[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) is third in cancer incidence and mortality, due in part to lack of awareness and low rates of screening. The purpose of the present study was to evaluate the efficacy of a spiritually based CRC educational intervention delivered by trained Community Health Advisors, in Alabama churches. The aim of the intervention was to increase knowledge and awareness of CRC and early detection, and to eventually increase CRC screening rates. Participants age-eligible for screening (N = 122) completed baseline, 6-month, and 12-month surveys by telephone. Increases in CRC knowledge, perceived benefits of CRC screening, and awareness of the screening modalities and decreases in perceived barriers to screening suggested that this type of intervention may be promising for CRC control and should be examined further.
Health Promotion Practice 04/2011; 12(4):577-88. · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban-rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban-rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.
Health Education Research 05/2009; 24(5):876-89. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Physician recommendation is a major determinant of colorectal cancer screening. The purpose of this study was to examine physician attitudes and self-reported colorectal cancer patient screening. In a physician survey, perceived patient barriers included preparation for the tests and patient dislike of the blood stool test. Physician semistructured interviews revealed that perception of patient barriers included cost, time off from work, and transportation. Most physicians reported low knowledge of insurance coverage for screening, and self-reported screening rates among physicians themselves were not optimal. Evidence-based interventions to increase physician recommendations for screening, such as reminder and tracking systems, may be of value. Interventions that target physician knowledge of insurance coverage and encourage physicians to adopt screening themselves could also be considered.
American Journal of Medical Quality 03/2009; 24(2):116-22. · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined colorectal cancer (CRC) knowledge and the relationship between knowledge, risk factors and screening behaviors among African Americans and Whites in the Deep South. One hundred and twenty three African Americans and Whites age-eligible for CRC screening were interviewed by telephone survey as part of a church-based CRC educational intervention. CRC knowledge was lower among those with less education, unemployed, Medicaid, Medicare, and less family income. Generally, participants who had more CRC knowledge were more likely to have engaged in screening behaviors. Participants who had a family history of CRC were more likely to have had a fecal occult blood test (OR = 2.55, 0.99-6.60) or barium enema (OR = 3.84, 1.44-10.24) than those without. Whites were more likely to have had a flexible sigmoidoscopy (OR = 4.17, 1.09-16.67), colonoscopy (OR = 7.14, 1.72-25) or barium enema (OR = 6.25, 1.67-25) than African Americans. Church-based CRC screening intervention programs should target African Americans, those with no family history of CRC, and those with less education.
Journal of Community Health 11/2008; 34(2):90-7. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and affects all racial and ethnic groups, although taking a particularly heavy toll on African Americans, who are more likely to die from the disease than Whites. Even with the availability of CRC screening, only an estimated 30% of the US population takes advantage of these tests. This suggests that interventions should focus both on increasing awareness as well as decreasing barriers to CRC screening. Culturally-relevant community-based interventions are one way to achieve this goal. The primary purpose of this project is to evaluate the effectiveness of a spiritually-based intervention to increase colorectal cancer knowledge and screening among church-attending African Americans and Whites. The spiritually-based approach involved framing the CRC early detection message with relevant spiritual themes (e.g., balance of healthy body, mind, and spirit; body is a temple of holy spirit which should be taken care of) and scripture, identified and pilot tested with the priority communities. The intervention was implemented in three churches (two African American and one White). It was implemented by Community Health Advisors, who were trained to talk to their fellow church members about CRC, based on spiritually-based print materials developed for the study. Study outcomes included CRC knowledge, perceived barriers to and benefits of screening, actual screening behavior, and participant satisfaction with the program, and were assessed at baseline and six-month and 12-month follow-up through use of self-administered survey. Results are discussed overall and by racial group.
135st APHA Annual Meeting and Exposition 2007; 11/2007
[Show abstract][Hide abstract] ABSTRACT: To examine the pattern of physician advice-giving to individuals with hypertension and to determine if advice-giving and adherence to advice vary by race.
Frequency of physician recommendations and patient adherence to such advice were analyzed using data from the Third National Health and Nutrition Examination Survey conducted from 1988 to 1994. A total of 2066 women were included in the study.
The frequency of advice-giving and patient adherence to that advice varied as a function of the type of advice dispensed. Physician advice-giving and patient adherence also varied as a function of race; compared to Black women, White women were 60% less likely [OR (95% CI): 0.41 (0.25, 0.65)] to be told to take prescribed medicines and 56% less likely [OR (95% CI): 0.44 (0.26, 0.76)] to be told to exercise. Regarding patient adherence, compared to Black women, White women were 37% less likely [OR (95% CI): 0.63 (0.44, 0.91)] to use prescribed medicines, 59% less likely [OR (95% CI): 0.41 (0.26, 0.66)] to report reducing use of salt/sodium, and among overweight women, 50% less likely [OR (95% CI): 0.50 (0.31, 0.81)] to report efforts to control/lose weight.
The variability of physician advice and patient adherence as a function of race warrants further study.
Preventive Medicine 11/2006; 43(4):337-42. · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this population-based study was to examine the relationship between race, socioeconomic characteristics (socioeconomic status, SES), physician density, and colon cancer incidence in Alabama.
Data for 5,788 colon cancer cases from 1996 to 1999 provided by the Alabama Statewide Cancer Registry are linked to county-level measures of SES, including median household income, percentage of high school graduates, percentage of families below poverty level, and occupational and health care factors. Poisson regression is used to model the predictors adjusting for age, gender, and race.
Blacks had higher incidences of colon cancer compared with whites and presented with later stages (20.4% versus 14.8% for distant disease (P = 0.0089). After controlling for race, gender, and age at diagnosis, significant associations were detected between colon cancer incidence and higher education (RR = 1.10; 95% CI, 1.03-1.17), and increased number of physicians per 1,000 (RR = 1.14; 95% CI, 1.06-1.22). The county percentage of families below poverty is associated inversely with localized disease and positively with distant stage.
Colon cancer incidence varies geographically across Alabama and is positively related to aggregate SES factors, including education and physician density. A higher incidence of distant disease is related to black race and increased poverty. Health disparities in colon cancer across Alabama warrant further investigation.
Southern Medical Journal 12/2005; 98(11):1076-82. · 0.92 Impact Factor