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1.  Seasonal Variation in Fruit and Vegetable Consumption in a Rural Agricultural Community 
Background
Seasonal variation in fruit and vegetable consumption has been documented in a limited number of previous investigations and is important for the design of epidemiologic investigations and in the evaluation of intervention programs.
Objective
This study investigates fruit and vegetable consumption behaviors among Hispanic farmworkers and non-farmworkers in a rural agricultural community.
Methods
A larger study recruited 101 farmworker families and 100 non-farmworker families from the Yakima Valley in Washington State between December 2004 and October 2005. All families were Hispanic. An in-person administered questionnaire collected information on consumption of locally-grown fruits and vegetables and sources of obtaining fruits and vegetables. Data on dietary intake asked whether or not the respondent had consumed a given fruit or vegetable in the past month. Data were collected longitudinally coinciding with three agricultural seasons: thinning (June–July); harvest (September–October); and, non-spray (December–January).
Statistical analyses performed
Generalized estimating equations were used to test for statistical significance between proportions of the population who consumed a given fruit or vegetable across agricultural seasons. Multivariable logistic regression was performed and corresponding odds ratios and 95% confidence intervals are reported.
Results
The proportion of respondents who ate apples, pears, plums, peaches, apricots, peppers, corn, and cucumbers was highest in the fall harvest season, whereas the proportions of those who ate cherries and asparagus were highest in the summer thinning season. Compared to non-farmworkers, a higher proportion of farmworkers reported having eaten peaches, apricots, cherries, green beans, carrots, peppers, corn, pumpkin, squash, and onions, in the past month.
Conclusions
Epidemiologic investigations and public health interventions that examine the consumption of fruits and vegetables ought to consider the seasonal variation in consumption patterns, especially in agricultural communities.
doi:10.1016/j.jada.2008.10.007
PMCID: PMC3983846  PMID: 19103322
fruit and vegetable consumption; agricultural season; Hispanic
2.  Breast cancer interventions serving US-based Latinas: current approaches and directions 
Women's health (London, England)  2013;9(4):335-350.
Despite efforts to reduce morbidity and mortality in breast cancer, Latinas continue to have lower 5-year survival rates than their non-Latina white counterparts. All along the cancer continuum from screening to follow-up of abnormal screening to diagnosis and treatment to survivorship, Latinas fare poorer than non-Latina whites. To close this gap, a number of research projects across the continuum have attempted to improve breast cancer outcomes. In this review, we examine studies that have been carried out in breast cancer along the cancer continuum. We focus not only on randomized, controlled trials, but also on quasi-experimental, and pre- and post-test studies that provided interventions for positive breast cancer outcomes. We examine not only the intervention outcomes, but also the type of intervention targets and type of intervention implementation. In future breast cancer research among Latinas, more emphasis should be placed on the steps in detection and treatment that occur after screening.
doi:10.2217/whe.13.30
PMCID: PMC3969611  PMID: 23826775
breast cancer; breast cancer disparities; cancer control continuum; interventions Latinas
3.  Racial/ethnic differences in use and duration of adjuvant hormonal therapy for breast cancer in the Women’s Health Initiative 
Background
Five-year breast cancer survival rates are lower among Hispanic and African American women than among Non-Hispanic White (NHW) women. Differences in breast cancer treatment likely play a role. Adjuvant hormonal therapies increase overall survival among women with hormone receptor-positive breast cancer.
Methods
We examined racial/ethnic differences in use and duration of adjuvant hormonal therapy among 3,588 postmenopausal women enrolled in the Women’s Health Initiative (WHI) Extension Study. Women diagnosed with hormone receptor-positive localized or regional stage breast cancer after study enrollment were surveyed between September 2009 and August 2010 and asked to recall prior use and duration of adjuvant hormonal breast cancer therapy. Odds ratios [OR] comparing self-reported use and duration by race/ethnicity (Hispanic, African American, Asian/Pacific Islander vs. NHW) were estimated using multivariable-adjusted logistic regression.
Results
Of the 3,588 women diagnosed from 1994–2009; 3,039 (85%) reported any use of adjuvant hormonal therapy and 67% of women reporting ever-use who were diagnosed prior to 2005 reported using adjuvant hormonal therapy for the optimal duration of ≥5 years. In adjusted analysis, no statistically significant differences in use or duration by race/ethnicity were observed.
Conclusions
This study did not find significant differences in use or duration of use of adjuvant hormonal therapy by race/ethnicity.
Impact
Findings should be confirmed in other population-based samples and potential reasons for discontinuation of therapy across all racial/ethnic groups should be explored.
doi:10.1158/1055-9965.EPI-12-1225
PMCID: PMC3596451  PMID: 23275187
postmenopausal breast cancer; adjuvant hormonal therapy; racial/ethnic disparities
4.  Diabetes Prevention in Hispanics: Report From a Randomized Controlled Trial 
Introduction
Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation.
Methods
We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm.
Results
The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group.
Conclusion
This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.
doi:10.5888/pcd11.130119
PMCID: PMC3938962  PMID: 24576395
5.  Do workplace and home protective practices protect farm workers? Findings from the For Healthy Kids Study 
Objective
To assess associations of protective workplace and home practices to pesticide exposure levels.
Methods
Using data from orchard workers in the Yakima Valley, Washington, we examined associations of workplace and home protective practices to (1) urinary metabolite concentrations of dimethylthiophosphate (DMTP) in adults and children aged 2–6; and (2) azinphos-methyl levels in house and vehicle dust.
Results
Data were from 95 orchard workers and 94 children. Contrary to expectation, adult farm workers who wore boots or washed hands using hand sanitizer had higher concentrations of DMTP than those who did not. Children who attended daycare had higher DMTP concentrations than children who did not.
Conclusions
Few workplace or home practices were associated with pesticide exposure levels; workers who used hand sanitizer had higher concentrations of DMTP, as did children who attended daycare.
doi:10.1097/JOM.0b013e31825902f5
PMCID: PMC3866960  PMID: 22772953
Pesticides; agriculture; United States Environmental Protection Agency Worker Protection Standard; home practices; workplace practices
6.  Issues in Biomedical Research: What Do Hispanics Think? 
American journal of health behavior  2013;37(1):10.5993/AJHB.37.1.9.
Objective
To examine barriers and facilitators of biomedical research participation among Hispanics in a rural community in Washington State.
Methods
Questionnaires addressed socio-demographics, health care access, and barriers and facilitators of participation in biomedical studies. This is a descriptive analysis of the findings.
Results
Barriers include the need to care for family members (82%), fear of having to pay for research treatments (74%), cultural beliefs (65%), lack of time (75%) and trust (71%), and the degree of hassle (73%). Facilitators include having a friend/relative with the disease being researched (80%) and monetary compensation (73%).
Conclusion
Researchers should be mindful of these facilitators and barriers when recruiting for biomedical research studies.
doi:10.5993/AJHB.37.1.9
PMCID: PMC3860276  PMID: 22943104
biomedical research; Hispanic; research ethics; recruitment
7.  IMPROVING KNOWLEDGE AND SCREENING FOR COLORECTAL CANCER AMONG HISPANICS: OVERCOMING BARRIERS THROUGH A PROMOTORA-LED HOME-BASED EDUCATIONAL INTERVENTION 
Nearly 67% of Hispanics ages 50 and older report that they have never had a screening colonoscopy. Barriers to screening include cost, lack of health insurance, anticipation of pain, fear, lack of awareness, and embarrassment, significantly more problematic among those Hispanics who are poor and lived in underserved rural and border communities. This study addressed barriers using promotoras and a home-based educational intervention to improve knowledge of and screening for colorectal cancer among Hispanics in Yakima Valley, Washington. Study participants completed pre and post surveys on general cancer knowledge and knowledge specific to colorectal cancer and screening practices and attended a promotora led home-based educational intervention consisting of home-health parties. Results indicated increase in knowledge of and participation in screening for colorectal cancer. Promotora facilitated home-based interventions offer ways to reach Hispanics in rural and other underserved communities to reduce barriers and improve access to cancer screening.
doi:10.1007/s13187-012-0357-9
PMCID: PMC3860278  PMID: 22488199
Hispanics; barriers; colorectal cancer; promotora; home-based; education
8.  Breast Cancer Knowledge and Early Detection among Hispanic Women with a Family History of Breast Cancer along the U.S.-Mexico Border 
Background
Breast cancer is the leading cause of cancer-related death among U.S. Hispanic women. Hispanics are less likely than non-Hispanic White women to be diagnosed at an early stage and survive breast cancer.
Methods
For this cross-sectional study, we assessed differences in breast cancer knowledge, attitudes, and screening practices between Hispanic women with (FH+) and without (FH−) a family history of breast cancer in three U.S.-Mexico border counties.
Results
Among 137 Hispanic women age 40 and older, FH+ women had levels of knowledge and attitudes about breast cancer similar to those of FH− women. FH+ participants were more likely to have ever performed breast self-examinations, although levels of compliance with screening guidelines did not significantly differ between FH+ and FH− groups.
Conclusion
U.S. Hispanic women with a family history of breast cancer constitute an at-risk group for which adhering to preventive screening guidelines could substantially reduce breast cancer mortality.
doi:10.1353/hpu.0.0292
PMCID: PMC3860280  PMID: 20453351
Breast cancer; knowledge; detection; Hispanic
9.  Evaluating breast cancer risk projections for Hispanic women 
Breast cancer research and treatment  2011;132(1):10.1007/s10549-011-1900-9.
For Hispanic women, the Breast Cancer Risk Assessment Tool (BCRAT; “Gail Model”) combines 1990–1996 breast cancer incidence for Hispanic women with relative risks for breast cancer risk factors from non-Hispanic white (NHW) women. BCRAT risk projections have never been comprehensively evaluated for Hispanic women. We compared the relative risks and calibration of BCRAT risk projections for 6,353 Hispanic to 128,976 NHW postmenopausal participants aged 50 and older in the Women’s Health Initiative (WHI). Calibration was assessed by the ratio of the number of breast cancers observed with that expected by the BCRAT (O/E). We re-evaluated calibration for an updated BCRAT that combined BCRAT relative risks with 1993–2007 breast cancer incidence that is contemporaneous with the WHI. Cox regression was used to estimate relative risks. Discriminatory accuracy was assessed using the concordance statistic (AUC). In the WHI Main Study, the BCRAT underestimated the number of breast cancers by 18% in both Hispanics (O/E = 1.18, P = 0.06) and NHWs (O/E = 1.18, P < 0.001). Updating the BCRAT improved calibration for Hispanic women (O/E = 1.08, P = 0.4) and NHW women (O/E = 0.98, P = 0.2). For Hispanic women, relative risks for number of breast biopsies (1.71 vs. 1.27, P = 0.03) and age at first birth (0.97 vs. 1.24, P = 0.02) differed between the WHI and BCRAT. The AUC was higher for Hispanic women than NHW women (0.63 vs. 0.58, P = 0.03). Updating the BCRAT with contemporaneous breast cancer incidence rates improved calibration in the WHI. The modest discriminatory accuracy of the BCRAT for Hispanic women might improve by using risk factor relative risks specific to Hispanic women.
doi:10.1007/s10549-011-1900-9
PMCID: PMC3827770  PMID: 22147080
Hispanic; Breast cancer; Risk prediction; Risk assessment; BCRAT
10.  Perceived and objective breast cancer risk assessment in Chilean women living in an underserved area 
Background
Breast cancer is the most frequently diagnosed malignancy among Chilean women and an increasingly significant public health threat. This study assessed the accuracy of breast cancer risk perception among underserved, Chilean women.
Methods
Women aged 50 to 70 years, with no mammogram during the last two years, were randomly selected from a community clinic registry in Santiago, Chile (n=500). Perceived risk was measured using three methods: absolute risk, comparative risk and numerical risk. Risk comprehension was measured by comparing women’s perceived and objective risk estimates. Multivariate logistic regression was used to assess overestimation of perceived risk.
Results
Women at high risk of breast cancer were more likely than average risk women to perceive themselves at high or higher risk, using absolute and comparative risk approaches (p<0.001). The majority of participants (67%) overestimated their breast cancer risk, based on risk comprehension; although, participants achieved higher accuracy with comparative risk (40%) and absolute risk (31.6%) methods. [Age, breast cancer knowledge and Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk were significantly associated (p<0.01) with accuracy of perceived risk].
Conclusion
Chilean women residing in an underserved community may not accurately assess their breast cancer risk, though risk perception and level of accuracy differed between perceived risk measures. Comparative and absolute risk methods may better reflect women’s interpretation and accuracy of risk perception.
Impact
Improving our understanding of Chilean women’s perceptions of developing breast cancer may lead to the development of culturally relevant efforts to reduce the breast cancer burden in this population.
doi:10.1158/1055-9965.EPI-12-0242
PMCID: PMC3467315  PMID: 22837144
Hispanic; Latina; Breast Cancer; Risk perception; Risk comprehension
11.  Racial and Ethnic Differences in Adjuvant Hormonal Therapy Use 
Journal of Women's Health  2012;21(9):950-958.
Abstract
Background
In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18–64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time.
Methods
Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995–September 1998, phase II, diagnosed October 1998–April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled.
Results
Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06–0.60; OR 0.40, CI 0.17–0.94, respectively). No racial/ethnic differences in use were observed among women with 1+ susceptibility indicators from either recruitment phase.
Conclusions
Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.
doi:10.1089/jwh.2011.3254
PMCID: PMC3430474  PMID: 22731764
12.  Intrapersonal, Behavioral, and Environmental Factors Associated With Meeting Recommended Physical Activity Among Rural Latino Youth 
Pediatric exercise science  2011;23(4):521-536.
This study aimed to identify intrapersonal, behavioral, and environmental factors associated with engaging in recommended levels of physical activity among rural Latino middle school youth. Data were from an anonymous survey of 773 Latino youth (51% female) about level of and barriers and motivators to physical activity, risk behaviors, and park use. Logistic regression models identified factors correlated with meeting recommended levels of physical activity (5 days or more 360 min/day). Thirty-four percent of girls and 41% of boys reported meeting this physical activity recommendation. Participation in an organized after school activity (p < .001) and in physical education (PE) classes 5 days a week (p < .001) were strongly associated with meeting recommended physical activity level. Making PE available 5 days a week and creating opportunities for organized after school physical activity programs may increase the number of rural Latino middle school youth who meet recommended physical activity level.
PMCID: PMC3677811  PMID: 22109778
13.  Long-term Fruit and Vegetable Change in Worksites: Seattle 5 A Day Follow-up 
Objective
To evaluate long-term change in fruit and vegetable intake following a group randomized trial of worksites.
Methods
Medium-sized blue-collar businesses in the Seattle metropolitan area were recruited. Intake was assessed using serial cross-sectional samples of current workforce at 3 time points. The multilevel 18-month intervention involved partnership with the companies. Long-term follow-up was at 4.4 years postbaseline. Statistical analysis used general linear models, adjusting for worksite random effects.
Results
Initially, 45 worksites were randomized, with 29 agreeing to participate in a new study. Fruits and vegetable intake increased, with larger sustained changes in the intervention worksites, resulting in a long-term differential change of 0.25 servings per day, 95% confidence interval (0.09 to 0.40).
Conclusions
Intervention sustained small effects at 4 years, including 2 years with no contact. Although effects were not large, this low-intensity intervention approach could provide an important public health model.
PMCID: PMC3658284  PMID: 20604696
Intervention evaluation studies; behavior change persistence; food; fruits and vegetables; long-term effects
15.  Breast Cancer Knowledge, Attitudes, and Early Detection Practices in United States-Mexico Border Latinas 
Journal of Women's Health  2012;21(1):101-107.
Abstract
Introduction
Evidence suggests Latinas residing along the United States-Mexico border face higher breast cancer mortality rates compared to Latinas in the interior of either country. The purpose of this study was to investigate breast cancer knowledge, attitudes, and use of breast cancer preventive screening among U.S. Latina and Mexican women residing along the U.S.-Mexico border.
Methods
For this binational cross-sectional study, 265 participants completed an interviewer-administered questionnaire that obtained information on sociodemographic characteristics, knowledge, attitudes, family history, and screening practices. Differences between Mexican (n=128) and U.S. Latina (n=137) participants were assessed by Pearson's chi-square, Fischer's exact test, t tests, and multivariate regression analyses.
Results
U.S. Latinas had significantly increased odds of having ever received a mammogram/breast ultrasound (adjusted odds ratio [OR]=2.95) and clinical breast examination (OR=2.67) compared to Mexican participants. A significantly greater proportion of Mexican women had high knowledge levels (54.8%) compared to U.S. Latinas (45.2%, p<0.05). Age, education, and insurance status were significantly associated with breast cancer screening use.
Conclusions
Despite having higher levels of breast cancer knowledge than U.S. Latinas, Mexican women along the U.S.-Mexico border are not receiving the recommended breast cancer screening procedures. Although U.S. border Latinas had higher breast cancer screening levels than their Mexican counterparts, these levels are lower than those seen among the general U.S. Latina population. Our findings underscore the lack of access to breast cancer prevention screening services and emphasize the need to ensure that existing breast cancer screening programs are effective in reaching women along the U.S.-Mexico border.
doi:10.1089/jwh.2010.2638
PMCID: PMC3304252  PMID: 21970564
16.  Organophosphate Pesticide Exposure and Residential Proximity to Nearby Fields: Evidence for the Drift Pathway 
Objectives
Residential proximity to pesticide-treated farmland is an important pesticide exposure pathway.
Methods
In-person interviews and biological samples were collected from 100 farmworker and 100 non-farmworker adults and children living in Eastern Washington State. We examined the relationship of residential proximity to farmland to urinary metabolite concentrations of dimethylphosphate (DMTP) and levels of pesticide residues in house dust.
Results
DMTP concentrations were higher in farmworkers than non-farmworkers (71 μg/L vs 6 μg/L) and in farmworker children than non-farmworker children (17 μg/L vs 8 μg/L). Compared to non-farmworker households, farmworker households had higher levels of azinphos-methyl (643 ng/g vs 121 ng/g) and phosmet (153 ng/g vs 50 ng/g). Overall, a 20% reduction in DMTP concentration was observed per mile increase in distance from farmland.
Conclusions
Lower OP metabolite concentrations correlated with increasing distance from farmland.
doi:10.1097/JOM.0b013e318222f03a
PMCID: PMC3414435  PMID: 21775902
PESTICIDES; DRIFT; RESIDENTIAL PROXIMITY TO FARMLAND
17.  Sociodemographic Correlates of Cancer Screening Services Among Hispanics and Non-Hispanic Whites in a Rural Setting 
Objectives
To examine the relationship between age, race, ethnicity, education, insurance coverage, and income and use of cancer screening services.
Methods
We used a population-based sample (N = 1863) from a community randomized intervention study that took place in eastern Washington State.
Results
Pap testing was directly associated with having public health insurance, being 40 and older, and having a high income (>$35,000). Having Medicare coverage was predictive of having had a mammogram or sigmoidoscopy / colonoscopy screening, but not an FOBT.
Conclusions
Our findings may reflect age-dependent factors that influence access to health care.
PMCID: PMC3401118  PMID: 18844512
cervical cancer; breast cancer; colorectal cancer; Hispanic; demographic factors
18.  Exploring the role of co-worker social support on health care utilization and sickness absence 
Objectives
To explore the association of baseline co-worker social support with follow-up measures of health care use and sickness absence.
Methods
Data were obtained on 1,240 employees from 33 worksites, through Promoting Activity and Changes in Eating, a group randomized weight maintenance trial. Co-worker social support, health care utilization, and absenteeism were assessed via a self-reported questionnaire. Generalized Estimating Equations were employed using STATA version 10.
Results
Higher baseline co-worker social support was significantly associated with a greater number of doctors’ visits (p = 0.015). Co-worker social support was unrelated to number of hospitalizations, emergency room visits, or absenteeism.
Conclusions
The relationship between co-worker social support and health care utilization and absenteeism is complex and uncertain. Future studies should measure more specific outcomes, incorporate important mediating variables, and distill how social networks influence these outcomes.
doi:10.1097/JOM.0b013e318223d42f
PMCID: PMC3132298  PMID: 21685798
19.  The association between worksite social support, diet, physical activity and body mass index 
Preventive medicine  2011;53(1-2):53-56.
Objective
Social support may be associated with improved diet and physical activity—determinants of overweight and obesity. Wellness programs increasingly target worksites. The aim was to evaluate the relationship between worksite social support and dietary behaviors, physical activity, and body mass index (BMI).
Method
Baseline data were obtained on 2,878 employees from 2005 to 2007 from 34 worksites through Promoting Activity and Changes in Eating, a group-randomized weight reduction intervention in Greater Seattle. Worksite social support, diet, physical activity, and BMI were assessed via self-reported questionnaire. Principal components analysis was applied to workgroup questions. To adjust for design effects, random effects models were employed.
Results
No associations were found with worksite social support and BMI, or with many obesogenic behaviors. However, individuals with higher worksite social support had 14.3% higher (95% CI: 5.6%-23.7%) mean physical activity score and 4% higher (95% CI: 1%–7%) mean fruit and vegetable intake compared to individuals with one-unit lower support.
Conclusion
Our findings do not support a conclusive relationship between higher worksite social support and obesogenic behaviors, with the exception of physical activity and fruit and vegetable intake. Future studies are needed to confirm these relationships and evaluate how worksite social support impacts trial outcomes.
doi:10.1016/j.ypmed.2011.04.012
PMCID: PMC3143200  PMID: 21570422
20.  Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer 
Purpose
Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as 2 or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC).
Methods
Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White (NHW)) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use.
Results
Our sample included 13,753 women aged 20–79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]=0.82; [CI] 0.71–0.96 and [OR]=0.78; [CI] 0.63–0.98; respectively).
Conclusions
Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other populations and the reasons for under-initiation among these groups need to be explored.
doi:10.1007/s10549-011-1762-1
PMCID: PMC3375495  PMID: 21922245
breast cancer; adjuvant hormonal therapy; tamoxifen; aromatase inhibitors; racial/ethnic disparities
21.  Rural Latino Youth Park Use: Characteristics, Park Amenities, and Physical Activity 
Journal of community health  2011;36(3):389-397.
Less than half of youth engage in sufficient physical activity to achieve health benefits. Key environmental factors of park and recreation spaces may influence youth physical activity. We sought to ascertain youth characteristics and behaviors that attract youth to parks with specific amenities and encourage physical activity while at the parks in a rural, predominantly Latino community. We examined the quality of amenities in the 13 parks and recreation spaces that middle school aged youth have access to in their community using the Environmental Assessment of Parks and Recreation Spaces (EAPRS) tool. Middle school students completed surveys in the school classroom (n = 1,102) regarding park use, physical activity, and intrapersonal characteristics (e.g., motivators). We used logistic regression to identify correlates of any park use, use of higher quality field and court parks, and active and sedentary park use. Younger age, participation in an after school activity, and identification of a team as a motivator were positively associated with any park use. Use of higher quality court and field parks was associated with participation in an after school activity and being Latino. The odds of being active in the parks were greater for boys and Latinos. Older age and alcohol use are correlated with being sedentary at the park, while odds of being sedentary at the park were lower for boys and youth who met physical activity guidelines. Organized team activities may encourage active use of higher quality fields and courts parks by Latino youth; thereby, increasing their level of physical activity.
doi:10.1007/s10900-010-9320-z
PMCID: PMC3056890  PMID: 20924779
Physical activity; Parks; Youth; Rural; Latino
22.  Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women 
BMC Cancer  2012;12:170.
Background
In the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US.
Methods/design
A parallel randomized-controlled trial of 600 Hispanic women aged 21–64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a ‘promotora’ or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs.
Discussion
This culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer.
Trial registration
NCT01525433
doi:10.1186/1471-2407-12-170
PMCID: PMC3407514  PMID: 22559251
Hispanic women; Pap test; Cervical cancer screening; Cancer disparities
23.  Mammogram screening in Chile: Using mixed methods to implement health policy planning at the primary care level 
Breast (Edinburgh, Scotland)  2011;20(Suppl 2):S40-S45.
Summary
Breast cancer has the highest incidence of all cancers among women in Chile. In 2005, a national health program progressively introduced free mammography screening for women aged 50 and older; however, three years later the rates of compliance with mammographic screening was only 12% in Santiago, the capital city of Chile. This implementation article combines the findings of two previous studies that applied qualitative and quantitative methods to improve mammography screening in an area of Santiago. Socio-cultural and accessibility factors were identified as barriers and facilitators during the qualitative phase of the study and then applied to the design of a quantitative randomized clinical trial. After six months of intervention, 6% of women in the standard care group, 51.8% in the low intensity intervention group, and 70.1% in the high intensity intervention group had undergone a screening mammogram. This review discusses how the utilization of mixed methods research can contribute to the improvement of the implementation of health policies in local communities.
doi:10.1016/j.breast.2011.02.002
PMCID: PMC3072454  PMID: 21334897
Breast cancer screening; Chile; implementation; mixed models
24.  Environmental assessment at worksites following a multilevel intervention to promote activity and changes in eating: The PACE Project 
Objective
To evaluate changes in the worksite environment in response to a multilevel intervention over a two year period.
Methods
Worksites were recruited in the greater Seattle area, and 34 were randomized to intervention or comparison condition. The intervention was based on the ecological model, with a framework of defined phases of intervention that included worksite wide events implemented in partnership with employee-based advisory boards. The assessment of the worksite environment used a modification of the CHEW. Subscales were developed using baseline data only. The intervention effect on different aspects of the worksite environment was estimated using logistic regression with robust estimating procedures.
Results
Only changes in the physical activity and nutrition information environments were significantly associated with the intervention.
Conclusions
This paper provides one of the first attempts at using environmental assessment in the evaluation of worksite interventions.
doi:10.1097/JOM.0b013e3181c7512c
PMCID: PMC3261837  PMID: 20061883
25.  Where’s the Dust? Characterizing Locations of Azinphos-Methyl Residues in House and Vehicle Dust Among Farmworkers with Young Children 
Organophosphate pesticides (OPs) are commonly used in the United States, and farm workers are at risk for chronic exposure. Using data from a community randomized trial to interrupt the take-home pathway of pesticide exposure, we examined the association between floor surface type (smooth floor, thin carpet, and thick carpet) and rooms in which dust samples were collected (living room vs. non-living room) and concentrations of azinphos-methyl residues in home environments. We also examined the association between vehicle type (truck, auto, or other) and footwell floor surfaces (carpeted, smooth surface, or no mat) and concentrations of azinphos-methyl in vehicle dust samples. Dust samples were collected from 203 and 179 households and vehicles, respectively. All households had at least one child aged 2–6. Vehicle dust samples were collected from footwells of the vehicle used for commuting to and from work. A total of 183 samples were collected from living rooms, and 20 were collected from other rooms in the home. Forty-two samples were collected from thick carpets, 130 from thin carpets, and 27 from smooth floor surfaces. Thick and thin carpets had a significantly greater dust mass than smooth floor surfaces (6.0 g/m2 for thick carpets, 7.8 g/m2 for thin carpets, and 1.5 g/m2 for smooth surfaces). Of the 179 vehicle samples, 113 were from cars, 34 from trucks, and 32 from other vehicles. Vehicles with no mats had a significantly higher mass of dust (21.3 g) than those with hard mats (9.3 g) but did not differ from vehicles with plush mats (12.0g). Further research is needed to characterize the environment in which children may be exposed to pesticides.
doi:10.1080/15459624.2010.521028
PMCID: PMC2956613  PMID: 20945243
farmworkers; floor surface; house dust; pesticides; take-home pathway; vehicle dust

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