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1.  Assessing Colorectal Cancer Screening Behaviors and Knowledge among At-Risk Hispanics in Southern New Mexico* 
Journal of cancer therapy  2013;4(6B):15-25.
Purpose
Colorectal cancer (CRC) mortality rates in New Mexico (NM) continue to be higher than national rates. Hispanic CRC mortality rates in NM surpass those of overall Hispanics in the US. This study was designed to characterize and understand factors contributing to low CRC screening rates in this border region.
Methods
A CRC Knowledge Assessment Survey (KAS) was administered in either English or Spanish to 247 individuals attending community events throughout southern NM. A subset of these individuals completed an online CRC risk assessment survey managed by the National Cancer Institute (NCI). Data analysis tested for significant differences in knowledge, physician-patient CRC interactions, CRC risk level perception, and screening rates across diverse ethnic and age groups.
Results
Both CRC knowledge and physician-patient CRC interactions were positively associated with participant screening history. Significant age and ethnic differences for CRC knowledge, physician-patient CRC interactions, and screening history in the NM border sample were also seen. Age-eligible Hispanics (50+) as well as those less than 50 years of age had lower CRC knowledge and were less likely to engage in physician-patient CRC interactions than non-Hispanic Whites (NHWs). The age-eligible Hispanics also reported lower CRC screening rates than their NHW counterparts.
Conclusions
Low CRC knowledge and limited physician-patient CRC interactions appear to contribute to low screening rates in this NM population. Expanding education and outreach efforts for this border population are essential to promote early CRC detection and thereby decrease overall CRC mortality rates.
doi:10.4236/jct.2013.46A2003
PMCID: PMC4303072  PMID: 25621179
Colorectal Cancer; Health Disparity; Hispanics; Knowledge; Knowledge; Screening
2.  Physician and Family Recommendations to Obtain a Mammogram and Mammography Intentions: The Moderating Effects of Perceived Seriousness and Risk of Breast Cancer 
A growing body of literature has demonstrated psychosocial factors enable mammography intentions and usage among Latinas. Although these factors (e.g., family recommendations, breast cancer perceptions) likely influence one another, little research has examined interactive effects. The current study assessed the moderating effect of perceived breast cancer seriousness and risk on associations between recommendations to obtain mammography and mammography intentions. This sample included 97 Latinas in rural Eastern Washington State. After adjusting for age, two significant interactions emerged: perceived seriousness × physician recommendation and perceived risk × family recommendation. This exploratory study provides important directions for future communication research and planning to improve screening disparities.
doi:10.4172/2167-0420.1000199
PMCID: PMC4281937  PMID: 25558437
Mammography; Latina; Family recommendations; Physician recommendations; Perceived risk
3.  Understanding and Reducing Obstacles in a Collaboration between a Minority Institution and a Cancer Center 
Summary
Reducing the cancer incidence and mortality rates of underserved populations will require multidisciplinary efforts involving teams of diverse investigators. We describe a collaborative program between a National Cancer Institute-designated cancer center and a minority-serving institution. The organizations worked together to discover institutional and cultural barriers and facilitators to productive collaboration.
doi:10.1353/hpu.2013.0167
PMCID: PMC4037139  PMID: 24185160
4.  Advancing Transdisciplinary Research: The Transdisciplinary Research on Energetics and Cancer Initiative 
Strategies for constructing and maintaining cross-disciplinary teams are in their infancy. We outline strategies to support one form, transdisciplinary research, in a major initiative of the National Cancer Institute, the Transdisciplinary Research in Energetics and Cancer 2 (TREC2) initiative. Discussion of the TREC2 sites’ experiences with transdisciplinarity is structured around a conceptual model that identifies four iterative phases of transdisciplinary research. An active coordination center, regular face-to-face meetings, and input from external advisors were instrumental in moving TREC2 to the translation phase. The possibilities for advancements in the science of energetics and cancer increased as investigator ties became denser. TREC2 can be seen as a flagship effort in transdisciplinary science that provides lessons on moving ideas from development to translation.
PMCID: PMC4209479  PMID: 25356437
Transdisciplinary; Team science; Cancer; Translation
5.  Plans to obtain a mammogram among Chilean women: the roles of recommendations and self-efficacy 
Health Education Research  2013;28(5):784-792.
Social factors may heavily influence cancer screening decisions and practices among Latinas, given the importance their culture places on close, interpersonal relationships. Recommendations by healthcare providers, family and friends have been associated with early detection strategies among US-based Latina populations, but little is known about other Latin American populations. Furthermore, less is known about mechanisms underlying this relationship. In this study, we sought to (i) understand if different types of recommendations were associated with subsequent plans to obtain a mammogram and (ii) assess the potential mediating roles of perceived importance of these recommendations and self-efficacy. Our sample included 250 women residing in a low-income, urban area of Santiago, Chile, and who had participated in a 6-month intervention to increase mammography screening, but remained non-compliant. Women who received family recommendations were more likely to indicate they planned to receive a mammogram in the next 6 months. Perceived self-efficacy mediated this relationship, such that women who received a family recommendation appeared to be more likely to plan to get a mammogram because of increased perceived capabilities to do so. Future research should consider the cultural context of family and self-efficacy in the development of screening interventions for Latinas.
doi:10.1093/her/cyt047
PMCID: PMC3772330  PMID: 23515116
6.  Cancer Screening at a Federally Qualified Health Center: A qualitative study on organizational challenges in the era of health care reform 
Background
Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context.
Methods
We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes.
Results
We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening.
Conclusions
To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.
doi:10.1007/s10903-012-9701-8
PMCID: PMC3530661  PMID: 22878911
cancer prevention; cancer screening; Latinos; uninsured; primary care medical home; organizational change
7.  Psychological Distress, Social Withdrawal, and Coping Following Receipt of an Abnormal Mammogram Among Different Ethnicities: A Mediation Model 
Oncology nursing forum  2014;41(5):523-532.
Purpose/Objectives
To explore ethnic differences in psychological distress and social withdrawal after receiving an abnormal mammogram result and to assess if coping strategies mediate ethnic differences.
Design
Descriptive correlational.
Setting
Two urban mobile mammography units and a rural community hospital in the state of Washington.
Sample
41 Latina and 41 non-Latina Caucasian (NLC) women who had received an abnormal mammogram result.
Methods
Women completed standard sociodemographic questions, Impact of Event Scale–Revised, the social dimension of the Psychological Consequences Questionnaire, and the Brief COPE.
Main Research Variables
Ethnicity, psychological distress, social withdrawal, and coping.
Findings
Latinas experienced greater psychological distress and social withdrawal compared to NLC counterparts. Denial as a coping strategy mediated ethnic differences in psychological distress. Religious coping mediated ethnic differences in social withdrawal.
Conclusions
Larger population-based studies are necessary to understand how ethnic differences in coping strategies can influence psychological outcomes. This is an important finding that warrants additional study among women who are and are not diagnosed with breast cancer following an abnormal mammogram.
Implications for Nursing
Nurses may be able to work with Latina patients to diminish denial coping and consequent distress. Nurses may be particularly effective, given cultural values concerning strong interpersonal relationships and respect for authority figures.
doi:10.1188/14.ONF.523-532
PMCID: PMC4172284  PMID: 25158657
breast cancer; coping; cultural competence; Hispanic; prevention; detection; quality of life
8.  Perspectives of Mothers in Farmworker Households on Reducing the Take-Home Pathway of Pesticide Exposure 
Farmworkers carry pesticide residue home on their clothing, boots, and skin, placing other household members at risk, particularly children. Specific precautions are recommended to reduce this take-home pathway, yet few studies have examined the perspectives of farmworkers and other household members regarding these behaviors and the reasons for or against adoption. The authors conducted semistructured interviews with 37 Mexican/Mexican-American women in farmworker households to explore the family and cultural context in which pesticide safety practices are performed and to identify factors that facilitate or hinder their adoption. Whereas women could describe the take-home pathway, they were less able to connect it with their family’s susceptibility to pesticide exposure. Women experienced difficulty integrating the prevention behaviors into their everyday lives because of competing responsibilities, conflicts with their husbands’ intentions and with cultural health beliefs, perceived lack of control, and community barriers that interfered with women’s motivations. Implications for practice are discussed.
doi:10.1177/1090198108328911
PMCID: PMC4111917  PMID: 19136611
pesticides; farmworker; take-home pathway
9.  The Impact of Family History of Breast Cancer on Knowledge, Attitudes, and Early Detection Practices of Mexican Women Along the Mexico-US Border 
Rates of breast cancer (BC) have increased in Mexico, with the highest incidence and mortality rates observed in the northern Mexican states. This study aimed to describe the BC knowledge, attitudes and screening practices among Mexican women with and without a family history of BC residing along the Mexico-US border, and identify factors associated with screening behaviors. One hundred and twenty eight Mexican women aged 40 and older completed an interviewer-administered questionnaire on sociodemographic characteristics, knowledge, family history, and screening practices. There were no significant differences between Mexican women with and without a family history. Over 60% of women in both groups had never had a mammogram/breast ultrasound, and more than 50% had never obtained a clinical breast exam. Age, marital status, insurance, and breast cancer knowledge significantly influenced BC screening behaviors among Mexican women. Further research is needed to examine other key factors associated with screening utilization, in effort of improving BC rates.
doi:10.1007/s10903-010-9418-5
PMCID: PMC4111087  PMID: 21104130
Breast cancer; Family history; Screening; Knowledge; Mexican
10.  Utilizing Pyrosequencing and Quantitative PCR to Characterize Fungal Populations among House Dust Samples 
Molecular techniques are replacing culturing and counting methods in quantifying indoor fungal contamination. Pyrosequencing offers the possibility of identifying unexpected indoor fungi. In this study, 50 house dust samples were collected from homes in the Yakima Valley, WA. Each sample was analyzed by quantitative PCR (QPCR) for 36 common fungi and by fungal tag-encoded flexible (FLX) amplicon pyrosequencing (fTEFAP) for these and additional fungi. Only 24 of the samples yielded amplified results using fTEFAP but QPCR successfully amplified all 50 samples. Over 450 fungal species were detected by fTEFAP but most were rare. Twenty-two fungi were found by fTEFAP to occur with at least an average of ≥ 0.5% relative occurrence. Many of these fungi seem to be associated with plants, soil or human skin. Combining fTEFAP and QPCR can enhance studies of fungal contamination in homes.
doi:10.1039/c2em30229b
PMCID: PMC4079115  PMID: 22767010
11.  Factores predictores de inicio y cesación de tabaquismo en una cohorte de mujeres chilenas con 5,5 años de seguimiento 
Revista medica de Chile  2009;137(8):1001-1009.
Background
Chilean women have one of the highest smoking prevalence in the world.
Aim
To estimate the main factors associated with smoking initiation and quitting among a cohort of adult women living in a low socioeconomic status area of Santiago, Chile.
Material and methods
A random population-based sample of 1,100 women, 18 years and older, were selected from a community located in the South East area of Santiago. Sociodemographic, as well as smoking, beliefs, behaviors, stages of change and nicotine addiction level were recorded during a personal interview. After an average follow-up period of 5.5 years, women were re-evaluated.
Results
Seventy-three percent of women completed the study. At baseline, 39% of women were smokers. At the end of the study, there was an absolute smoking rate reduction of 7.1% (p<0.001). The main variables associated with smoking initiation were younger age (Odds ratio (OR): 1.08, 95% confidence intervals (CI): 1.05–1.12), higher education level (OR: 1.2, 95% CI: 1.07–1.35), and having fewer children (OR: 1.3 95% CI: 1.01–1.66). Factors related with quitting were younger age of onset (OR: 1.06 95% CI: 1.02–1.1), higher level of nicotine dependence (OR: 4.22, 95% CI: 1.74–10.27), and higher perception of smoking addiction (OR: 4.34, 95% CI: 2–9.09). Stage of change was associated with smoking cessation but its effect was diluted after adjusting for the level of nicotine addiction.
Conclusions
Sociodemographic and family factors were the main variables related with initiation, whereas age of onset, belief of addiction, and nicotine dependence were the main factors related with cessation. Women with a high motivation for quitting should be evaluated for nicotine addiction level to define the best strategy for intervention (Rev Méd Chile 2009; 137: 1001–9).
PMCID: PMC4065611  PMID: 19915762
Cohort studies; Smoking; Tobacco use disorder
12.  Evaluation of a Radionovela to Promote HPV Vaccine Awareness and Knowledge Among Hispanic Parents 
Journal of community health  2011;36(6):957-965.
Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States. The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years, though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV (HPV-16 and HPV-18) that cause approximately 70% of cervical cancer cases. Few culturally-tailored Spanish HPV vaccine awareness programs have been developed. This study evaluates the efficacy of a Spanish radionovela as an educational tool. Rural Hispanic parents of daughters aged 9–17 (n = 88; 78 mothers and 10 fathers) were randomized to listen to the HPV vaccine radionovela or to another public service announcement. Participants completed a 30 min pretest posttest questionnaire. Parents who listened to the HPV radionovela (intervention group) scored higher on six knowledge and belief items. They were more likely to confirm that HPV is a common infection (70% vs. 48%, P = .002), to deny that women are able to detect HPV (53% vs. 31%, P = .003), to know vaccine age recommendations (87% vs. 68%, P = .003), and to confirm multiple doses (48% vs. 26%, P = .03) than control group parents. The HPV vaccine radionovela improved HPV and HPV vaccine knowledge and attitudes. Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents.
doi:10.1007/s10900-011-9395-1
PMCID: PMC4065612  PMID: 21452030
Rural Hispanic parents; HPV vaccine education; Cervical cancer prevention; Efficacy evaluation
13.  Having a Diagnosis of Diabetes Is Not Associated With General Diabetes Knowledge in Rural Hispanics 
Purpose
The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic Whites. Hispanics also have higher rates of diabetes-related complication and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population.
Methods
This study was conducted as part of a larger project in partnership with a local community hospital in Washington State’s Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5-statements selected from the Diabetes Knowledge Questionnaire. Men and women (N=1297) between the ages of 18–92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status and family history of diabetes were tested as predictors of diabetes knowledge.
Findings
Overall, general knowledge was high with 71–84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a 5th statement. Although, no variable was associated with all statements, family history, gender and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements.
Conclusion
Contrary to expectations having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender and diabetic status as conduits of diabetes education among rural Hispanics.
doi:10.1111/j.1748-0361.2010.00299.x
PMCID: PMC4022479  PMID: 21029169
diabetes; health promotion; Hispanic; rural; social determinants of health
14.  Strategies for Increasing Mammography Screening in Primary Care in Chile: Results of a Randomized Clinical Trial 
Background
Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.
Methods
We compare the effects on mammography screening rates of standard care, of a low intensity intervention based on mail contact, and of a high intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past two years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self report and by electronic clinical records. An intention to treat model was used to analyze the results.
Results
Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low intensity group, and 70.1% in the high intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low and high intensity groups received the mail contact, and 50% in the high intensity group received a telephone or personal contact.
Conclusion
A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.
Impact
A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.
doi:10.1158/1055-9965.EPI-10-0313
PMCID: PMC3985495  PMID: 20826832
15.  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
16.  THE 2011-2016 TRANSDISCIPLINARY RESEARCH IN ENERGETICS AND CANCER (TREC) INITIATIVE: RATIONALE AND DESIGN 
Cancer causes & control : CCC  2013;24(4):695-704.
Purpose
Recognition of the complex, multidimensional relationship between excess adiposity and cancer control outcomes has motivated the scientific community to seek new research models and paradigms.
Methods
The National Cancer Institute developed an innovative concept to establish a centers grant mechanism in nutrition, energetics, and physical activity; referred to as the Transdisciplinary Research on Energetics and Cancer (TREC) Initiative. This paper gives an overview of the 2011-2016 TREC Collaborative Network and the 15 research projects being conducted at the Centers.
Results
Four academic institutions were awarded TREC center grants in 2011: Harvard University, University of California San Diego, University of Pennsylvania, and Washington University in St. Louis. The Fred Hutchinson Cancer Research Center is the Coordination Center. The TREC research portfolio includes 3 animal studies, 3 cohort studies, 4 randomized clinical trials, 1 cross-sectional study, and 2 modeling studies. Disciplines represented by TREC investigators include basic science, endocrinology, epidemiology, biostatistics, behavior, medicine, nutrition, physical activity, genetics, engineering, health economics, and computer science. Approximately 41,000 participants will be involved in these studies, including children, healthy adults, and breast and prostate cancer survivors. Outcomes include biomarkers of cancer risk, changes in weight and physical activity, persistent adverse treatment effects (e.g., lymphedema, urinary and sexual function), and breast and prostate cancer mortality.
Conclusion
The NIH Science of Team Science group will evaluate the value-added by this collaborative science. However, the most important outcome will be whether this transdisciplinary initiative improves the health of Americans at risk for cancer as well as cancer survivors.
doi:10.1007/s10552-013-0150-z
PMCID: PMC3602225  PMID: 23378138
energetics; obesity; diet; physical activity; cancer; transdisciplinary
17.  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
18.  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
19.  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
20.  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
21.  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
22.  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
23.  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
24.  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
25.  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

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