine 06/2015; 48(6):714-21. DOI:10.1016/j.amepre.2014.12.016 · 4.28 Impact Factor
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    ABSTRACT: Little is known about validity of self-reported mammography surveillance among breast cancer survivors. Most studies have focused on accuracy among healthy, average-risk populations and none have assessed validity by electronic medical record (EMR) extraction method. To assess validity of survivor-reported mammography post-active treatment care, we surveyed all survivors diagnosed 2004-2009 in an academic hospital cancer registry (n = 1441). We used electronic query and manual review to extract EMR data. Concordance, sensitivity, specificity, positive predictive value, and report-to-records ratio were calculated by comparing survivors' self-reports to data from each extraction method. We also assessed average difference in months between mammography dates by source and correlates of concordance. Agreement between the two EMR extraction methods was high (concordance 0.90; kappa 0.70), with electronic query identifying more mammograms. Sensitivity was excellent (0.99) regardless of extraction method; concordance and positive predictive value were good; however, specificity was poor (manual review 0.20, electronic query 0.31). Report-to-records ratios were both over 1 suggesting over-reporting. We observed slight forward telescoping for survivors reporting mammograms 7-12 months prior to survey date. Higher educational attainment and less time since mammogram receipt were associated with greater concordance. Accuracy of survivors' self-reported mammograms was generally high with slight forward telescoping among those recalling their mammograms between 7 and 12 months prior to the survey date. Results are encouraging for clinicians and practitioners relying on survivor reports for surveillance care delivery and as a screening tool for inclusion in interventions promoting adherence to surveillance guidelines.
    Breast Cancer Research and Treatment 04/2015; DOI:10.1007/s10549-015-3387-2 · 4.20 Impact Factor
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    ABSTRACT: To reduce the high incidence of cervical cancer among Latinas in the United States it is important to understand factors that predict screening behavior. The aim of this study was to test the utility of theory of planned behavior in predicting cervical cancer screening among a group of Latinas. A sample of Latinas (N = 614) completed a baseline survey about Pap test attitudes subjective norms, perceived behavioral control, and intention to be screened for cervical cancer. At 6 months postbaseline, cervical cancer screening behavior was assessed. Structural equation modeling was used to test the theory. Model fit statistics indicated good model fit: χ(2)(48) = 54.32, p = .246; comparative fit index = .992; root mean square error of approximation = .015; weighted root mean square residual = .687. Subjective norms (p = .005) and perceived behavioral control (p < .0001) were positively associated with intention to be screened for cervical cancer, and the intention to be screened predicted actual cervical cancer screening (p < .0001). The proportion of variance (R(2)) in intention accounted for by the predictors was .276 and the R(2) in cervical cancer screening accounted for was .130. This study provides support for the use of the theory of planned behavior in predicting cervical cancer screening among Latinas. This knowledge can be used to inform the development of a theory of planned behavior-based intervention to increase cervical cancer screening among Latinas and reduce the high incidence of cervical cancer in this group of women. © 2015 Society for Public Health Education.
    Health Education &amp Behavior 02/2015; DOI:10.1177/1090198115571364 · 1.54 Impact Factor
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    ABSTRACT: Research has shown that recent post-treatment breast cancer survivors face significant challenges around physical activity as they transition to recovery. This review examined randomized controlled trials targeting physical activity behavior change in breast cancer survivors <5 years post-treatment and described (1) characteristics of interventions for breast cancer survivors as well as (2) effect size estimates for these studies. A systematic search was conducted following PRISMA guidelines with Medline, PubMed, PsycINFO, CINAHL, and Scopus databases. Data were abstracted for primary intervention strategies and other details (e.g., setting, duration, theory use). A subgroup analysis was conducted to assess intensity of exercise supervision/monitoring and intervention effectiveness. The search produced 14 unique behavior intervention trials from the US and abroad published 2005-2013. The mean sample size was 153 participants per study. All interventions included moderate-intensity activities plus various behavioral change strategies. Most interventions were partially or entirely home based. The overall standardized mean difference was 0.47 (0.23, 0.67) with p < 0.001. Most interventions were effective in producing short-term behavior changes in physical activity, but varied greatly relative to intervention strategies and intensity of supervision/monitoring. Highly structured interventions tended to produce larger behavior change effects overall, but many larger effect sizes came from interventions supported by phone counseling or e-mail. We observed that 'more' may not be better in terms of direct supervision/monitoring in physical activity behavior interventions. This may be important in exploring less resource-intensive options for effective behavior change strategies for recent post-treatment survivors.
    Breast Cancer Research and Treatment 01/2015; 149(2). DOI:10.1007/s10549-014-3255-5 · 4.20 Impact Factor
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    ABSTRACT: Background Colorectal cancer (CRC) is the second and third leading cause of cancer death for Hispanic men and women, respectively. CRC can be prevented if precursors are detected early and removed and can be successfully treated if discovered early. While one-on-one interventions for increasing CRC screening (CRCS) are recommended, few studies specifically assess the effectiveness of lay health worker (LHW) approaches using different educational materials. Purpose To develop and evaluate the effectiveness of two LHW-delivered CRCS interventions known as Vale la Pena (VLP; “It’s Worth It!”) on increasing CRCS among Hispanics. Design The study design was a cluster randomized controlled trial with two treatment arms. Setting/participants Six hundred and sixty five Hispanics 50 years and older were recruited from 24 colonias (neighborhoods) in the Lower Rio Grande Valley of the Texas–Mexico border. Intervention The interventions were a small media print intervention (SMPI) (including DVD and flipchart), and a tailored interactive multimedia intervention (TIMI) delivered on tablet computers. A no intervention group served as the comparison group. Data were collected between 2007 and 2009 and analyzed between 2009 and 2013. Main outcome measures Measures assessed CRCS behavior, self-efficacy, knowledge, and other psychosocial constructs related to CRCS and targeted through VLP. Results Among participants reached for follow-up, 18.9 % in the SMPI group, 13.3 % in the TIMI group, and 11.9 % in the comparison group completed CRCS. Intent-to-treat analysis showed that 13.6 % in the SMPI group, 10.2 % in the TIMI group, and 10.8 % in the comparison group completed CRCS. These differences were not statistically significant. Conclusion Results indicated that there are no significant differences in CRCS uptake between groups.
    Cancer Causes and Control 12/2014; DOI:10.1007/s10552-014-0472-5 · 2.96 Impact Factor
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    ABSTRACT: The study aimed to determine the effect of preference-based tailored navigation on colorectal cancer (CRC) screening adherence and related outcomes among African Americans (AAs). We conducted a randomized controlled trial that included 764 AA patients who were age 50 to 75 years, were eligible for CRC screening, and had received care through primary care practices in Philadelphia. Consented patients completed a baseline telephone survey and were randomized to either a Standard Intervention (SI) group (n = 380) or a Tailored Navigation Intervention (TNI) group (n = 384). The SI group received a mailed stool blood test kit plus colonoscopy instructions, and a reminder. The TNI group received tailored navigation (a mailed stool blood test kit or colonoscopy instructions based on preference, plus telephone navigation) and a reminder. A six-month survey and a 12-month medical records review were completed to assess screening adherence, change in overall screening preference, and perceptions about screening. Multivariable analyses were performed to assess intervention impact on outcomes. At six months, adherence in the TNI group was statistically significantly higher than in the SI group (OR = 2.1, 95% CI = 1.5 to 2.9). Positive change in overall screening preference was also statistically significantly greater in the TNI group compared with the SI group (OR = 1.5, 95% CI = 1.0 to 2.3). There were no statistically significant differences in perceptions about screening between the study groups. Tailored navigation in primary care is a promising approach for increasing CRC screening among AAs. Research is needed to determine how to maximize intervention effects and to test intervention impact on race-related disparities in mortality and survival. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
    JNCI Journal of the National Cancer Institute 12/2014; 106(12). DOI:10.1093/jnci/dju344 · 15.16 Impact Factor
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    ABSTRACT: Background: Twenty-nine states and tribal organizations receive funding from the Centers for Disease Control and Prevention to increase colorectal cancer (CRC) screening by (1) promoting CRC screening population-wide using evidence-based approaches (EBAs) and (2) providing CRC screening to the un/underinsured. This analysis examines the implementation of the Colorectal Cancer Control Program (CRCCP) and includes a comparison group of unfunded organizations. Methods: An online survey was conducted in fall 2012 that asked the 29 CRCCP grantees about CRC screening activities in the 3rd year of the program (7/2011-6/2012). The comparison group included 24 Breast and Cervical Cancer Early Detection Program grantees that did not receive CRCCP funding; they were asked about CRC prevention and control activities funded by other sources. Results: CRCCP grantees were more likely than unfunded sites to use the following EBAs to promote CRC screening: small media - 97% of grantees versus 50% of unfunded sites; client reminders - 76% versus 21%; reducing structural barriers - 59% versus 25%; provider reminders - 38% versus 17%; provider assessment and feedback - 45% versus 12%. All grantees provided CRC screening but only 50% of the unfunded sites. The two groups also differed with respect to their partnerships for screening provision, use of patient navigators, recruitment of patients, professional development and other activities. Conclusions: CRCCP grantees implemented EBAs promoting CRC screening at a higher rate than unfunded sites. Both groups were equally likely to implement other CRC promotion approaches, suggesting that CRCCP funding and support was key to increasing EBA use.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Follow-up after a positive colorectal cancer screening test is necessary for screening to be effective. We hypothesized that nurse navigation would increase the completion of colonoscopy after a positive screening test. Methods: This study was conducted between 2008 and 2012 at 21 primary care medical centers in western Washington State. Participants in the Systems of Support to Increase Colorectal Cancer Screening study who had a positive fecal occult blood test (FOBT) or flexible sigmoidoscopy needing follow-up were randomized to usual care (UC) or a nurse navigator (navigation). UC included an electronic health record-based positive FOBT registry and physician reminder system. Navigation included UC plus care coordination and patient self-management support from a registered nurse who tracked and assisted patients until they completed or refused colonoscopy. The primary outcome was completion of colonoscopy within 6 months. After 6 months, both groups received navigation. Results: We randomized 147 participants with a positive FOBT or sigmoidoscopy. Completion of colonoscopy was higher in the intervention group at 6 months, but differences were not statistically significant (91.0% in navigation group vs 80.8% in UC group; adjusted difference, 10.1%; P = .10). Reasons for no or late colonoscopies included refusal, failure to schedule or missed appointments, concerns about risks or costs, and competing health concerns. Conclusions: Navigation did not lead to a statistically significant incremental benefit at 6 months. Impact: Follow-up rates after a positive colorectal cancer (CRC) screening test are high in a health care system where UC included a registry and physician reminders. Because of high follow-up rates in a health care system where UC included a registry and physician reminders, and small sample size, we cannot rule out incremental benefits of nurse navigation.
    The Journal of the American Board of Family Medicine 11/2014; 27(6):789-795. DOI:10.3122/jabfm.2014.06.140125 · 1.85 Impact Factor
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    ABSTRACT: Treatment fidelity is associated with improvement in research outcomes and increased confidence in significant findings. However, few studies report on recommended areas of treatment fidelity (i.e., study design, training, treatment delivery, treatment receipt, and treatment enactment), leaving a dearth of information about implementation components that contributed to a study’s success. Without such information, it is difficult for researchers to correctly assess previous findings and for practitioners to correctly implement findings into practice. Thus, it is crucial that studies assess both treatment fidelity and applicability of treatment fidelity findings. We report measures of treatment fidelity in a randomized controlled trial of an intervention promoting colonoscopy in at-risk relatives of colorectal cancer (CRC) patients. We describe assessments related to both treatment delivery and treatment receipt. We conducted separate ANCOVAs to model the change in each of the treatment receipt variables, comparing the two intervention arms. Compared with the control group, the intervention group had significantly greater improvements in CRC knowledge (f = 17.46, p < .0001), perceptions about susceptibility (f = 15.08, p = .0002), response efficacy (f = 7.46, p = .0076), self-efficacy (f = 8.16, p = .0053), and reduced decisional uncertainty (f = 19.59, p < .0001) from baseline to 1-month follow-up. Overall, our study adhered to most of the best-practice guidelines for behavioral intervention fidelity. This demonstrates that our intervention was delivered as intended and positively affected the cognitive processes that are purported to be predictive of adherent behavioral outcomes.
    SAGE Open 10/2014; October-December:1-13. DOI:10.1177/2158244014559021
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    ABSTRACT: Since 2009, the Centers for Disease Control and Prevention (CDC) has awarded nearly $95 million to 29 states and tribes through the Colorectal Cancer Control Program (CRCCP) to fund 2 program components: 1) providing colorectal cancer (CRC) screening to uninsured and underinsured low-income adults and 2) promoting population-wide CRC screening through evidence-based interventions identified in the Guide to Community Preventive Services (Community Guide). CRCCP is a new model for disseminating and promoting use of evidence-based interventions. If the program proves successful, CDC may adopt the model for future cancer control programs. The objective of our study was to compare the colorectal cancer screening practices of recipients of CRCCP funding (grantees) with those of nonrecipients (nongrantees).
    Preventing chronic disease 10/2014; 11:E170. DOI:10.5888/pcd11.140183 · 1.96 Impact Factor
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    ABSTRACT: Context: Colorectal cancer (CRC) is the second leading cause of cancer death among cancers affecting both men and women in the United States. The Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP) supports both direct clinical screening services (screening provision) and activities to promote screening at the population level (screening promotion). Objective: The purpose of this study was to characterize patient navigation (PN) programs for screening provision and promotion for the first 1 to 2 years of program funding. Participants: We conducted a cross-sectional survey of the 29 CRCCP grantees (25 states and 4 tribal organizations) and 14 in-depth interviews to assess program implementation. Main Outcome Measures: The survey and interview guide collected information on CRC screening provision and promotion activities and PN, including the structure of the PN program, characteristics of the navigators, funding mechanism, and navigators' activities. Results: Twenty-four of 28 CRCCP grantees of the survey used PN for screening provision whereas 18 grantees used navigation for screening promotion. Navigators were often trained in nursing or public health. Navigation activities were similar for both screening provision and promotion, and common tasks included assessing and responding to patient barriers to screening, providing patient education, and scheduling appointments. For screening provision, activities centered on making reminder calls, educating patients on bowel preparation for colonoscopies, and tracking patients for completion of the tests. Navigation may influence screening quality by improving patients' bowel preparation for colonoscopies. Conclusions: Our study provides insights into PN across a federally funded CRC program. Results suggest that PN activities may be instrumental in recruiting people into cancer screening and ensuring completed screening and follow-up.
    Journal of public health management and practice: JPHMP 08/2014; DOI:10.1097/PHH.0000000000000132 · 1.47 Impact Factor
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    ABSTRACT: Latinos have lower colorectal cancer screening (CRCS) and survival rates compared to other race/ethnic groups. This cross-sectional study examines relationships between acculturation, access to and utilization of healthcare services, and CRCS in low-income Latinos. Bilingual data collectors conducted structured interviews with 544 Latino men and women (>50 years) residing in the Texas-Mexico border area. Using a hierarchical logistic regression model, we examined the relationship between lifetime history of any CRCS test and indicators of acculturation, healthcare utilization and access to care, adjusting for socio-demographic characteristics. Survey results revealed a 34 % prevalence of CRCS. Participants reporting a provider recommendation for screening, regular check-ups, higher acculturation level, and health insurance had significantly increased odds of CRCS. Findings indicate CRCS intervention research in Latinos should focus on (1) increasing physicians' recommendations for screening, (2) promoting regular check-ups, (3) and increasing CRC prevention efforts on less acculturated and uninsured groups.
    Journal of Immigrant and Minority Health 07/2014; 17(3). DOI:10.1007/s10903-014-0061-4 · 1.16 Impact Factor
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    ABSTRACT: Few studies use longitudinal data to identify predictors of colorectal cancer screening (CRCS). We examined predictors of: 1) initial CRCS during the first year of a randomized trial, and 2) repeat CRCS during the second year of the trial among those that completed FOBT in Year 1.
    Preventive Medicine 06/2014; 66. DOI:10.1016/j.ypmed.2014.06.013 · 2.93 Impact Factor
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    ABSTRACT: Understanding how interventions affect time to completion of colorectal cancer (CRC) screening might assist in planning and delivering population-based screening interventions. The Systems of Support to Increase CRC Screening (SOS) study was conducted between 2008 and 2011 at 21 primary care medical centers in Western Washington. Participants in the study, aged 50-73 years, were eligible if they were enrolled in Group Health and were due for CRC screening. 4,675 recruited participants were randomized to usual care (UC) or one of three interventions with incremental levels of systems of support for completion of CRC screening. We conducted time to screening analyses of the SOS data in year 1 and year 2. We investigated whether these effects were time-varying. For year 1, the intervention effects on the time to completion of CRC screening were the strongest during the first two post-randomization months then decreased, with no significant effect after the 5th month. For year 2, the intervention effects on the time to CRC screening increased from the 1st to the 3rd month and then decreased, with no significant effect after the 5th month. Hence, each of the interventions to increase CRC screening had its greatest effect within the first 3 months after being offered to participants. Future studies should test whether booster interventions offered later could increase screening rate among those who remain unscreened. Additional research is needed to develop intervention strategies for CRC screening that focus on sustained behavior over time.
    Cancer Epidemiology Biomarkers & Prevention 06/2014; 23(8). DOI:10.1158/1055-9965.EPI-14-0270 · 4.32 Impact Factor
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    ABSTRACT: Background. Little is known about how colorectal cancer screening test preferences operate together with test access and navigation to influence screening adherence in primary care. Methods. We analyzed data from a randomized trial of 945 primary care patients to assess the independent effects of screening test preference for fecal immunochemical test (FIT) or colonoscopy (CX), mailed access to FIT and CX, and telephone navigation for FIT and CX, on screening. Results. Preference was not associated with overall screening, but individuals who preferred FIT were more likely to complete FIT screening (p = 0.005), while those who preferred CX were more likely to perform CX screening (p = 0.032). Mailed access to FIT and CX was associated with increased overall screening (OR = 2.6, p = 0.001), due to a 29-fold increase in FIT use. Telephone navigation was also associated with increased overall screening (OR = 2.1, p = 0.005), mainly due to a 3-fold increase in CX performance. We estimated that providing access and navigation for both screening tests may substantially increase screening compared to a preference-tailored approach, mainly due to increased performance of non-preferred tests. Conclusions. Preference influences the type of screening tests completed. Test access increases FIT and navigation mainly increases CX. Screening strategies providing access and navigation to both tests may be more effective than preference-tailored approaches. Impact. Preference tailoring in colorectal cancer screening strategies should be avoided if the objective is to maximize screening rates, although other factors (e.g., costs, necessary follow-up) should also be considered.
    Cancer Epidemiology Biomarkers & Prevention 05/2014; 23(8). DOI:10.1158/1055-9965.EPI-13-1176 · 4.32 Impact Factor
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    ABSTRACT: Objective. To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. Method. Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). Results. In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. Conclusion. CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
    Health Education &amp Behavior 04/2014; 42(1). DOI:10.1177/1090198114529592 · 1.54 Impact Factor
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    ABSTRACT: Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of a mailed standard intervention (SI) and tailored navigation interventions (TNIs) to increase CRC screening use in the context of a randomized trial among primary care patients. Participants (n = 945) were randomized either to a usual care control group (n = 317), to an SI group (n = 316), or to a TNI group (n = 312). The SI group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference. TNI group participants were sent instructions for scheduling a colonoscopy, a stool blood test, or both based on their test preference, as determined at baseline; then, they received a navigation telephone call. Activity cost estimation was used to determine the cost of each intervention and to compute incremental cost-effectiveness ratios. Statistical uncertainty within the base case was assessed with 95% confidence intervals derived from net benefit regression analysis. The effects of uncertain parameters, such as the cost of planning, training, and involvement of those receiving "investigator salaries," were assessed with sensitivity analyses. Program costs of the SI were $167 per participant. The average cost of the TNI was $289 per participant. The TNI was more effective than the SI but substantially increased the cost per additional individual screened. Decision-makers need to consider cost structure, level of planning, and training required to implement these 2 intervention strategies and their willingness to pay for additional individuals screened to determine whether a tailored navigation would be justified and feasible. Cancer 2013. © 2013 American Cancer Society.
    Cancer 04/2014; 120(7). DOI:10.1002/cncr.28535 · 4.90 Impact Factor
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    ABSTRACT: The rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer (CRC) is suboptimal, especially among rural and other geographically underserved populations. Remote interventions may overcome geographic and system-level barriers. We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC. Eligible individuals age 30 to 74 years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states. Enrollees were randomly assigned as family units to either an active, personalized intervention that incorporated evidence-based risk communication and behavior change techniques, or a mailed educational brochure. The primary outcome was medically verified colonoscopy within 9 months of the intervention. Of the 481 eligible and randomly assigned at-risk relatives, 79.8% completed the outcome assessments within 9 months; 35.4% of those in the personalized intervention group and 15.7% of those in the comparison group obtained a colonoscopy. In an intent-to-treat analysis, the telehealth group was almost three times as likely to get screened as the low-intensity comparison group (odds ratio, 2.83; 95% CI, 1.87 to 4.28; P < .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents. Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.
    Journal of Clinical Oncology 01/2014; 32(7):654-62. DOI:10.1200/JCO.2013.51.6765 · 17.88 Impact Factor

Publication Stats

7k Citations
845.31 Total Impact Points

Institutions

  • 1990–2015
    • University of Texas Health Science Center at Houston
      • • School of Public Health
      • • Division of Health Promotion and Behavioral Sciences
      • • Center for Health Promotion and Prevention Research
      Houston, Texas, United States
  • 2004–2014
    • University of Houston
      Houston, Texas, United States
    • Baylor College of Medicine
      • Veterans Affairs Medical Center
      Houston, TX, United States
  • 2011
    • University of Texas Health Science Center at San Antonio
      San Antonio, Texas, United States
  • 2010
    • University of Texas at Dallas
      Richardson, Texas, United States
  • 1982–2008
    • University of Texas Medical School
      • • Department of Internal Medicine
      • • Department of Psychiatry & Behavioral Sciences
      Houston, TX, United States
  • 2007
    • University of California, San Francisco
      San Francisco, California, United States
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
  • 2006–2007
    • Thomas Jefferson University
      • Department of Medicine
      Filadelfia, Pennsylvania, United States
    • Fox Chase Cancer Center
      Filadelfia, Pennsylvania, United States
    • Brown University
      Providence, Rhode Island, United States
    • National Cancer Institute (USA)
      • Division of Cancer Control and Population Sciences
      Bethesda, MD, United States
  • 2003–2006
    • Houston Graduate School of Theology
      Houston, Texas, United States
    • Salt Lake City Community College
      Salt Lake City, Utah, United States
    • Texas A&M University
      • Department of Psychology
      College Station, TX, United States
    • University of Texas MD Anderson Cancer Center
      • Department of Behavioral Science
      Houston, TX, United States
    • University of Washington Seattle
      • Department of Health Services
      Seattle, WA, United States
  • 2005
    • Emory University
      • Winship Cancer Institute
      Atlanta, GA, United States
  • 1994
    • Houston Zoo
      Houston, Texas, United States