Sally W Vernon

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

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Publications (218)762.46 Total impact

  • [Show abstract] [Hide abstract]
    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: 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).
    Journal of public health management and practice: JPHMP 08/2014; · 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 / Center for Minority Public Health. 07/2014;
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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;
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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.
    06/2014;
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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 &amp Prevention 05/2014; · 4.56 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; · 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 01/2014; · 5.20 Impact Factor
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    ABSTRACT: Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs in Texas and highlights effective intervention programs, methods and strategies. We reviewed and summarized cervical cancer control efforts targeting Hispanic women in Texas, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts. Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions. Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources.
    Gynecologic Oncology 01/2014; · 3.93 Impact Factor
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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 01/2014; 11:E170. · 1.82 Impact Factor
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    ABSTRACT: Racial and ethnic minority patients continue to die disproportionately from breast cancer compared with their white counterparts, even after adjusting for insurance status and income. No studies have examined whether surveillance mammography reduces racial disparities in survival among elderly breast cancer survivors following active treatment for breast cancer. This study included 28,117 cases diagnosed with primary breast cancer at age 66 years and over, identified from SEER data during 1992-2005. Kaplan-Meier methods and Cox regression models were used for survival analysis. A higher proportion of whites received surveillance mammograms during the surveillance period compared with nonwhites: 71.7 % of African-Americans, 72.5 % of Hispanics, and 69.3 % of Asians had mammograms compared with 74.9 % of whites. In propensity-score-adjusted analysis, women who had a mammogram within 2 years were less likely (hazard ratio 0.84; 95 % CI 0.78-0.82) to die from any cause compared with women who did not have any mammograms during this time period. The hazard ratio of cancer-specific mortality elevated for Hispanics compared with whites (hazard ratio 1.5; 95 % CI 0.6-3.2) and was reduced after adjusting for surveillance mammography (hazard ratio 1.4; 95 % CI 0.5-2.9). Similar pattern in the reduction in disease-specific hazard ratio was observed for blacks: After controlling for patient and tumor characteristics, hazard ratio was elevated but not significantly different from that in whites (hazard ratio 2.0; 95 % CI 0.9-3.7), and hazard ratio adjusting for surveillance mammography further reduced the point estimate (hazard ratio 1.5; 95 % CI 0.7-2.8). Asian and Pacific Islanders and Hispanics appeared to have lower risks of all-cause mortality compared with whites after controlling for patient and tumor characteristics and surveillance mammogram received. Our findings indicates that while surveillance mammograms and physician visits may play a contributory role in achieving equal outcomes for breast cancer-specific mortality for women with breast cancer, searching for other factors that might help achieve national goals to eliminate racial disparities in healthcare, and outcomes is warranted.
    Medical Oncology 12/2013; 30(4):691. · 2.14 Impact Factor
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    ABSTRACT: Colorectal cancer (CRC) screening is recommended for adults aged 50-75 years, yet screening rates are low, especially among the uninsured. The CDC initiated the Colorectal Cancer Control Program (CRCCP) in 2009 with the goal of increasing CRC screening rates to 80% by 2014. A total of 29 grantees (states and tribal organizations) receive CRCCP funding to (1) screen uninsured adults and (2) promote CRC screening at the population level. CRCCP encourages grantees to use one or more of five evidence-based interventions (EBIs) recommended by the Guide to Community Preventive Services. The purpose of the study was to evaluate grantees' EBI use. A web-based survey was conducted in 2011 measuring grantees' use of CRC screening EBIs and identifying their implementation partners. Data were analyzed in 2012. Twenty-eight grantees (97%) completed the survey. Most respondents (96%) used small media. Fewer used client reminders (75%); reduction of structural barriers (50%); provider reminders (32%); or provider assessment and feedback (50%). Provider-oriented EBIs were rated as harder to implement than client-oriented EBIs. Grantees partnered with several types of organizations to implement EBIs, many with county- or state-wide reach. Almost all grantees implement EBIs to promote CRC screening, but the EBIs that may have the greatest impact with CRC screening are implemented by fewer grantees in the first 2 years of the CRCCP.
    American journal of preventive medicine 11/2013; 45(5):644-8. · 4.24 Impact Factor
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    ABSTRACT: Objectives: Although large differences by race/ethnicity in breast cancer survival are well established, it is unknown whether disparities in nodal surgery utilization explain the racial/ethnic disparities in survival among women with micrometastasis and macrometastasis in sentinel lymph nodes (SLNs). Study Design: Retrospective cohort study. Methods: Women with breast cancer who underwent sentinel lymph node biopsy (SLNB) and who were found to have nodal metastases were identified from the Surveillance, Epidemiology, and End Results database (1998-2005). Outcomes data were examined for patients who underwent SLNB alone versus SLNB with axillary lymph node dissection (ALND). Results: Proportions of patients receiving SLNB alone or receiving SLNB with a complete ALND were not statistically different among women of different racial/ethnic backgrounds (P = .8). Patients of African American descent or Hispanic origin had reduced overall survival, whereas patients of Hispanic origin had reduced diseasespecific survival after adjusting for selected covariates. Adjusting for nodal surgery did not reduce racial/ethnic disparities in overall survival or disease-specific survival. Conclusions: The disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization among women with micrometastasis and macrometastasis in SLNs.
    The American journal of managed care 10/2013; 19(10):805-10. · 2.12 Impact Factor
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    ABSTRACT: Background: Few studies have examined the psychometric properties and invariance of scales measuring constructs relevant to colorectal cancer screening (CRCS). We sought to: 1) evaluate the factorial validity of four core constructs associated with CRCS (benefits, barriers, self-efficacy, and optimism); and 2) examine measurement invariance by screening status (currently screened, overdue, never screened). Methods: We used baseline survey data from a longitudinal behavioral intervention trial to increase CRCS among U.S. veterans. Respondents were classified as currently screened (n=3,498), overdue (n=418), and never screened (n=1,277). The measurement model was developed using a random half of the sample and then validated with the second half of the sample and the full baseline sample (n=5,193). Single- and multi-group confirmatory factor analysis was used to examine measurement invariance by screening status. Results: The four-factor measurement model demonstrated good fit. Factor loadings, item intercepts, and residual item variance and covariance were invariant when comparing participants never screened and overdue for CRCS, indicating strict measurement invariance. All factor loadings were invariant among the currently screened and overdue groups. Only the benefits scale was invariant across current screeners and never screeners. Noninvariant items were primarily from the barriers scale. Conclusion: Our findings provide additional support for the construct validity of scales of CRCS benefits, barriers, self-efficacy, and optimism. A greater understanding of the differences between current and never screeners may improve measurement invariance. Impact: Measures of benefits, barriers, self-efficacy, and optimism may be used to specify intervention targets and effectively assess change pre- and post-intervention across screening groups.
    Cancer Epidemiology Biomarkers &amp Prevention 09/2013; · 4.56 Impact Factor
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    ABSTRACT: Background/Aims Screening decreases colorectal cancer (CRC) incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals. Our objective was to determine whether interventions using electronic health records, automated mailings, and stepped increases in support increased being current for CRC testing over 2 years. Methods Setting and participants: SOS was a four-arm parallel design randomized controlled comparative effectiveness trial with concealed allocation and blinded outcome assessments (ClinicalTrials.gov registration number: NCT00697047). Patients aged 50-73 at baseline (n = 4674) not current for CRC screening and with no life-threatening illnesses from 21 primary care medical centers were randomized. Interventions: Usual care (UC), Automated mailed (Automated), Automated plus medical assistant telephone assistance (Assisted), or both Automated and Assisted interventions plus nurse navigation until testing was completed or declined (Navigated). Interventions were repeated in year 2. Measurements: Primary outcomes were the proportion current for screening in both years, defined as completion of a colonoscopy or sigmoidoscopy in year 1, or fecal occult blood test (FOBT) in year 1 and either FOBT, colonoscopy, or sigmoidoscopy in year 2. Results Compared to UC, intervention patients were more likely to be current for CRC screening for both years of the study, with incremental increases by intervention intensity (UC 26.5% vs. Automated 50.7%, Assisted 57.7%, or Navigated 64.4% P <.001). Automated interventions increased CRC screening in all patient subgroups compared to UC. The higher-intensity Assisted and Navigated interventions were less effective in patients age ≥65, and African American/Blacks and those reporting mixed race. Two-year intervention cost estimates were $57,000 for Automated, $67,000 for Assisted, and $79,000 for Navigated. Inclusion of CRC test costs produced total intervention costs of $314,000, $342,000, and $390,000 for three arms respectively, compared to $339,000 for UC costs for CRC tests alone. Conclusions A low-cost stepped intervention that leveraged automated data and centralized processes led to twice as many people being current for CRC screening over 2 years. The rapid growth of electronic health records provides opportunities for spreading this model broadly.
    Clinical Medicine &amp Research 09/2013; 11(3):123.
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    ABSTRACT: Despite the value of genetic counseling (GC) and genetic testing (GT) for high-risk breast cancer survivors, little is known about their uptake and validity of self-report data. This study evaluated the accuracy of self-reported genetic counseling and testing rates among breast cancer survivors. The current analysis focused on Stage 0-III female breast cancer survivors who were identified from an academic medical center's cancer registry and responded to a mailed survey (N = 452). Self-reported rates of GC and GT were validated using information from the electronic medical record. Overall, 30.8 % of survivors reported having seen a genetic counselor in the time period after their breast cancer diagnosis and 33.6 % noted having a genetic test. Concordance and specificity were good for both genetic questions; concordance agreements ranged from 86-88 %, while specificity was 83-86 %. Sensitivity (97-98 %) and negative predictive values (99 %) were excellent, while the positive predictive values for both GC and GT were poor (59-63 %). Among breast cancer survivors, self-reports of GC and GT were generally accurate, although a subset of respondents overestimated genetic service utilization. Future work should focus on validating GC and GT self-reports in medically underserved populations. Genetic counseling and testing are valuable aspects of survivorship care for high-risk breast cancer survivors; accurate understanding of their use is important for survivors, clinicians, and researchers.
    Journal of Cancer Survivorship 08/2013; · 3.57 Impact Factor
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    ABSTRACT: Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ (2) difference testing. Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.
    Annals of Behavioral Medicine 07/2013; · 4.20 Impact Factor
  • Amy McQueen, Paul R Swank, Sally W Vernon
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    ABSTRACT: To reduce negative psychological affect from information or behavior that is inconsistent with one's positive self-concept, individuals use a variety of defensive strategies. It is unknown whether correlates differ across defenses. We examined correlates of four levels of defensive information processing about colorectal cancer screening. Cross-sectional surveys were completed by a convenience sample of 287 adults aged 50-75 years. Defenses measures were more consistently associated with individual differences (especially avoidant coping styles); however, situational variables involving health-care providers also were important. Future research should examine changes in defenses after risk communication and their relative impact on colorectal cancer screening.
    Journal of Health Psychology 07/2013; · 1.88 Impact Factor
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    ABSTRACT: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.
    Cancer Causes and Control 07/2013; · 3.20 Impact Factor
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    ABSTRACT: Delivering personal narratives and peer support for CRC screening in an online weight-loss community could be an efficient approach to engaging individuals at increased risk, because obesity is associated with excess colorectal cancer (CRC) mortality and lower screening rates. Evaluate user engagement and impact of narratives and peer support for promoting CRC screening in an online weight-loss community. Pilot randomized trial. Members of an online weight-loss community who were not up-to-date with CRC screening were enrolled in the study in 2011. Basic and Enhanced groups (n=153 each) both received education. The Enhanced group also received narratives and peer support for CRC screening in online forums. The main measures were user engagement, psychosocial outcomes, and self-report CRC screening at 6 months. Analyses were conducted with (1) the full sample of participants and (2) a minimum dose sample of those who participated in their assigned intervention to a minimum degree. Analyses were completed in 2012. Participants were mostly female (92%) with a mean age of 56 years. More than 90% in both groups viewed the educational information. Only 57% in the Enhanced group joined the online team. The Enhanced group had greater improvement in motivation for screening than the Basic group at 1 month (p=0.03). In the full sample, there was no difference in CRC screening at 6 months (Enhanced 19% vs Basic 16%, adjusted OR=1.33, 95% CI=0.73, 2.42). In the minimum dose sample, fecal occult blood testing was higher in the Enhanced (14%) vs Basic (7%) group (adjusted OR=2.49, 95% CI=1.01, 6.17). Although no between-group differences in CRC screening were seen at 6 months, this study did demonstrate that it is feasible to deploy a narrative and peer support intervention for CRC screening in a randomized trial among members of an online community. However, modifications are needed to improve user engagement. This study is registered at ClinicalTrials.gov NCT01411826.
    American journal of preventive medicine 07/2013; 45(1):98-107. · 4.24 Impact Factor

Publication Stats

6k Citations
762.46 Total Impact Points

Institutions

  • 1990–2014
    • University of Texas Health Science Center at Houston
      • • School of Public Health
      • • Center for Health Promotion and Prevention Research
      • • Division of Health Promotion and Behavioral Sciences
      • • School of Nursing
      Houston, Texas, United States
  • 2013
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
  • 2003–2013
    • University of Washington Seattle
      • • Health Promotion Research Center
      • • Department of Health Services
      Seattle, Washington, United States
    • Texas A&M University
      • Department of Psychology
      College Station, TX, United States
    • Salt Lake City Community College
      Salt Lake City, Utah, United States
  • 2012
    • Texas Tech University Health Sciences Center
      El Paso, Texas, United States
  • 2004–2012
    • University of Texas Medical School
      • Department of Internal Medicine
      Houston, TX, United States
  • 1995–2012
    • University of Houston
      Houston, Texas, United States
  • 2011
    • University of Michigan
      • Department of Internal Medicine
      Ann Arbor, MI, United States
  • 2010–2011
    • Thomas Jefferson University
      • • Division of Internal Medicine
      • • Department of Family & Community Medicine
      Philadelphia, PA, United States
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • National Human Genome Research Institute
      Maryland, United States
    • Virginia Commonwealth University
      • Department of Epidemiology and Community Health
      Richmond, VA, United States
  • 2008–2010
    • Washington University in St. Louis
      • • Division of Health Behavior
      • • Department of Medicine
      Saint Louis, MO, United States
    • Centers for Disease Control and Prevention
      • National Center for Chronic Disease Prevention and Health Promotion
      Druid Hills, GA, United States
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
  • 2007–2010
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
  • 2005–2010
    • Emory University
      • • Department of Behavioral Sciences and Health Education
      • • Winship Cancer Institute
      Atlanta, GA, United States
  • 2003–2010
    • National Cancer Institute (USA)
      • • Applied Research Program (ARP)
      • • Division of Cancer Control and Population Sciences
      Maryland, United States
  • 2004–2009
    • Baylor College of Medicine
      • • Department of Family & Community Medicine
      • • Veterans Affairs Medical Center
      Houston, TX, United States
  • 1992–2009
    • University of Texas MD Anderson Cancer Center
      • • Department of Behavioral Science
      • • Cancer Prevention Center
      • • Department of Medical Oncology
      Houston, Texas, United States
  • 2003–2006
    • Houston Graduate School of Theology
      Houston, Texas, United States
  • 1998
    • University of North Carolina at Chapel Hill
      North Carolina, United States