Recruitment and Retention for the Evaluation of a Healthy Food Initiative in Economically Disadvantaged, Majority African American Communities

Effective recruitment and retention supports equitable participation in research. The aim of this article is to describe recruitment and retention methods among residents of highly disadvantaged, predominantly African American communities in the southeastern United States during the evaluation of a healthy food access initiative. We proposed that active and passive recruitment methods, intensive retention strategies, community outreach and involvement, over-enrollment to anticipate attrition, and applied principles of community participation would achieve the study's recruitment and retention goals. The enrollment goal of 560 was met at 94% (n = 527), and the retention goal of 400 was achieved (n = 408).

Persistence and transience of food insecurity and predictors among residents of two disadvantaged communities in South Carolina

BACKGROUND

Little is known about patterns of household food insecurity (HFI) across more than two time points in adults in the United States, the frequency predictors of different trajectories. The distinctions between persistent and transient food insecurity trajectories may be crucial to developing effective interventions.

OBJECTIVE

To characterize dominant trajectories of food security status over three time points between 2013 and 2016 and identify demographic, socioeconomic and health-related predictors of persistent and transient HFI.

DESIGN

Cohort study in disadvantaged communities in South Carolina.

SETTING

and subjects: 397 middle-aged participants, predominantly female, African American, living in USDA-designated food deserts.

MAIN OUTCOME MEASURE

Household food insecurity over time using the 18-item USDA's Household Food Security Survey Module.

STATISTICAL ANALYSES PERFORMED

Descriptive analyses of food security trajectories and multinomial regression analyses.

RESULTS

At baseline (2013-2014), 61% of households reported HFI during the previous 12 months, which decreased to 54% in 2015 and to 51% in 2016. Only 27% of households were persistently food secure, 36% experienced transient and 37% persistent food insecurity. Female sex (OR 2.7, 95%CI 1.2-5.9), being married or living with a partner (OR 2.4, 95CI% 1.1-5.3) and fair health status (OR 4.4, 95%CI 2.2-8.8) were associated with increased odds of persistent food insecurity. Fair health was also a significant predictor of transient food insecurity.

CONCLUSIONS

These findings suggest that future research should focus on persistent versus transient trajectories separately and that tailored interventions may be needed to make progress on alleviating food insecurity among disadvantaged communities.

Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States

Objective: To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design: We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results: Participants (n = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households (p < .05). Household income and food security were positively associated with meeting several dietary guidelines (p < .05). Food desert residence was unrelated to diet variables. Conclusions: In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.

Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation

A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.

Community Health Advisors' Characteristics and Behaviors, Role Performance, and Volunteer Satisfaction in a Church-Based Healthy Eating and Physical Activity Intervention

Community Health Advisors (CHAs) contribute to health promotion program effectiveness, but their role in faith-based programs is understudied, and little is known about their role performance or satisfaction. In a dissemination and implementation study, 19 CHAs were trained to provide healthy eating (HE) and physical activity (PA) program training to church committees. Of these, 17 CHAs trained 347 attendees from 115 churches. Thirteen CHAs remained for the 12-month period and provided telephone-based technical assistance (TA) to churches. To evaluate their experiences and satisfaction, CHAs completed questionnaires at baseline and 12 months. Staff observers and church committee members evaluated CHAs' effectiveness as trainers. There were no significant changes in the CHAs' own body mass index, PA, fruit and vegetable intake, or self-rated health but significant increases in their perceived knowledge of PA (p = 0.01) and HE (p = 0.02). CHAs reported high agreement regarding the quality of their training for the role and moderate volunteer satisfaction on average but thought that the time required of them was somewhat more than expected, though they were interested in volunteering for a future, similar role. Church committee members agreed with CHAs' effectiveness as trainers and the helpfulness of the TA calls. Staff observers rated CHAs' as having covered 87.8% of church training content and agreed that, on average, the CHAs were effective trainers. Assessing CHAs' availability, clear communication about the time requirements, and over-recruitment to offset attrition and decrease the workload may be needed to improve retention and support satisfaction.

A food hub to address healthy food access gaps: Residents' preferences

Interventions aimed at improving access to healthy food in low-income communities should consider the preferences of residents. Household food shoppers in two urban, low-income communities were asked about their preferences for vendors at, and qualities of, a potential nearby food hub. Universally, participants preferred availability of whole foods, primarily fruits and vegetables. They also favored cleanliness, quality, and affordability. The demographics and preferences of potential customers raise central issues that would need to be integrated into the development of a food hub, namely affordability (likely through subsidization), attention to accommodation and cultural accessibility, and programming that builds community.

Socioecological Path Analytic Model of Diet Quality among Residents in Two Urban Food Deserts

BACKGROUND

Diet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality.

OBJECTIVE

The goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts.

DESIGN

A cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments.

PARTICIPANTS/SETTING

Data collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH.

MAIN OUTCOME MEASURE

HEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research.

ANALYSIS

Separate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community.

RESULTS

Across both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P<0.05) and distance traveled to primary food store (β=.111, Cleveland, P<0.10; β=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=-.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R²=.282 and R²=.152, respectively).

CONCLUSIONS

Findings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away.

Church leaders' barriers and facilitators before and after implementing a physical activity and nutrition intervention

Faith-based health promotion programs have been effective in increasing healthy eating (HE) and physical activity (PA). Very few reports exist regarding church leaders' anticipated and experienced barriers and facilitators to program implementation. Pastors (n = 38, 70%) and program coordinators (n = 54, 100%) from churches (N = 54) who attended a program training answered open-ended questions about anticipated barriers and facilitators to implementing the HE and PA parts of the Faith, Activity, and Nutrition (FAN) program. Twelve months later, pastors (n = 49, 92%) and coordinators (n = 53, 98%) answered analogous questions about their experienced barriers and facilitators to implementing the HE and PA parts of the FAN program. Responses were coded using thematic analysis. Similar themes appeared at baseline and follow-up for anticipated and experienced barriers and facilitators. The most common barriers were no anticipated barriers, resistance to change, church characteristics, and lack of participation/motivation. The most common facilitators were internal support, leadership, and communication. Few differences were found between anticipated and experienced barriers and facilitators. Understanding these perspectives, particularly overcoming resistance to change and church characteristics through strong leadership and internal support from church leaders, will improve future program development, resources, and technical assistance in faith-based and non-faith-based communities alike.

Sumter County on the Move! Evaluation of a Walking Group Intervention to Promote Physical Activity Within Existing Social Networks

BACKGROUND

Social network-driven approaches have promise for promoting physical activity in community settings. Yet, there have been few direct investigations of such interventions. This study tested the effectiveness of a social network-driven, group-based walking intervention in a medically underserved community.

METHODS

This study used a quasi-experimental pretest-posttest design with 3 measurement time points to examine the effectiveness of Sumter County on the Move! in communities in Sumter County, SC. A total of 293 individuals participated in 59 walking groups formed from existing social networks. Participants were 86% females, 67% black, and 31% white, with a mean age of 49.5 years. Measures included perceptions of the walking groups; psychosocial factors such as self-regulation, self-efficacy, and social support; and both self-reported and objectively measured physical activity.

RESULTS

The intervention produced significant increases in goal setting and social support for physical activity from multiple sources, and these intervention effects were sustained through the final measurement point 6 months after completion of the intervention. Nonetheless, few of the desired changes in physical activity were observed.

CONCLUSION

Our mixed results underscore the importance of future research to better understand the dose and duration of intervention implementation required to effect and sustain behavior change.

Food Acquisition and Shopping Patterns among Residents of Low-Income and Low-Access Communities in South Carolina

BACKGROUND

Little is known about the food acquisition and shopping habits of residents living in food deserts.

OBJECTIVE

To identify distinct food acquisition and shopping patterns among residents, most of whom (81%) live in food desert (low income and low access) census tracts, and characterize these patterns with respect to the residents' socioeconomic status, nutrition knowledge, and perceptions of their food environment.

DESIGN

This is a cross-sectional study.

PARTICIPANTS/SETTING

Four hundred sixty-six primary food shoppers were included from two counties in South Carolina during 2013-2014.

MAIN OUTCOME MEASURES

Participants' self-reported food acquisition and shopping habits, including shopping distance; frequency; store type; transportation mode; use of farmers' markets, food banks/pantries, and church/social service organizations, were used to develop shopping patterns and group residents. Supplemental Nutrition Assistance Program participation, food security, income, and education, nutrition knowledge, and perceptions of the food environment were used to characterize these groups.

STATISTICAL ANALYSES PERFORMED

Latent class analysis and multinomial logistic regression were used to identify and characterize patterns, respectively.

RESULTS

Three patterns were identified, including those who use community food resources, are infrequent grocery shoppers, and use someone else's car or public transportation when shopping (Class 1) (35%), those who use community food resources and are more frequent and proximal shoppers (Class 2) (41%), and those who do not use community food resources and are distal shoppers (Class 3) (24%). Compared with Class 3, Class 1 had comparatively lower socioeconomic status. Class 2 also had comparatively lower socioeconomic attributes except for income. Class 2 was not significantly different from Class 1 except that a higher proportion in Class 1 saw food access as a problem. No significant differences across classes were found regarding fruit and vegetable recommendation knowledge.

CONCLUSIONS

Shopping frequency, use of community food resources, transportation methods, and shopping distance were the key factors that defined distinct patterns among residents living in low-income areas. Future interventions to increase healthy food access in underserved areas should not only consider accessibility but also community food resource use.

Impact on Dietary Choices After Discount Supermarket Opens in Low-Income Community

OBJECTIVE

To examine (1) the association of a new supermarket opening with dietary intake and perceptions of healthy food availability, and (2) associations of distance to the primary food store and mean prices of fruits, vegetables, and sugary beverages with levels of consumption of these foods and body mass index in a low-income, southeastern community.

METHODS

The researchers used cross-sectional, self-administered questionnaire data and supermarket audit data collected in the supermarket community and comparison community before (2015) and after (2016) the supermarket opening. A difference-in-difference analysis employed propensity scores to compare pretest and posttest differences between communities.

RESULTS

There were no significant differences between communities on dietary behaviors. There was a significant cross-sectional, inverse association between distance to the primary food store and fruit and vegetable consumption among all respondents in 2016.

CONCLUSIONS AND IMPLICATIONS

The results suggest that adding a new discount supermarket is not necessarily associated with improvements in residents' fruit, vegetable, or sugary beverage consumption, or in their perceptions of the availability of healthy food in the neighborhood. However, distance to the store may be important.

Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness

INTRODUCTION

Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study.

DESIGN

This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017.

SETTING/PARTICIPANTS

Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated).

INTERVENTION

Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance.

MAIN OUTCOMES MEASURES

The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis.

RESULTS

Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group.

CONCLUSIONS

This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02868866.

Household food security and use of community food sources and food assistance programs among food shoppers in neighborhoods of low income and low food access

Food insecurity exceeds the 14% national level in severely disadvantaged households, and food shoppers seek food sources and assistance. In 513 predominantly African American households in South Carolina, USA, food security was a significant predictor of sources used, adjusted for socio-demographic characteristics (least-squares means = high food security, 2.10; marginal, 2.96; low, 2.91; very low, 3.40). The top sources were churches/social services, food bank/pantry, farmers' market, family/friend/neighbor, soup kitchen/shelter, and hunting/fishing/trapping. Adjusted odds were significantly greater among households of lower food security levels compared to high food security for food from church/social services, food bank/pantry, family/friend/neighbors, soup kitchen/shelter, and community/school/church garden.

The Association between Food Security and Store-Specific and Overall Food Shopping Behaviors

BACKGROUND

Food security is a severe problem in the United States. Few studies have examined its relationship with food shopping behaviors.

OBJECTIVE

This study aimed to examine the association between food security and store-specific and overall food shopping among residents of low-income neighborhoods.

DESIGN

We conducted a cross-sectional study.

PARTICIPANTS/SETTING

Five hundred twenty-seven households were recruited from two counties in South Carolina from November 2013 to May 2014, and 474 households were included in the final analysis.

MAIN OUTCOMES MEASURES

Food security was assessed using the 18-item US-Household Food Security Module questionnaire, and classified into three categories: high or marginal food security (FS), low food security (LFS), and very low food security (VLFS). Store-specific shopping behaviors including frequency, store type, and transportation were queried via in-person interview for the three most-frequented grocery stores. Distance from participants' homes to their reported stores was calculated using Geographic Information Systems.

STATISTICAL ANALYSES

Multivariate linear regression for analyses of distance and frequency and multinomial/ordinary logistic regression for analyses of store type and transportation were used.

RESULTS

Compared to FS participants, a significantly higher proportion of VLFS participants reported a convenience/dollar store as their most-frequented store (odds ratio [OR] 2.31, 95% CI 1.08 to 4.95) or a lack of transportation (OR 2.04, 95% CI 1.25 to 3.33). They also shopped less frequently (b=-.31, P=0.03) at their third most-frequented store and traveled fewer total miles for shopping (b=-4.71, P=0.04). In analyses considering all stores jointly, LFS participants had lower odds of shopping at both supermarkets and convenience/dollar stores (OR 0.44, 95% CI 0.21 to 0.91) compared to food-secure residents.

CONCLUSIONS

The current findings suggest that households with VLFS tend to shop more frequently in stores that have less-healthful options, such as convenience/dollar stores. These findings lend support to ongoing community and policy interventions aimed at improving food access among food-insecure populations.

"Participation, satisfaction, perceived benefits, and maintenance of behavioral self-management strategies in a self-directed exercise program for adults with arthritis"

A process evaluation was conducted in conjunction with a controlled trial of a self-directed exercise program among people with arthritis to describe the program's reach; self-management behaviors, exposure to materials, program perceptions, satisfaction, and perceived benefits; compatibility with targeted participants' needs; and maintenance. Participants (n=197) were predominantly white, middle-aged, college-educated women. At 12 weeks, 73.2% had read ≥90% of the program materials (at nine months>70% had "occasionally" or "often" looked back over each of the five parts of the materials); 63.3% had set goals (52.5% at nine months), and 83.9% had "some" or "a lot" of success following their plan (64.2% at nine months), while 90.4% rated the program "good" or "excellent" (87.5% at nine months). At 12 weeks, the majority (89.3%) used written logs to self-monitor (mean=9.3 logs); by nine months, >70% never kept logs. Most (>80%) rated twelve of thirteen program components as helpful, and 98.6% would recommend the program. From 38% to 62.4% endorsed each of eight program benefits, with small declines of ≤9% at nine months. Qualitative response identified ways the program met and did not meet expectations. The main program compatibility issue was targeting all adults with arthritis, while featuring older adults in materials.

Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities

Community asset mapping (CAM) is the collective process of identifying local assets and strategizing processes to address public health issues and concerns and improve quality of life. Prior to implementing a community-based physical activity intervention with Latinas in the Texas Lower Rio Grande Valley, promotoras [community health workers] conducted 16 interactive sessions in 8 colonias. The analysis of the transcribed CAM recordings and on-site observational data resulted in the construction of Living in Limbo as the thematic representation of these Latinas' social isolation and marginalization associated with pervasive poverty, undocumented immigration status or lack of citizenship, their fears emanating from threats to physical and emotional safety, and the barriers created by lack of availability and access to resources.

Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities

OBJECTIVE

To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index.

METHODS

Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages.

RESULTS

Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02).

CONCLUSIONS AND IMPLICATIONS

Future studies should examine associations between elements of the in-store food environment, purchases, and consumption.

Use of formative research and social network theory to develop a group walking intervention: Sumter County on the Move!

Although social support is a frequently cited enabler of physical activity, few studies have examined how to harness social support in interventions. This paper describes community-based formative research to design a walking program for mobilizing naturally occurring social networks to support increases in walking behavior. Focus group methods were used to engage community members in discussions about desired walking program features. The research was conducted with underserved communities in Sumter County, South Carolina. The majority of focus group participants were women (76%) and African American (92%). Several important themes emerged from the focus group results regarding attitudes toward walking, facilitators of and barriers to walking, ideal walking program characteristics, and strategies for encouraging community members to walk. Most noteably, the role of existing social networks as a supportive influence on physical activity was a recurring theme in our formative research and a gap in the existing evidence base. The resulting walking program focused on strategies for mobilizing, supporting and reinforcing existing social networks as mechanisms for increasing walking. Our approach to linking theory, empirical evidence and community-based formative research for the development of a walking intervention offers an example for practitioners developing intervention strategies for a wide range of behaviors.

Training former dementia caregivers to provide peer education and social support

The purpose of this pilot study was to develop and evaluate a training program for volunteer peer educators of Alzheimer's disease caregivers. Curriculum development included a literature review and a focus group needs assessment with 25 caregivers. Eight former caregivers participated in pilot testing of a 10-unit, 30-hour training program to develop knowledge regarding Alzheimer's disease, caregiving, services, resources, and skills for effective communication. Qualitative and quantitative evaluation revealed gains in skills and knowledge, a high level of participant satisfaction, and suggestions for future training. This study suggests that former caregivers who are no longer actively involved in caregiving can acquire new knowledge and skills as peer educators and work with professionals to provide education, support and referral.

Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium

BACKGROUND

Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession.

PURPOSE

To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice.

SETTING

A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain.

PARTICIPANTS

Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada.

DESIGN

Qualitative analysis of secondary cross-sectional data using a grounded theory approach.

RESULTS

Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice.

DISCUSSION

The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy.

CONCLUSIONS

Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues.

Implementing a Community Empowerment Center to Build Capacity for Developing, Implementing, and Sustaining Interventions to Promote Community Health

The Community Empowerment Center used a community-engaged approach to build capacity among residents to develop and implement interventions focused on creating a healthier environment. The Center partnered with residents living in a public housing community and adjacent low-income neighborhood and provided support through a mini-grant program. A six-session training program guided community members in mini grant development; 25 individuals attended at least one session. Six grant proposals were submitted; three were awarded $12,000 each for intervention implementation. Findings offer a model for engaging residents from low-resource settings in intervention development, implementation, and sustainability for community health promotion.

Dietary Intake, Behaviors and Psychosocial Factors Among Women from Food-Secure and Food-Insecure Households in the United States

OBJECTIVE

Determine whether macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake, and psychosocial and behavioral factors are associated with household food security.

DESIGN

Baseline data from in-person interviews and telephone-based, 24-hour dietary recall from women recruited to a diet and physical activity controlled trial.

SETTING

Neighborhoods encompassing 18 urban census tracts in South Carolina.

PARTICIPANTS

Participants (n=202) were predominantly African American (87%), overweight or obese women aged 25 to 51 years with mean body mass index of 40.6±8.7.

MAIN OUTCOME MEASURES

Macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake (via multi-pass, 24-h recall); diet-related self-efficacy and social support, healthy/lowfat and emotional eating behaviors, and depressive symptoms.

RESULTS

Women in food-secure (FS) and food insecure (FI) households were not different on health and sociodemographic characteristics. Women in FI households had lower self-efficacy and healthy/low-fat eating behaviors, and higher emotional eating and depressive symptoms compared with women in FS households. The groups did not differ on social support. Significant dietary differences were few (FS>FI on protein and lean meat; FS<FI on carbohydrate intake). For 29 of 35 (74%) dietary intake recommendations, less than 75% of women in both groups met each recommendation.

CONCLUSIONS

While food security status was associated with diet-related psychosocial and behavioral factors, it was associated with few aspects of dietary intake. Dietary intake overall was poor. Participants were not meeting guidelines for a diet supportive of general health or weight loss and management, regardless of food security status.

Process for massage therapy practice and essential assessment

BACKGROUND

Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice.

METHODS

31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes.

RESULTS

Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded.

DISCUSSION

Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed.

CONCLUSION

The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession.

Association of complementary and alternative medicine use with symptoms and physical functional performance among adults with arthritis

BACKGROUND

Research shows high prevalence of complementary and alternative medicine (CAM) use in individuals with arthritis. Little is known about CAM use and objectively measured physical functional performance.

OBJECTIVE

The main objective was to determine if CAM use was associated with self-reported symptoms and physical functional performance in adults with arthritis. The secondary objectives were to describe the perceived helpfulness and correlates of CAM use.

METHODS

We analyzed cross-sectional data from a self-administered questionnaire and objectively measured physical functional performance prior to randomization to a self-paced exercise program or control condition (n = 401). We used the Fisher's exact test, analysis of variance, and general linear models to examine the association of CAM use with socio-demographic characteristics, symptoms and functional performance. Logistic regression computed the odds of perceiving CAM as helpful by level of use.

RESULTS

Most respondents had used CAM (76%). Dietary supplements were the most-used (53.1%). Female gender and college education predicted greater number of modalities used. Compared to non-users, use of any CAM was associated with greater fatigue and lower grip strength; relaxation techniques with lower walk distance and gait speed; dietary change with greater pain and stiffness and lower walk distance; and yoga with lower pain and stiffness, greater walk distance, chair stands, seated reach and gait, but lower grip strength. Perceived help was positively associated with the number of modalities used.

CONCLUSIONS

Associations between CAM and symptoms or functional performance were mixed. Only yoga showed positive associations; however, yoga practitioners were more physically active overall than non-practitioners.

Promotoras de Salud: roles, responsibilities, and contributions in a multisite community-based randomized controlled trial

There is widespread recognition of the cultural and linguistic appropriateness of (a Spanish term for community health workers [CHW]) in health education and outreach among Hispanic communities. Yet, there are significant gaps in the literature regarding the preparation, implementation, and evaluation of ' engagement in research. To address this gap, we examine ' research-related training, roles, responsibilities, and contributions in a community-based participatory research project involving a multisite randomized controlled trial (RCT) of a physical activity intervention for Mexican-origin women in Texas and South Carolina. We identify both benefits and challenges associated with ' engagement as community researchers; examine variations and differences in roles and responsibilities related to the research contexts, sites, settings, and individual characteristics; and discuss implications for research and practice.

Body Size Perceptions among Overweight and Obese African American Women

OBJECTIVE

Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women.

DESIGN

Cross-sectional using baseline data from a randomized controlled trial.

SETTING

18 census tracts in a central South Carolina city where ≥ 25% of residents were below poverty income.

PARTICIPANTS

147 economically disadvantaged, overweight and obese African American women.

MAIN OUTCOME MEASURES

Using Pulvers' figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women.

RESULTS

Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m(2) larger, P<.0001) than those established in the sample of White women.

CONCLUSIONS

Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss.

Building capacity in disadvantaged communities: development of the community advocacy and leadership program

BACKGROUND

Successful community groups have the capacity to mobilize community assets to address needs. Capacity-building education is integral to building competent communities.

OBJECTIVES

A community-university team developed and pilot tested an education program for community advocates from disadvantaged neighborhoods with high chronic disease burden.

METHODS

The Community Advocacy and Leadership Program (CALP) included eight monthly workshops, a mini-grant opportunity, and technical assistance. A nominal group with community health practitioners, focus group with community advocates, and a literature search comprised a triangulated educational needs assessment. A participating pretest with 35 community health practitioners guided curriculum refinement. Seven representatives from three community groups in a medically underserved South Carolina county participated in pilot implementation and evaluation. Qualitative and quantitative data informed the process and impact evaluation.

RESULTS

The mean knowledge score at 1 month after the program was 77% (range, 52%-96%). The mean score on post-program self-assessment of skills improvement was 3.8 out of a possible 4.0 (range, 3.6-4.0). Two groups submitted successful community mini-grant applications for playground improvements, and the third group successfully advocated for public funding of neighborhood park improvements. Participants reported favorable impressions and both personal and community benefits from participation.

CONCLUSIONS

A community-university partnership successfully conducted a local educational needs assessment and developed and pilot tested a capacity development program within a CBPR partnership. Successes, challenges, and lessons learned will guide program refinement, replication, and dissemination.

Predicting outdoor recreation area use in a Southeastern US county: a signal detection analysis

Use of outdoor recreation areas (ORAs) is correlated with physical activity (PA) in community-dwelling adults. Additionally, the wide spread availability of ORAs, including their placement in disadvantaged neighborhoods, make them an especially promising venue through which to promote PA. The purpose of this study was to examine the combination of individual-level factors associated with ORA use in a socioeconomically diverse Southeastern US county. A 2011 random digit-dial survey included 829 adults aged 18+ years with complete data; questions assessed PA level and use/perceived safety of ORAs. Signal detection analysis, a non-parametric recursive partitioning technique, identified cutpoints for defining subgroups of respondents based on ORA use. Seven subgroups were defined ranging from 77.2 % ORA use (younger, met PA recommendations) to 31.8 % ORA use (older, perceived ORAs to be less safe). Signal detection did not identify gender or race as important for defining subgroups. Results suggest that gendered and ethnically-focused ORA promotion campaigns might be unnecessary. Instead, efforts could focus on increasing awareness of ORA facilities among older, less active adults.

Baseline predictors of physical activity in a sample of adults with arthritis participating in a self-directed exercise program

OBJECTIVES

To examine baseline predictors of moderate-to-vigorous intensity physical activity (MVPA) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed, multicomponent exercise program.

STUDY DESIGN

Pretest-posttest. Analyses were limited to those randomized to the exercise intervention.

METHODS

Participants (n = 152) completed a survey assessing demographic, health-related, and arthritis-related factors, and completed anthropometric and functional measurements at baseline. Self-reported MVPA was assessed at baseline and 12 weeks. Participants were classified as engaging in ≥2.5 or <2.5 h/week of MVPA at the 12-week follow-up. Baseline demographic, health-related, arthritis-related, and functional factors were examined as predictors of engaging in ≥2.5 h of MVPA.

RESULTS

At the 12-week follow-up, 66.5% (n = 101) of participants engaged in ≥2.5 h/week of MVPA. Those with a higher body mass index, more days with poor physical health, a greater number of health conditions, self-reported hypertension, self-reported high cholesterol, and greater pain and stiffness were less likely to engage in ≥2.5 h of MVPA at the 12-week follow-up; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely. None of the other factors examined were associated with MVPA.

CONCLUSIONS

This study uncovered health-related, arthritis-related, and functional factors associated with MVPA that may help guide intervention strategies. Participants with less severe symptoms, better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis, while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured, individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed.

Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: results from a focus groups assessment

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Examining connections between screening for breast, cervical and prostate cancer and colorectal cancer screening

AIM

To compare participation in breast, cervical and prostate cancer screening with colorectal cancer (CRC) screening.

MATERIALS & METHODS

This random digit-dialed survey includes participants (aged 50-75 years) from South Carolina (USA). Past participation information in fecal occult blood test, flexible sigmoidoscopy, colonoscopy, mammography, clinical breast examination, Pap test, prostate-specific antigen and digital rectal examination was obtained.Adjusted odds ratios are reported.

RESULTS

Among European-American women, any cervical or breast cancer screening was associated with adherence to any CRC screening. Among African-American women, mammography was associated with adherence to any CRC screening. Digital rectal examination and prostate-specific antigen tests were associated with adherence to any CRC screening test among all men.

CONCLUSION

Future research should explore approaches inclusive of cancer screening recommendations for multiple cancer types for reduction of cancer screening disparities.

Depressive symptoms are associated with dietary intake but not physical activity among overweight and obese women from disadvantaged neighborhoods

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower-income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American; age, 25-51 years). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale. Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using 4 items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (P < .05). Although not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (P = .06) and added sugars (P = .07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity, or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating.

Frequency of consumption at fast-food restaurants is associated with dietary intake in overweight and obese women recruited from financially disadvantaged neighborhoods

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods.

The role of family history of cancer on cervical cancer screening behavior in a population-based survey of women in the Southeastern United States

BACKGROUND

Our objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities.

METHODS

Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18-70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12.

FINDINGS

Although FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55-2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15-4.81) and younger age (18-30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample.

CONCLUSIONS

Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.

Development of culturally tailored educational brochures on HPV and pap tests for American Indian women

PURPOSE

Participatory formative research guided the creation of a culturally tailored educational brochure about human papillomavirus (HPV) at an American Indian women's clinic.

METHOD

A review of existing educational materials and in-depth interviews were conducted. Nine steps for creating health communications messages that were patterned after National Cancer Institute guidelines guided the brochure development process.

RESULTS

Of 95 women tested for HPV, 41% were positive, 32 (34%) agreed to the in-depth interview, and 9 agreed to the pretesting interview. Mean age was 41 years. Interviews revealed key themes concerning emotional reactions to abnormal Pap test results and HPV; need for basic information about HPV, Pap tests, and results; concerns about HPV stigma, sexual transmission, and communication with sexual partner; and the preferred source and format for HPV educational materials. A literature review revealed 12 areas of basic HPV content.

CONCLUSIONS

A participatory process successfully engaged nursing staff and patients in creating culturally appropriate brochures for clinic use.

IMPLICATIONS

This article provides specific steps for creating culturally tailored patient education materials.

Patterns of sedentary behavior in overweight and obese women

OBJECTIVES

Few studies have objectively quantified sedentary behavior, particularly in special population subgroups. This study quantified the volume of and breaks from sedentary behavior in a sample of overweight and obese, primarily African American, women.

DESIGN

Cross-sectional.

SETTING

18 census tracts in Columbia, South Carolina with higher than state and national poverty levels.

PARTICIPANTS

197 overweight/obese women (87% African American). Mean age 38.3 +/- 7.6 years, mean body mass index 40.6 +/- 8.8 kg/m2.

MAIN OUTCOMES MEASURES

Using a cut point of < 100 counts/minute, estimated daily averages of: 1) total volume, 2) > or = 10, 30, and 60-minute bouts, and 3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks, or interruptions, in sedentary time were also calculated.

RESULTS

Participants were sedentary 64.1% of the day, engaging in 10.5 +/- 2.8 daily bouts of sedentary behavior per hour of sedentary time; each bout lasted approximately 6.4 +/- 1.7 minutes. All participants engaged in > or = 1 daily bout of sedentary behavior > or = 10 and > or = 30 minutes, and most (83%) engaged in > or = 1 bout > or = 60 minutes. Participants were slightly more sedentary during the evening (6 pm-midnight) and on weekdays. On average, participants took 90.9 +/- 16.0 breaks from sedentary behavior; each break lasted 3.3 +/- .8 minutes.

CONCLUSIONS

Women engaged in more sedentary behavior than that reported in national data sets. In an effort to improve public health, efforts should not only focus on increasing physical activity, but also on decreasing time spent sedentary.

Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening

AIM

The aim was to describe the association of awareness and knowledge with participation in colorectal cancer (CRC) screening.

MATERIALS & METHODS

Telephone survey research was conducted with South Carolina (USA) residents aged 50-75 years using a 144-item instrument. Data were analyzed with SAS and Stata. Adjusted odds ratios are reported.

RESULTS

Respondents (n = 1302) had heard of CRC screening (96%) and exhibited high levels of CRC awareness and knowledge; only 74% had ever been screened. Higher levels of knowledge were associated with a greater likelihood of having ever been screened (odds ratio: 1.05; 95% CI: 1.02-1.41; p < 0.001).

CONCLUSION

Results showed high levels of awareness and knowledge, but modest participation in CRC. Transforming awareness and knowledge into CRC screening participation should be a priority.

Working to close the gap: identifying predictors of HPV vaccine uptake among young African American women

Factors associated with greater likelihood of human papillomavirus (HPV) vaccination among women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess factors associated with HPV vaccine uptake among young African American women. Three hundred sixty-three African American women aged 18-26 were recruited from Historically Black Colleges/Universities to complete a questionnaire to assess health beliefs associated with HPV vaccination. One quarter of participants reported uptake of the HPV vaccine. Women who reported uptake had significantly higher HPV knowledge, lower perceived barriers to vaccination, and were younger (all p<.05). Factors significantly associated with HPV vaccine uptake included HPV knowledge (OR=1.22), perceived severity of health outcomes (OR=0.48), perceived barriers to vaccination (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). Findings can be used to inform the development of targeted HPV vaccine promotion programs for African American women to prevent continued cervical cancer disparities.

A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS)

BACKGROUND

Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population.

OBJECTIVES

STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods.

DESIGN

A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes.

METHODS

Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment.

RESULTS

Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants.

SUMMARY

STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.

Do Health Beliefs, Health Care System Distrust, and Racial Pride Influence HPV Vaccine Acceptability among African American College Females?

The promise of human papillomavirus (HPV) vaccines rests with the ability to promote widespread uptake especially among populations at high risk of cervical cancer and other associated disease outcomes. The purpose of this study was to examine health beliefs and culturally specific influences of HPV vaccine acceptability among African American college females. Approximately 76 percent of participants reported HPV vaccine acceptability. Predictors of acceptability included: higher perceived benefit and lower racial pride. Findings can be used to inform development of campus-based HPV educational approaches to promote widespread HPV vaccine acceptability and safer sex practices among African American college females.

Abstract B35: Working to close the gap: Identifying predictors of HPV vaccine initiation among young African American women

Background: HPV (human papillomavirus) vaccines are recent innovations that have provided a new avenue for cervical cancer prevention. The role of HPV vaccines among groups of women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess health beliefs associated with HPV vaccine initiation among young African American (AA) women.

Methods: Three hundred sixty-three African American female college students aged 18-26 were recruited from three Historically Black Colleges/Universities in the southeastern United States. Participants were asked to complete a self-administered, anonymous survey to assess knowledge and beliefs related to HPV and the HPV vaccine.

Results: One-quarter (24%) of participants initiated the HPV vaccine. Women who initiated the HPV vaccine had significantly higher HPV knowledge (p=0.01), lower perceived barriers to vaccination (p&lt;0.01), and were younger (p&lt;0.01) compared to women who had not initiated vaccination. Factors significantly associated with HPV vaccine initiation included: HPV knowledge (OR=1.22), perceived severity of HPV health outcomes, (OR=0.48), perceived barriers to vaccination, (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). The model explained 19% of the variance in HPV vaccine initiation.

Conclusions: Study findings can be used to inform the development of targeted health education and promotion HPV vaccine programs for AA college-aged women to prevent continued disparities in cervical cancer incidence and mortality. Addressing health beliefs will be central to efforts to promote widespread vaccine uptake and future reduction in disease.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B35.

Abstract B112: Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening: results of a population-based study

Purpose: Participation in colorectal cancer (CRC) screening lags behind screening for other types of cancer despite the ability to prevent the development of CRC and down-stage disease. The purpose was to describe the association of CRC awareness and knowledge with CRC screening.

Methods: Trained interviewers from a professional survey firm conducted computer-assisted, random digit dialed telephone interviews, with landline and cell phone numbers, using a 144-item instrument developed via literature review, expert panel review, and pretesting. South Carolina residents aged 45-75 years were contacted. For this paper, analysis was restricted to respondents aged 50-75 (n=1,302) who fall in the recommended screening age range and answered knowledge, awareness, and screening items. Data were analyzed with SAS and STATA. Odds ratios were adjusted for race and gender.

Results: Respondents (n=1,503) were mostly female (63%), EA (77%), had at least some college education (59%), had household income of less than $49,999 (48%), married or lived with a partner (62%), had health insurance (91%), and unemployed/not working (57.1%). Mean age was 60.3 years (SD=8.6).

A majority of respondents had heard of CRC (91%). Of those who had heard of CRC, the majority had heard of CRC screening (96%). More than half of respondents (69%) could name any of the CRC screening tests. The most common CRC screening test named was colonoscopy (90%). Respondents who had heard of a CRC had greater odds of having had any CRC screening test (aOR=1.71; CI: 1.06-2.76; p&lt;0.028) and colonoscopy (aOR=1.59; CI: 1.03-2.45; p&lt;0.034) than those who had not heard. Respondents who could correctly name at least one CRC screening test had greater odds of having had any CRC screening test (aOR=3.74; CI: 2.76-5.08; p&lt;0.001) and colonoscopy (aOR=3.69; CI: 2.83-4.82; p&lt;0.001) than those who could not name a test. A CRC awareness index score (range 0-4) was created by assigning a +1 to each of four awareness items. A one-unit increase in the awareness score significantly increased respondents being more likely to have had CRC screening test (aOR=1.44; CI: 1.30-1.59; p&lt;0.001), colonoscopy (aOR=1.43; CI: 1.29-1.57; p&lt;0.001), flex sigmoidoscopy (aOR=1.27; CI: 1.13-1.41; p&lt;0.001), or FOBT (aOR=1.13; CI: 1.02-1.25; p&lt;0.016). The CRC knowledge item answered correctly most often was “colon cancer can start as a polyp, which is a small growth found in the colon” (97%) and least often was “colon cancer is most often caused by a person's behavior or lifestyle” (26%). A CRC knowledge index score (range=0-14) represented total number of correct responses. A one unit increase in knowledge score significantly increased respondents being more likely to have had any CRC screening test (aOR=1.05; CI: 1.02-1.10; p&lt;0.004), colonoscopy (aOR=1.05; CI: 1.02-1.09; p&lt;0.004), or FOBT (aOR=1.04, CI: 1.00-1.07; p=0.043). There were also statistically significant differences by race and gender.

Conclusion: Generally, there were high levels of awareness and knowledge scores, but modest participation in CRC screening. Higher levels of awareness and knowledge showed increased likelihood of CRC screening, yet CRC screening rates continue to be lower pointing to the need for interventions in addition to those focused on awareness and knowledge to improve adherence to recommended screening guidelines and reduced CRC cases.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B112.

Newspaper content analysis in evaluation of a community-based participatory project to increase physical activity

This study conducted a newspaper content analysis as part of an evaluation of a community-based participatory research project focused on increasing physical activity through policy and environmental changes, which included activities related to media advocacy and media-based community education. Daily papers (May 2003 to December 2005) from both the intervention and comparison counties were reviewed for topics related to physical activity and an active living environment (e.g. safety, policy, urban design, transportation and recreational resources). A total of 2681 articles from 1764 newspapers were analyzed. The intervention county had a greater proportion of articles on the selected topics. Specifically, the intervention county had a greater proportion of articles in topics related to safety, policy and community initiatives, as well as in sidewalks and recreational facilities; both priority areas for the intervention. Prominence of the articles was assessed using a composite index score. Generally, prominence of the topics analyzed was low. Articles in the sidewalks and recreational facilities topic category in the intervention county had higher prominence scores on average than the comparison county. The study demonstrates that media content analysis can be a valuable component in evaluating community-based interventions.

Impact of a Community-Based Prevention Marketing Intervention to Promote Physical Activity Among Middle-Aged Women

A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women ( n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- ( n = 245) and postprogram ( n = 820) from the media exposed county and a no-intervention county ( n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activity minutes, walking, and knowledge of mapped routes.

A randomised study of the effects of massage therapy compared to guided relaxation on well-being and stress perception among older adults

OBJECTIVE

The objective was to assess the effects of massage compared to guided relaxation on stress perception and well-being among older adults.

DESIGN

A randomised pilot study enrolled adults ages 60 and older to receive 50 min, twice weekly massage therapy or guided relaxation sessions. Questionnaires were administered at pre-test (1 week before the first session) and post-test (after the last session).

SETTING

Participants came to the University of South Carolina campus for sessions. Adults aged 60 and older were recruited from community venues and were briefly screened by telephone for contraindications.

INTERVENTION

Participants (n=54) received 50 min massage or guided relaxation sessions twice weekly for 4 weeks. The massage included Swedish, neuromuscular, and myofascial techniques. For the relaxation group, an appropriately trained assistant read a script to guide the participant in using visualization and muscle relaxation.

MAIN OUTCOME MEASURES

The General Well-being Schedule is an 18-item scale with subscales measuring anxiety, depression, positive well-being, self-control, vitality, and general health. The Perceived Stress Scale is a 14-item scale assessing the degree to which situations in one's life are appraised as stressful during the past month.

RESULTS

Significant improvements were found for the anxiety, depression, vitality, general health, and positive well-being subscales of the General Well-being Schedule and for Perceived Stress among the massage participants compared to guided relaxation.

CONCLUSIONS

Findings indicate that massage therapy enhances positive well-being and reduces stress perception among community-dwelling older adults.