Pilot study of peer modeling with psychological inoculation to promote coronavirus vaccination

Promoting coronavirus vaccination is deterred by misinformation, ranging from elaborate conspiracy theories about sinister purposes to exaggeration of side effects, largely promulgated by social media. In this pilot study, we tested the effects of different messages on actions leading to vaccination. Two theory-based advertisements were produced for Facebook, which provided video testimonials from peer role models recommending vaccination and its benefits while providing psychological inoculation through the models' acknowledging misinformation, rejecting it and receiving the vaccine. These ads were paid to appear on Facebook users' feeds in rural counties in South Texas, along with a generic vaccine promotion ad from the CDC without peer models or psychological inoculation. Ad viewers could click a link to 'find a vaccine near you'; these responses served as the outcome variable for assessing experimental effects. Ads featuring peer modeling with psychological inoculation yielded a significantly higher rate of positive responses than CDC ads (30.5 versus14.9/1000 people reached in English and 49.7 versus 31.5/1000 in Spanish; P < 0.001 for both English and Spanish rate comparisons). This provides useful pilot data supporting the hypothesis that theory-based communication, i.e. peer modeling with psychological inoculation, may be more effective than more traditional forms of advertising for promoting coronavirus vaccination.

Abstract ES5-2: Biologic, cultural and health systems influences on breast cancer disparities in Latinas

Rationale

Breast cancer is the top cause of cancer-related deaths in Latinas, who more likely than their peers to be diagnosed at advanced disease stage. This makes it critical to reduce the time from screening to diagnosis to treatment. Latinas also face other biologic issues, as well as cultural and linguistic barriers to proper breast cancer care. Patient navigation is a means for providing access to recommended cancer screening services, follow-up, diagnosis, and treatment in medically underserved populations.

Objectives

I led a series of studies to adapt patient navigation for Latino populations, specifically to reduce delays among Latinas to proper diagnoses and care. We trained our bilingual, bicultural patient navigators to help “navigate” underserved people through the complex care system and other barriers to care (finances, transit, child care, language, culture, etc.). Navigation aims to help reduce missed appointments, reduce delays in seeking care, increase follow-up care, and cover the entire ecological framework from policy, community, organizational, interpersonal, and survivor elements.

Results

The series of studies identified Latinas' delays in time to confirmatory diagnosis and start of treatment after an abnormal mammogram; and proved that patient navigation by a bilingual, bicultural patient navigator can reduce Latinas' times to diagnosis and treatment and significantly increase the proportion of Latinas initiating treatment. Our navigation helped patients receive diagnosis 4 times faster, and treatment start 1.5 times faster, than normal. Several aspects of a navigator's services were directly related to achieving these results. As a direct result of our patient navigation activities, we navigated significantly more women from confirmed breast cancer diagnosis to treatment initiation within 30 (69%) and 60 days (97.6%), with much lower rates for non-navigated women.

Conclusion

We conclude—based on a national study that shows women with breast cancer who wait longer than 60 days have a significantly lower survival rate—that our patient navigation is likely to have saved the lives of many Latinas. We have since applied this navigation to achieve greater compliance in following prescribed treatments and improved general and cancer-specific quality of life among cancer survivors. We also, based on these successful results, developed and posted online the Patient Navigator Manual: Developing and Implementing a Patient Navigator Program manual. The bilingual manual outlines the necessary steps and provides tools to incorporate navigation for Latinos at any organization.

Citation Format: Ramirez AG. Biologic, cultural and health systems influences on breast cancer disparities in Latinas [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES5-2.

Abstract PD08-05: Spanning the Continuum to assess, serve and navigate Latinas with breast cancer: A Tale of Six Projects

Background Breast cancer is the most commonly diagnosed cancer among Latinas: 14,200 diagnosed in 2009. Groundbreaking work has shown that patient navigation may assist minority patients to negotiate the Cancer Care Continuum. Here we report the efforts of Redes En Acción: The National Latino Cancer Research Network at the Institute for Health Promotion Research in San Antonio, Texas in applying these findings to Latinas.

Methods We conducted six studies to assess and address the needs and self-reported barriers to care of Latina breast cancer patients, leading to the development and controlled trial of a theory-driven, culturally appropriate patient navigation model and program. We currently are evaluating health-related quality of life and barriers to genetic testing in Latina breast cancer survivors.

Results Latinas with breast cancer face significant obstacles across the cancer care continuum, originating from multiple domains, including traditional values, timely access to care and cultural orientation. These have a direct influence on interaction with the system or indirectly via influences on existing barriers including socioeconomic marginalization and affective response to the stress of any of these.

Defect-driven synthesis of self-assembled single crystal titanium nanowires via electrochemistry

One-dimensional single crystal nanostructures have garnered much attention, from their low-dimensional physics to their technological uses, due to their unique properties and potential applications, from sensors to interconnects. There is an increasing interest in metallic titanium nanowires, yet their single crystal form has not been actualized. Vapor-liquid-solid (VLS) and template-assisted top-down methods are common means for nanowire synthesis; however, each has limitations with respect to nanowire composition and crystallinity. Here we show a simple electrochemical method to generate single crystal titanium nanowires on monocrystalline NiTi substrates. This work is a significant advance in addressing the challenge of growing single crystal titanium nanowires, which had been precluded by titanium's reactivity. Nanowires grew non-parallel to the surface and in a periodic arrangement along specific substrate directions; this behavior is attributed to a defect-driven mechanism. This synthesis technique ushers in new and rapid routes for single crystal metallic nanostructures, which have considerable implications for nanoscale electronics.

P2-14-04: The Influence of Demographic, Psychosocial and Emotional Barriers to Screening for Colorectal and Ovarian Cancer among Latina Breast Cancer Survivors

Background Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Breast cancer survivorship brings to the fore concern that survivors obtain thorough preventive health screening services. In two previous studies, we observed that Latina women are unable to comply with recommendations for breast cancer care due in part to psychosocial barriers including inability to understand physicians and fear of recommendations. Affective influences, particularly depression may also contribute to noncompliance via its inhibitory effect on vigilance. Here we test a hypothesis that similar barriers in addition to depression level restrict breast cancer survivor screening for colorectal and ovarian cancer.

Methods We conducted a cross-sectional study of 117 Latina breast cancer survivors using self-report data. Proportions of respondents compliant and noncompliant with recommended screening protocols were compared. Reasons were coded “yes"-"no”; depression was measured with the Center for Epidemiologic Studies (CESD) instrument dichotomized at the usual cutoff of 16 points or higher signifying depression. Cancer screening compliance was determined by published NCI guidelines. Associations were determined via chi-squared analysis. Multivariate analysis was conducted using logistic regression.

Results Only 5 (4.2%) of participants were screened for both cancers, 43 (36.8%) for either cancer, and 69 (59.0%) were screened for neither cancer. Reported barriers to cancer care were generally high with respect to screening for other cancers, but only “cannot understand English” (66% v 53%, p=.05) and “care is too expensive” (84% v 71%, p=.05) were associated with lack of ovarian cancer screening and none were associated significantly with lack of colorectal screening. Thirty-two percent of the sample met CESD criteria for depression, nearly twice the general population rate; it is associated with ovarian but not colorectal screening noncompliance. Factors including unemployment (74% v 57%, p=.03) and no familial history of cancer (75% v 53%, p=.02) are related to non-compliance with ovarian screening, but only unmarried status is related to colorectal screening (54% v 20%, p=.01). Separate multiple logistic regression analyses confirmed the independent significant association of these factors with ovarian and colorectal screening compliance, indicating good model fit and significant proportions of variance explained by the models.

Discussion There are significant impediments to cancer screening among Latina breast cancer survivors. They derive from multiple domains (demographic factors, psychosocial barriers, and affective states). For this reason they require further research to clearly identify them. Moreover we must develop an equally broad-based preventive strategy that addresses each of these domains to promote vigilance and increase healthy behaviors among Latina women.

Acknowledgement This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174), the Susan G. Komen Breast Cancer Foundation (POP 2000 704), and the National Cancer Institute, Redes En Acción (U01-CA86117).

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-14-04.

Fabrication and Field Emission Properties of Carbon Nanotube Cathodes

A variety of carbon nanotube films have been fabricated and tested as cold cathodes. A spray deposition technique was developed for processing as-grown bulk nanotubes, both single-walled and multi-walled, into films of randomly oriented nanotubes. Films of randomly oriented multi-walled nanotubes were grown using thermal chemical vapor deposition, and arrays of well-aligned multi-walled nanotubes have been fabricated using a microwave plasma enhanced chemical vapor deposition technique. The emission current-voltage (I-V) characteristics of these nanotube cathodes have been measured. Both multi-walled (random and aligned) and single-walled carbon nanotubes exhibit low turn-on fields (∼ 2 V/μm to generate 1 nA) and threshold fields (< 5 V/μm to generate 10 mA/cm2). Significantly, these cathodes were capable of operation at very large current densities (> 1A/cm2), making them candidates for application in a variety of vacuum microelectronic devices.

Abstract P1-10-04: Latina Interest in Genetic Breast Cancer Testing: The Significance of Having a Biological Daughter

Background. Breast cancer is a devastating disease. Identification of the BRCA1 and BRCA2 genetic mutations associated with it offer to provide an efficacious “early warning system”. However investigators question whether women are interested in knowing if they possess gene mutations, particularly minorities traditionally averse to dealing with a complex medical system. Effective means for addressing these gaps are unidentified. Here we determine the extent of interest in genetic testing among Latinas compared to Non-Hispanic White (NHW) women. Also, we identify factors associated with interest in genetic testing. Finally, we show why differences in interest in genetic testing for breast cancer exist among groups of women.

Material and Methods. We surveyed 290 women (153 Hispanic, 137 NHW) aged 26+ from the San Antonio Cancer Therapy and Research Center's catchment area. Surveys included demographic information, measures assessing breast cancer knowledge, attitudes, behaviors, and medical and family history data. Participants were assigned “high” or “moderate/low” cancer risk status according to American College of Medical Genetics Foundation guidelines. Chi-Square and Student's T-tests assessed bivariate relationships. Multivariate logistic regression identified factors associated with interest in genetic testing.

Results. 20% of women were not “Very interested” in genetic testing for the BRCA1/BRCA2 mutation. Bivariate results showed ethnicity, use of non-traditional health care sources and negative perceptions of genetic testing were associated with low interest in genetic testing among all women. A multivariate model of genetic testing interest revealed several measures significantly associated with it, including Hispanic ethnicity (OR 5.74, p&lt;.01), routine health care from any non-traditional source and negative perception of genetic testing (both OR 1.19, p&lt;.03). The Hispanic result reflected reduced interested in Genetic Testing, regardless cancer risk or having had cancer [Low-risk Latinas: 75.3% v 84.9% NHW (p&lt;.05); High-risk Latinas 75.3% v 84.9% NHW (p&lt;.05), Cochran Mantel-Haenszel (CMH) ns.], [NoHx of Cancer Latinas 75.6% v 90.2% p&lt;.04, Hx Cancer Latinas 72.0% v 82.9%, p&lt;.05, CMH ns.] Given this difference we stratified our analysis. In separate multivariate models we found that NHW women are not “very interested” in genetic testing when their perception of it is negative (OR 1.36, p&lt;.01). Latinas are significantly more likely to be interested in genetic testing when their perceived risk of breast cancer is high (OR 2.38, p&lt;.01), and importantly, when they have biological daughters (OR 7.85, p&lt;.001). 77.8% of Latinas with biological daughters (n = 98) compared to 55.6% of those without (n = 61) were “Very interested” in genetic testing for breast cancer (p&lt;.001). Conclusion: Genetic testing is generally acceptable to NHW and Hispanic women. However, Latinas are less likely to accept it than NHW.

Whereas NHW women are influenced in their decision chiefly by use of nontraditional sources of medical care, Latinas are strongly influenced by perceptions of personal risk and having biological daughters.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-04.

Repeated Pap smear screening among Mexican-American women

The factors that influence repeated cervical cancer screening among Latina women are not well understood. Studies of compliance in this population over-emphasize initial or recent screening and under-emphasize how this practice is repeated over time. The purpose of this study was to identify the demographic and psychosocial factors associated with repeated Pap smear screening among low-income Mexican-American women living in two urban communities in Texas. A total of 1804 Mexican-American women were interviewed as part of a community survey. Multiple regression results indicate that demographic characteristics such as age, marital status, level of acculturation and health insurance were associated with the total number of Pap smears reported for the 5 years prior to the interview. Pap smear beliefs were the strongest predictor of repeated screening, while global beliefs about cancer did not significantly explain the results. Health promotion interventions should take into consideration the cultural and psychosocial needs of Mexican-American women, placing emphasis on their specific screening-related beliefs, if they are to succeed in promoting repeated compliance with Pap smear screening guidelines.

Evaluating the impact of a conference

A comprehensive five-phase evaluation of the first Conference on Citizen CPR was implemented to measure its educational value and impact on attitudes regarding key issues in the lay CPR movement. Pre- and post-conference surveys of 480 members of the national CPR community and 165 conference participants along with an on-site evaluation of 152 participants indicated that participants felt that new and relevant information was presented and the conference resulted in little change in the attitudes of either participants or members of the national CPR community. The data reaffirm the educational value of conferences as new information was disseminated easily. However, the data raise questions about the impact conferences have upon attitudes, as only minor changes were reported. Weaknesses in the evaluation design are discussed, and recommendations for future conference evaluations are presented.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican-American youth aged 9-13 years. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-min videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Breast cancer screening in regional Hispanic populations

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer 'En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older (n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the 'Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples.

Social networks and cancer screening in four U.S. Hispanic groups

BACKGROUND

Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups.

METHODS

We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors.

RESULTS

Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08).

CONCLUSIONS

Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.

Developing a theory-based anti-drug communication campaign for Hispanic children and parents

Recent research suggests some alarming substance abuse trends among Hispanic/Latino adolescents. Children in this age group are at a particularly vulnerable juncture in their lives, and early prevention efforts are warranted. For a national anti-drug campaign targeting this young Hispanic/Latino audience and their parents, the White House Office of National Drug Control Policy and the Partnership for a Drug-Free America are incorporating culturally appropriate messages based on behavioral science research and theories. The purpose of this article is to provide information and recommendations on relevant factors and influences in the Hispanic/Latino culture that should be addressed in designing and implementing this campaign.

Hispanic women's breast and cervical cancer knowledge, attitudes, and screening behaviors

PURPOSE

This study examined breast and cervical cancer knowledge, attitudes, and screening behaviors among different Hispanic populations in the United States.

DESIGN

Data were collected from a random digit dial telephone survey of 8903 Hispanic adults from eight U.S. sites. Across sites, the average response rate was 83%.

SETTING

Data were collected as part of the baseline assessment in a national Hispanic cancer control and prevention intervention study.

SUBJECTS

Analysis was restricted to 2239 Hispanic women age 40 and older who were self-identified as either Central American (n = 174), Cuban (n = 279), Mexican American (n = 1550), or Puerto Rican (n = 236).

MEASURES

A bilingual survey instrument was used to solicit information on age, education, income, health insurance coverage, language use, U.S.-born status, knowledge of screening guidelines, attitudes toward cancer, and screening participation. Differences in knowledge and attitudes across Hispanic groups were assessed by either chi-square tests or analysis of variance. Logistic regression models assessed the influence of knowledge and attitudes on screening participation.

RESULTS

The level of knowledge of guidelines ranged from 58.3% (Mexican Americans) to 71.8% (Cubans) for mammography, and from 41.1% (Puerto Ricans) to 55.6% (Cubans) for Pap smear among the different Hispanic populations. Attitudes also varied, with Mexican Americans and Puerto Ricans having more negative or fatalistic views of cancer than Cuban or Central Americans. Knowledge was significantly related to age, education, income, language preference, and recent screening history. Overall, attitudes were not predictive of mammography and Pap smear behavior.

CONCLUSIONS

Factors related to mammography and Pap smear screening vary among the different Hispanic populations. Limitations include the cross-sectional nature of the study, self-reported measures of screening, and the limited assessment of attitudes. The data and diversity of Hispanic groups reinforce the position that ethno-regional characteristics should be clarified and addressed in cancer screening promotion efforts. The practical relationships among knowledge, attitudes, and cancer screening are not altogether clear and require further research.

Advancing the role of participatory communication in the diffusion of cancer screening among Hispanics

Based on previously demonstrated methods, a cancer prevention program combining media and interpersonal communication was conducted in a Texas border city (Brownsville) in 1995-1996. To evaluate the program a quasi-experimental panel design study followed 107 women in a program site and 105 women in a comparison site from 1994 to 1996. Women in the program site reported an increase in levels of Pap screening adherence.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican American youth 9 to 13 years of age. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-minute videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Implementation of individualized patient education for Hispanic children with asthma

An educational program known as the Childhood Asthma Project (CAP) was implemented to reduce morbidity among Hispanic children with chronic asthma. Seventy-three children, ages 6-16, participated in 4 program phases: baseline assessment, one-on-one child-centered education, application, and maintenance. During baseline assessment, child and parent asthma beliefs and behaviors were evaluated and used to create educational modules on symptom recognition, peak low meters, medications, and precipitating factors in Spanish and English. Children learned the importance of self-management, practiced using inhalers and peak flow meters and charted peak flow recordings. Videotapes provided peer modeling by showing Hispanic children with asthma performing self-management tasks. During the application phase, patients practiced self-management behaviors at home and reviewed progress with a nurse educator. During maintenance, the success of self-monitoring was reviewed at follow-up appointments. Recommendations for designing health education interventions for Hispanic children are provided.

Hypertension in Hispanic Americans: overview of the population

THE 23 MILLION HISPANICS IN THE UNITED STATES represent a mosaic of varied ethnic groups, and many share ancestry and language. They comprise one of the fastest-growing segments of the U.S. population. Social, cultural, and physical differences between Hispanics and non-Hispanics and among Hispanic subgroups affect the health of this population. Hispanics exhibit several risk factors for major health problems in differing levels from other populations. Most notably, Mexican Americans are 3 to 5 times more likely to have non-insulin-dependent diabetes than whites. Because of health factors and other distinguishing qualities, the health care establishment needs to do more research, especially on hypertension, and provide more culturally responsive health care for Hispanics. Surveys conducted in the early and mid-1980s show differing rates of hypertension among Hispanic groups, from lower levels to levels similar to those found in whites. Additional research is needed to identify the extent of hypertension incidence, awareness, and control in Hispanics, particularly among sub-groups. If hypertension rates are indeed lower than those in the general population, efforts should be made to identify and maintain the positive behaviors responsible.

Targeting Hispanic populations: future research and prevention strategies

Minority populations face a wide variety of economic, institutional, and cultural barriers to health care. These barriers and low levels of education and income pose significant challenges for health professionals in developing cancer research and prevention-control strategies. It is suggested that specific segments of Hispanic populations fit the model of an underdeveloped country in the intermediate stage of epidemiological transition. Since noncommunicable diseases have not yet fully emerged in some of these Hispanic population segments, the opportunity exists to apply primordial prevention strategies. Such campaigns would focus on dissuading members of these populations from adopting negative health behaviors while promoting positive lifestyle choices. Optimal programs would increase cancer screening participation and discourage risk behaviors through community-oriented, population-based interventions. Future directions in prevention and control efforts for minority populations should include expanded health insurance coverage, improved access to health care, greater emphasis on minority recruitment in health care fields, focused epidemiologic and clinical research, and identification and replication of effective components within existing prevention-control programs.

Implementation of a physician education intervention. The Childhood Asthma Project

OBJECTIVES

To increase pediatric residents' knowledge of the Guidelines for the Diagnosis and Management of Asthma (GDMA) developed by the Expert Panel of the National Asthma Education Program and to increase the residents' confidence in their ability to implement these guidelines. Emphasis was placed on the diagnosis and treatment of Hispanic children with asthma, a population at increased risk for morbidity.

SETTING

A continuity care clinic located in an urban ambulatory care facility.

SUBJECTS

Forty-four pediatric residents: 17 first-year residents, 15 second-year residents, and 12 third-year residents.

METHODS

Residents participated in a multicomponent asthma management curriculum that stressed active learning strategies, including the following: focus groups, computer-based testing, lectures, hands-on skill development seminars, role modeling by attending pediatricians, provision of GDMA pocket cards and posters, access to peak flowmeters and spirometry, and an interactive computer-based module. Content focused on pulmonary function testing with spirometry and peak flowmeters, stepwise use of medications, recognition of asthma symptoms and triggers, and cultural considerations that impact asthma management. Pediatric faculty and fellows also participated in a series of asthma seminars to increase the likelihood that faculty would role model the GDMA and provide appropriate feedback to residents.

RESULTS

Pediatric residents demonstrated significant increases in knowledge about evaluation of asthma, pulmonary function testing, and clinical management, displayed significantly enhanced levels of confidence, and were enthusiastic about the asthma management curriculum, rating it significantly higher than 15 other content areas in the general pediatric curriculum.

Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study

BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region.

METHOD

Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates.

RESULTS

Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling.

DISCUSSION

Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.

Family versus individually oriented intervention for weight loss in Mexican American women

Mexican Americans are more likely to be obese than non-Hispanic whites, yet little research has been conducted on the treatment of obesity in Mexican Americans. The purpose of this study was to compare a family-based intervention with a traditional program oriented to the individual for achieving weight loss by obese Mexican American women. A total of 168 obese women were randomly assigned to one of three groups. Group 1 served as a comparison group and received only printed materials on nutrition, exercise, and behavioral principles for weight loss. Subjects in the individual group (group 2) received the same printed information, but they also attended classes led by bilingual registered dietitians. Subjects in the family group (group 3) received materials and attended classes that emphasized a family-oriented approach to making changes in eating habits and exercise behavior. Spouses and children attended classes with subjects in this group. Results revealed a significant linear trend in both body mass index and weight reduction across the groups, with losses greatest in the family group, followed by the individual group, and least in the comparison group. Both the individual and the family groups lost significantly more weight than the comparison group, although the difference between these two groups was not statistically significant. The results suggest that a culturally and linguistically appropriate program can achieve significant weight reduction among Mexican Americans. More research should be conducted on the effects of family and other types of social support on weight loss by Mexican Americans.

Cuidando El Corazon--a weight-reduction intervention for Mexican Americans

Cuidando El Corazon (CEC; Taking Care of Your Heart) was designed to assess the effectiveness of a culturally adapted weight-reduction and exercise program for achieving long-term weight loss in Mexican Americans. CEC used a family-oriented approach to achieve lifestyle change in behavior. Participants were assigned to 1) a booklet-only comparison group that received a manual including behavior change, nutrition, and exercise information and traditional recipes modified in fat content; 2) an individual group that received the same manual and attended year-long classes; or 3) a family group that received a manual and attended classes that emphasized techniques for making changes in the family's eating and exercising habits. The family and individual groups had significantly greater weight losses than the information-only group. Weight loss was greatest in the family-involvement group and least in the information-only comparison group.

Beliefs about high blood pressure prevention in a survey of blacks and Hispanics

Beliefs about the potential for high blood pressure prevention were assessed during a telephone survey of cardiovascular risk factor awareness among black and Hispanic adults in Chicago, Illinois. A high proportion of those interviewed-82% of blacks and 69% of Hispanics--thought a person could do something to prevent getting high blood pressure and either selected one or more of several possible preventive measures listed by the interviewer or volunteered other measures. Awareness of two widely cited prevention possibilities that may be particularly important for black and Hispanic populations--lowering salt intake and maintaining ideal weight--was low. Fewer than half of the respondents in this survey (44% of blacks and 26% of Hispanics) thought that lowering salt intake would help prevent high blood pressure. An even smaller number (10% of blacks and 20% of Hispanics) thought that maintaining ideal weight would help prevent high blood pressure. Moreover, other measures that are unrelated to high blood pressure or for which a relation to high blood pressure is not well established were selected frequently. These findings were contrary to our expectations, because black and Hispanic populations have been targeted by the National High Blood Pressure Education campaign and because high levels of awareness in other areas of cardiovascular disease risk were observed in this sample. These data suggest that awareness of potential strategies for high blood pressure prevention among black and Hispanic communities needs to be addressed specifically in related educational campaigns.

Mass media campaign--A Su Salud

A mass media health promotion program directed toward reducing future cancer trends among Mexican Americans, the largest subgroup of Hispanics in the United States, by decreasing smoking and encouraging smoking prevention and other health practices is described. Included is an outline of the program design and its significant features and a discussion of social modeling, the theoretical approach which provides a framework for the program. The development of the program, including the role focus groups played in the identification of areas to be targeted by the program, and the production and implementation of the mass media campaign based upon the targeted program areas are also discussed.

Communicating health information to urban Mexican Americans: sources of health information

Data from a six-week hypertension campaign aimed at urban Mexican Americans were analyzed to document how they receive their health information and to identify the communication channels most likely to reach different segments of the Mexican-American community. The nine sources of information examined were doctor, nurse, pharmacist, family, friends, radio, newspaper, television, and magazine. The most common source of health information reported was doctor, followed by television, newspapers, magazines, family, and radio. Interview language (Spanish or English) was a significant predictor of the amount of health information received from all nine sources. Sex, family income, education, and age also were shown to affect the amount of health information received from various sources. Profiles of respondents most likely to use each source of health information are presented and implications for health educators are discussed.

Indicators of response to a mass media CPR recruitment campaign

Respondents to a mass media cardiopulmonary resuscitation (CPR) recruitment campaign in Harris County, Texas were more likely than non-respondents to be White, female, and under 45 years of age, to have had previous CPR training, experienced an incident in which knowledge of CPR might have been useful, or to have a friend or relative with a relevant medical history. The majority of the respondents were housewives, and professionals or technical workers, particularly in the health field. Findings can be used to identify audiences for future mass media CPR campaigns.

Impact on retention: comparison of two CPR training programs

CPR trainees who completed 8-hour, 3 session and 4-hour single session courses were studied for skill and cognitive retention one year after certification. Knowledge and performance scores were significantly higher for trainees from the long course, but performance skills for both groups were below certification level when compared to American Heart Association standards. The findings suggest the need for further evaluation of course components which could improve retention levels for all trainees.

El asesino silencioso: a methodology for alerting the Spanish-speaking community

Information describing the health status of the Spanish-speaking population, the nation's second largest minority, is extremely scarce. In particular, few studies have attempted to document the prevalence or ascertain the extent of treatment or the level of public awareness of hypertension or other cardiovascular diseases in this minority population. However, before any large scale effort to determine the prevalence or to determine the treatment and awareness needs related to hypertension is initiated, preliminary questions concerning how to reach and motivate the Spanish-speaking population to adopt cardiovascular health risk-reducing behaviors must be answered.

Trainees' retention of cardiopulmonary resuscitation. How quickly they forget

Lay persons trained in cardiopulmonary resuscitation (CPR) were evaluated six months after completion of a four-hour basic life support course to determine the degree to which CPR cognitive and psychomotor performance skills were retained. Evaluation criteria were based on the American Heart Association's recommended standards. The data disclosed a significant decrease in the resuscitators' retention of CPR knowledge and skills.