[Show abstract][Hide abstract] ABSTRACT: Objectives
Interventions are needed to reduce disparities in breast and cervical cancer (BCC) for Latinas in the USA. This study compares screening adherence between two educational outreach messages followed by navigation support to increase BCC screening for Latinas.
A cluster-randomized study (by group) of 1,333 diverse Latinas in Arkansas, Buffalo, and New York City (2007–2009) attending group educational programs on cancer or diabetes screening was conducted. Screening adherence by each program type was analyzed at 2 months followed by analysis of navigation support for non-adherent women at 8 months.
Participation in educational programs alone significantly increased mammography (O.R. = 2.16), clinical breast exams (O.R. = 2.14), and Pap tests (O.R. = 2.14) from baseline to 2 months with no significant differences by message type. Screening further increased with the addition of navigation.
Specific health messaging may not be as critical to increasing BCC screening behaviors as cultural- and language-specific outreach into the community disseminating resources about accessing services. Moreover, the addition of navigation services and, potentially, the time lapse between follow-up intervals, significantly increased screening regardless of country of birth, documentation status, insurance status, or geographic location.
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations.
Trained interviewers in 2006 conducted a random-digit-dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status.
Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice.
Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.
Full-text · Article · Aug 2012 · Preventing chronic disease
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Colorectal cancer is the third leading cause of death that disproportionately affects the poor and underserved. A community-based participatory approach (CBPR) is a promising approach to prevent colorectal cancer in this population. The collaborative development of a theory-grounded, randomized-controlled trial designed to test two colorectal cancer screening interventions through fecal-occult blood testing (total participant n=1050) is described, with an emphasis on how community and academic partners worked together to design intervention and research components.
METHODS: Empowering Communities for Life (EC4L) takes place in two underserved counties in the Arkansas Lower Mississippi Delta with marked health disparities. The program arose from a 9-year partnership between academics and nine Cancer Councils across Arkansas. Community and academic partners collaborated over 25 months to develop research infrastructure, intervention materials and methods, and the assessment instrument.
RESULTS: Strengthened community-academic partnerships, certification in Human Subjects and HIPPA, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models, and an assessment tool are project development outcomes. Additionally, several lessons were learned about working collaboratively with diverse groups.
CONCLUSIONS: Few studies have developed a community-based colorectal cancer prevention intervention for an at-risk population using a participatory approach. EC4L is a useful model for community-based interventions seeking to incorporate sound research methodology and health behavior theory to increase colorectal cancer screening among rural, underserved African Americans and Caucasians in the context of eliminating social disparities in health.
[Show abstract][Hide abstract] ABSTRACT: The Arkansas Cancer Connection Program is a community-academic partnership between the University of Arkansas for Medical Sciences and nine community-based coalitions designed to address cancer health disparities through community-based participatory research. In 2005, a survey measuring coalition capacity was administered to 51 Cancer Council members to assess training needs and increase coalition capacity. The highest scoring components were leadership and member engagement while the lowest were development and capacity effectiveness. Effectiveness correlated with aspects of coalition capacity. The evaluation identified training needs, which were met by projects leveraging the coalition's strengths to advance community-based participatory research addressing cancer disparities.
No preview · Article · Jun 2011 · Journal of Cancer Education
[Show abstract][Hide abstract] ABSTRACT: Disparities in breast cancer survival rates suggest that biological processes contribute. Translational research addressing health disparities would benefit from using a community-based participatory approach (CBPR) to examine biological processes commonly seen as the proximal causes of illness as well as behavioral and social-ecological "causes of the causes" within an integrated conceptual framework. This paper describes a CBPR study that explored perceptions regarding breast cancer relevant behaviors, and the application of the study's results to develop translational research. Data from eight focus groups of African American (n = 29) and Caucasian women (n = 27) were analyzed, using the framework of the social-ecological model. Nutrition and physical activity were valued over screening and research participation. Treatment of illness was emphasized over prevention. Women's perspectives are presented within a framework that facilitated the collaborative development of translational research to examine associations among biological, behavioral, and societal processes contributing to disparities.
Full-text · Article · Jun 2011 · Translational Behavioral Medicine
[Show abstract][Hide abstract] ABSTRACT: The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population.
The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas.
Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument.
Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system.
Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.
Full-text · Article · Mar 2011 · Preventing chronic disease
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer incidence and mortality rates in Arkansas exceed national averages and can be reduced through systematic screening that either identifies precursor lesions that can be removed before cancer develops, or diagnoses cancer at an early stage when it is most responsive to treatment. Results of a survey assessing screening status of Arkansas residents and dimensions of health care supporting colorectal screening indicate that primary care providers can play an important role in efforts to decrease the burden of colorectal cancer by informing patients about risk factors and providing advice about the full range of screening options.
No preview · Article · Sep 2009 · The Journal of the Arkansas Medical Society
[Show abstract][Hide abstract] ABSTRACT: The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.
Full-text · Article · Aug 2009 · Health Education Research
[Show abstract][Hide abstract] ABSTRACT: There is a significant benefit in campus and community coalitions working together. Especially, as cancer disparities continue to plague our healthcare system. Literature supports collaboration with communities to co-develop interventions designed to address and reduce cancer disparities. This abstract highlights the development of a three phase process for the implementation of a community-based research training program to prepare both community and academic researchers for Community-based Participatory Research (CBPR). The Arkansas Cancer Community Network (AR-CCN) developed and implemented a program that included CBPR planning, Community Development, and pilot research. The tools developed included the Arkansas Community Action Training (AR-CAT) and the Coalitions Online web-collaborating tool which are meant to prepare the community partners and academic investigators to work together to conceptualize and implement a CBPR project. A competitive grant submission process was developed in order to introduce CBPR to the Cancer Councils. Six out of the seven Cancer Councils submitted CBPR Planning Grants. Four of the Cancer Councils were successful in their submission and participated in the training program. Three of the four Cancer Councils collaborated with AR-CCN to write a Community Development Proposal. Of those three, two received $10,000 grants to support implementation. The collaborative project collected data that provided pilot information to support the submission of an R24 CBPR Minority Health Disparities Proposal. The three phase process has allowed community and academic researchers to tailor interventions to the identified needs of the community and translate evidence-based interventions into sustainable community change. Process, benefits and challenges will be addressed.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Traditional policy development relies on organized interest groups and minimizes the role of communities. Minority and underserved communities can contribute to policies for reducing cancer disparities. The Arkansas Cancer Community Network (ARCCN) developed a model for engaging communities with decision makers and researchers in community-focused, evidence-based cancer policy development. Early experiences with the model's implementation were documented. OBJECTIVES: This study profiles the evaluation design for the AR-CCN policy model and presents early findings. METHODS: Assessment of this integrated approach occurs at three levels: advisory, institutional, and community. The evaluation design tracks policy development activities in five domains: 1. Information Dissemination 2. Partnership Building. 3. Policy Assessment 4. Policy Alternatives 5. Program Development. Key process measures are collected using a tool that monitors these and other common elements across all components of ARCCN. Items are categorized according to their proximal, intermediate or distal impact on cancer policy development. A community policy needs assessment was developed to determine local knowledge of policy processes and resources for engagement. FINDINGS: Early findings indicate progress in all five domains with significant movement in information dissemination, partnership building and policy assessment. Findings from the community policy needs assessment suggest that policy awareness is relatively low in most communities but significant resources exist for policy engagement. CONCLUSIONS: The AR-CCN policy model achieved success in stimulating activities that inform cancer policy through the integrated model. Transferability to other health policy issues appears promising. The health impact and sustainability of resulting policies are areas for future study.
[Show abstract][Hide abstract] ABSTRACT: We sought to determine whether adding motivational interviewing to a behavioral weight control program improves weight loss outcomes and glycemic control for overweight women with type 2 diabetes.
We conducted a randomized, controlled, clinical trial in which participants all received an 18-month, group-based behavioral obesity treatment and were randomized to individual sessions of motivational interviewing or attention control (total of five sessions) as an adjunct to the weight control program. Overweight women with type 2 diabetes treated by oral medications who could walk for exercise were eligible. Primary outcomes were weight and A1C, assessed at 0, 6, 12, and 18 months.
A total of 217 overweight women (38% African American) were randomized (93% retention rate). Women in motivational interviewing lost significantly more weight at 6 months (P = 0.01) and 18 months (P = 0.04). Increased weight losses with motivational interviewing were mediated by enhanced adherence to the behavioral weight control program. African-American women lost less weight than white women overall and appeared to have a diminished benefit from the addition of motivational interviewing. Significantly greater A1C reductions were observed in those undergoing motivational interviewing at 6 months (P = 0.02) but not at 18 months.
Motivational interviewing can be a beneficial adjunct to behavioral obesity treatment for women with type 2 diabetes, although the benefits may not be sustained among African-American women.
[Show abstract][Hide abstract] ABSTRACT: The origin of cancer health disparities and mortality in Arkansas is multifactorial. In response to a cooperative agreement with the National Cancer Institute's Center to Reduce Cancer Health Disparities, the Arkansas Special Populations Access Network (ASPAN) was developed to reduce these disparities. ASPAN's partnership with local primary care physicians of the Arkansas Medical, Dental, and Pharmaceutical Association through the Cancer Education Awareness Program is the focus of this article. A quasi-experimental intervention, the Community Cancer Education Awareness Program, was employed that included 1) physician education to increase awareness of risk factors and cancer screening; and 2) patient education to increase screening, and 3) patient-generated screening questionnaires to prompt discussion of cancer risk and screening recommendations between patients and physicians. Two urban and 2 rural clinics were targeted during a 12-month period with interval intervention assessments. Baseline review of records (n = 200) from patients >/=40 were utilized to assess the rate of breast, prostate, and colorectal screenings among clinics. For the patient education intervention, patients (n = 120) were interviewed via a 34-item assessment. Physician awareness of cancer risk factors and screening recommendations significantly increased. Statistically significant increases were seen for prostate (P = .028), breast (P = .036), and colorectal (P < .001) cancer screening across all 4 clinics. Patients' increased likelihood of cancer screenings was associated with knowledge about consumption of animal fat (P < .001), dietary fiber (P < .013), and mammograms (P < .001). Utilizing the physician as the central change agent, the ASPAN provider network successfully enhanced cancer screening awareness of minority physicians and their patients. Cancer 2006. (c) 2006 American Cancer Society.
[Show abstract][Hide abstract] ABSTRACT: Few studies have investigated community clinic-based interventions to promote mammography screening among rural African American women. This study randomized older low-income rural African American women who had not participated in screening in the previous 2 years to a theory-based, personalized letter or usual care; no group differences in mammography rate were evident at 6-month follow-up. Women who had not obtained a mammogram were then randomized to a tailored call delivered by community health care workers or a tailored letter. There were no group differences in mammography rates after the second 6-month follow-up. However, among women who had never had a mammogram, the tailored call was more effective in promoting mammography use. Tailored counseling may be an effective screening promotion strategy for hard-to-reach rural African American women with no history of screening. Further research into this strategy may facilitate efforts to reduce health disparities in underserved low-income rural African American populations.
No preview · Article · Sep 2004 · Health Education & Behavior
[Show abstract][Hide abstract] ABSTRACT: Women with a family history of breast cancer are at increased risk for developing cancer and, therefore, might be expected to engage in early detection practices more actively than women without a family history. Alternatively, women with a family history may avoid thinking about cancer and have attitudes and practices that do not promote early detection.
This study examined breast cancer attitudes and practices among African American women aged >or=50 who had not had a mammogram in the last 2 years.
Phone survey data from 320 female clients of low-income, rural primary care clinics (91% African American) indicated that 15% self-reported a family history of breast cancer (FH(+)). Half of the FH(+) women did not know their relative risk of developing breast cancer. Of those providing a risk estimate, 67% perceived themselves at low risk compared with other women their age. Perceived relative risk was comparable between FH(+) and FH(-) women. Further, FH(+) women did not indicate greater worry about breast cancer, nor did they have more accurate knowledge of mammography recommendations than FH(-) women. Two thirds of FH(+) women had never had a mammogram. Monthly breast self-examination did not differ between FH(+) and FH(-) women.
Thus, neither knowledge of a positive family history nor perceived relative risk of breast cancer was associated with either increased or decreased early detection practices among these low-income, rural, African American women who have underused mammography. Furthermore, a substantial proportion of FH(+) women had not ever participated in screening mammography. Interventions to increase mammography rates in this population of underusers are indicated.
No preview · Article · Oct 2003 · Journal of Women's Health
[Show abstract][Hide abstract] ABSTRACT: From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.
No preview · Article · Dec 2002 · Health Psychology
[Show abstract][Hide abstract] ABSTRACT: In the case of recurrent ovarian cancer, salvage therapy represents the potential to trade off between quality and quantity of life. Patient and physician face a choice between chemotherapy directed at slowing disease progression and supportive or palliative care that focuses on symptom management. To date, no studies have investigated the effects of best supportive care on ovarian cancer patients' quality of life and length of life as compared to salvage therapy. In other cancers, both quantity and quality of life considerations have been shown to affect treatment preferences.
Using a decision board, we assessed preferences for salvage therapy or palliative care in the case of recurrent ovarian cancer among 81 ovarian cancer patients receiving first-line chemotherapy and 75 Noncancer Controls.
Compared to Noncancer Controls, ovarian cancer patients overwhelmingly preferred salvage therapy; quantity of life was of primary importance. In both groups, preference was not related to age, marital status, number of children, or employment status. On average, patients indicated they would switch from salvage therapy to palliative care when the median survival associated with salvage therapy was reduced to 5 months. Noncancer Controls would switch significantly sooner, when the median increment in survival period was reduced to 8 months. Switchpoint was not associated with life satisfaction, quality of life, or psychological or spiritual well-being in either group.
The majority of women, independent of a cancer diagnosis, indicated a desire for continuing aggressive treatment, despite poor outcomes. Quality of life was of secondary importance, especially among ovarian cancer patients.
No preview · Article · Sep 2002 · Gynecologic Oncology
[Show abstract][Hide abstract] ABSTRACT: We measured health-related quality of life (HRQL) by using the Medical Outcomes Study 36-Item Short-Form (SF-36) in a cross-sectional study of 1,094 African American men and women with mild to moderate chronic renal insufficiency (mean glomerular filtration rate, 45.7 mL/min/1.73 m2) caused by hypertension before randomization onto the African American Study of Kidney Disease and Hypertension (AASK) Trial. Scales contributing to physical health and a summary measure, the Physical Component Summary (PCS) score (mean, 43.4 +/- 10.9 [SD]), were significantly lower than scales relating to mental health and the Mental Component Summary (MCS) score (51.3 +/- 10.3). All scales (except Role-Physical) and the PCS and MCS were significantly higher in men (44.3 +/- 10.9 and 51.8 +/- 10.0, respectively) than women (41.9 +/- 10.8 and 50.5 +/- 10.6, respectively). In multivariate analysis, employment status, education level, household income, body mass index, comorbid medical conditions, years of hypertension, number of antihypertensive drugs prescribed, exercise status, and male sex were significant independent predictors of PCS. Fewer factors predicted MCS and included employment status, marital status, current smoking, age, comorbid medical conditions, and male sex. In the entire AASK cohort, mean scores for individual scales, except Mental Health, and the PCS were lower, but the mean MCS score was slightly higher than values for the US general population. Values for individual scales of the SF-36 and the PCS were substantially higher among AASK participants compared with African-American hemodialysis patients. Six of the eight scales were lower in the AASK cohort compared with groups of racially mixed and exclusively African-American hypertensive subjects. We conclude that physical aspects of quality of life are substantially reduced compared with mental components among AASK participants, and a number of demographic and clinical characteristics significantly impact on HRQL.
No preview · Article · Apr 2002 · American Journal of Kidney Diseases
[Show abstract][Hide abstract] ABSTRACT: To compile lessons learned from the Uniontown Community Health Project.
Lessons-learned information was gathered from project staff and community volunteers.
Analysis led to the identification of 6 lessons: (a) Establish personal working relationships in communities; (b) find a local community coordinator to lead efforts; (c) be patient in implementing a community health advisor (CHA) model; (d) be flexible and emphasize simplicity when implementing community activities; (e) recognize that meeting research goals requires compromise; and (f) plan transfer of project activities to the community from the beginning.
These lessons may benefit others implementing CHA programs.
No preview · Article · Jan 2002 · American journal of health behavior
[Show abstract][Hide abstract] ABSTRACT: Relative risks computed from known breast cancer risk factors can be used to quantitate a woman's individual risk of developing breast cancer. However, among older women the absolute risk of developing breast cancer over a specified time interval may be more useful in risk-benefit counseling. The objective of this investigation is to characterize the relationships between relative risks and absolute risks of breast cancer among a population of rural, older African American women. Among 224 African American women aged 50–91 years, relative risks were computed from historical information on age at menarche, number of previous biopsies, age at first birth, and number of first-degree relatives with breast cancer. These estimates, combined with the woman's current age, average remaining life expectancy, age-specific mortality, and breast cancer incidence rates, were used to estimate lifetime probabilities of developing breast cancer. Most women in the cohort (72.8%) had weak relative risks of 1.01–1.5 and only 3.5% of the women had relative risks of greater than 3.0. The majority of the women (87.5%) had lifetime probabilities of developing breast cancer that were less than 5%. Although there is a marked increase in age-specific breast cancer incidence with age, the probability of developing breast cancer in this population is low, primarily due to the low relative risks and the effects of competing mortality at older ages. Screening mammography should be directed toward women with high risks who are not receiving regular screening mammograms.
No preview · Article · Oct 1999 · The Breast Journal
[Show abstract][Hide abstract] ABSTRACT: Cancer screening rates are particularly low among poor, minority, and rural women, those segments of the population with the highest cancer mortality risk. Therefore, targeted strategies to increase screening in these population groups are needed.
This paper describes a partnership between the University of Alabama at Birmingham (UAB) and Family HealthCare of Alabama, a nonprofit health care agency, initiated to promote cancer control and prevention in a predominantly low-income, African-American population in rural western Alabama. The partnership has collaborated in the development of two research proposals designed specifically to evaluate cancer control strategies within the context of routine health care delivery.
The UAB/Family HealthCare partnership is conducting two randomized treatment outcome studies funded by the National Cancer Institute to evaluate theory-based patient management strategies to promote patient adherence to screening recommendations for cervical cancer and breast cancer.
The success of this academic-practice partnership can be seen in the funded research projects, the enhancement of preventive services in rural primary care, and in the potential to disseminate theory-based cancer control strategies throughout an extended primary care network.
No preview · Article · May 1999 · American Journal of Preventive Medicine