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1.  Increasing HPV vaccination through policy for public health benefit 
Human Vaccines & Immunotherapeutics  2015;12(6):1623-1625.
ABSTRACT
Vaccines against specific types of human papillomavirus (HPV) linked to cancer and other diseases have been met with mixed acceptance globally and in the United States. Policy-level interventions have been shown to be effective in increasing public health benefit. Government policies and mandates may result in improved HPV vaccination coverage and reduced disease burden, and alternative policies that improve unhindered access to HPV vaccination may allow success as well. The purpose of this commentary is to summarize policy efforts to maximize the public health benefit of HPV vaccination. We examine selected examples of HPV vaccination policy in global contexts and in the United States.
doi:10.1080/21645515.2015.1122145
PMCID: PMC4964717  PMID: 26669416
cancer prevention; HPV; HPV vaccination; public health policy; public health intervention; vaccination
2.  Race and prevalence of large bowel polyps among the low-income and uninsured in South Carolina 
Digestive diseases and sciences  2015;61(1):265-272.
Background
Compared to whites, blacks have higher colorectal cancer (CRC) incidence and mortality rates and are at greater risk for early onset disease. The reasons for this racial disparity are poorly understood, but one contributing factor could be differences in access to high quality screening and medical care.
Aims
The present study was carried out to assess whether a racial difference in prevalence of large bowel polyps persists within a poor and uninsured population (n=233, 124 blacks, 91 whites, 18 other) undergoing screening colonoscopy.
Methods
Eligible patients were uninsured, asymptomatic, had no personal history of colorectal neoplasia, and were between the ages 45–64 years (blacks) or 50–64 years (whites, other). We examined the prevalence of any adenoma (conventional, serrated) and then difference in adenoma/polyp type by race and age categories.
Results
Prevalence for ≥ 1 adenoma was 37% (95% CI 31%–43%) for all races combined and 36% in blacks < 50 years, 38% in blacks ≥ 50 years, 35% in whites. When stratified by race, blacks had a higher prevalence of large conventional proximal neoplasia (8%) compared to whites (2%) (p-value =0.06) but a lower prevalence of any serrated-like polyp (blacks 18%, whites 32%); p-value=0.02) and sessile serrated adenomas/polyps (blacks 2%, whites 8% chi-square p-value; p=0.05).
Conclusions
Within this uninsured population the overall prevalence of adenomas was high and nearly equal by race, but the racial differences observed between serrated and conventional polyp types emphasizes the importance of taking polyp type into account in future research on this topic.
doi:10.1007/s10620-015-3862-y
PMCID: PMC5125220  PMID: 26386856
race; colorectal adenomas; serrated polyps; socioeconomic status; screening
3.  A Technology-Mediated Behavioral Weight Gain Prevention Intervention for College Students: Controlled, Quasi-Experimental Study 
Background
Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students.
Objective
This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students.
Methods
Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral weight gain prevention intervention (Healthy Weight, HW; N=29) or a human papillomavirus (HPV) vaccination awareness intervention (control; N=29). All students were enrolled, regardless of initial body weight or expressed interest in weight management. The interventions delivered 8 lessons via electronic newsletters and Facebook postings over 9 weeks, which were designed to foster social support and introduce relevant educational content. The HW intervention targeted behavioral strategies to prevent weight gain and provided participants with a Wi-Fi-enabled scale and an electronic physical activity tracker to facilitate weight regulation. A repeated-measures analysis of variance was conducted to examine within- and between-group differences in measures of self-reported weight control practices and objectively measured weight. Use of each intervention medium and device was objectively tracked, and intervention satisfaction measures were obtained.
Results
Students remained weight stable (HW: −0.48+1.9 kg; control: −0.45+1.4 kg), with no significant difference between groups over 9 weeks (P =.94). However, HW students reported a significantly greater increase in the number of appropriate weight control strategies than did controls (2.1+4.5 vs −1.1+3.4, respectively; P =.003) and there was no increase in inappropriate weight control behaviors (P =.11). More than 90% of students in the HW arm opened the electronic newsletters each week, and the average number of Facebook interactions (comments and likes) per student each week was 3.3+1.4. Each self-monitoring device was initialized by 90% of HW students. On average, they used their physical activity tracker for 23.7+15.2 days and their Wi-Fi scale for 14.1+13.1 days over the 9 weeks. HW students rated the intervention favorably.
Conclusions
The short-term effect of this technology-based weight gain prevention intervention for college students is promising and merits evaluation over a longer duration to determine whether engagement and behavioral improvements positively affect weight outcomes and can be maintained.
doi:10.2196/jmir.5474
PMCID: PMC4923588  PMID: 27296086
weight gain prevention; college students; social media; wearables; behavior change
4.  Cancer Research Participation Beliefs and Behaviors of a Southern Black Population: A Quantitative Analysis of the Role of Structural Factors in Cancer Research Participation 
Increasing the participation of Blacks in cancer research is a vital component of a strategy to reduce racial inequities in cancer burden. Community-based participatory research (CBPR) is especially well-suited to advancing our knowledge of factors that influence research participation to ultimately address cancer-related health inequities. A paucity of literature focuses on the role of structural factors limiting participation in cancer research. As part of a larger CBPR project, we used survey data from a statewide cancer needs assessment of a Black faith community to examine the influence of structural factors on attitudes toward research and the contributions of both structural and attitudinal factors on whether individuals participate in research. Regression analyses and non-parametric statistics were conducted on data from 727 adult survey respondents. Structural factors, such as having health insurance coverage, experiencing discrimination during health care encounters, and locale, predicted belief in the benefits, but not the risks, of research participation. Positive attitudes towards research predicted intention to participate in cancer research. Significant differences in structural and attitudinal factors were found between cancer research participants and non-participants; however, directionality is confounded by the cross-sectional survey design and causality cannot be determined. This study points to complex interplay of structural and attitudinal factors on research participation as well as need for additional quantitative examinations of the various types of factors that influence research participation in Black communities.
doi:10.1007/s13187-014-0749-0
PMCID: PMC4428991  PMID: 25385692
5.  Federally Qualified Health Centers’ Capacity and Readiness for Research Collaborations: Implications for Clinical-Academic-Community Partnerships 
Background
Federally qualified health centers (FQHCs) provide a health care safety net for underserved populations and contribute unique expertise to research that could further enhance quality of patient care. The purpose of this research was to assess interest in, readiness to, and capacity for conducting research in FQHCs in South Carolina (SC).
Methods
A web-based survey was administered to 20 FQHCs across SC. Fourteen representatives of FQHCs completed the 39-item survey that assessed research experience and interest, partnerships and funding, barriers and benefits to research participation, training and technical assistance needs, and research capacity.
Results
FQHCs are interested in conducting research. FQHCs reported that health center leadership, organizational benefit, active engagement of staff, and clear roles for partners were important factors for successful partnerships. Inequity of budget and resources were the greatest challenges encountered. Improved patient outcomes, additional resources for the center, reduction in disparities, and academic partnerships were considered benefits for participation. FQHCs were interested in training and technical assistance opportunities for research funding and best practices for the use of research to inform programs and services.
Conclusions
FQHCs are willing to collaborate on research. For successful research partnerships, collaborators should understand FQHCs’ challenges and barriers to participation.
doi:10.1111/cts.12272
PMCID: PMC4553115  PMID: 25962873
Federally Qualified Health Center; Research partnership; Capacity; Readiness
6.  Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening 
Colorectal cancer  2012;1(5):383-396.
SUMMARY
Aim
The aim was to describe the association of awareness and knowledge with participation in colorectal cancer (CRC) screening.
Materials & methods
Telephone survey research was conducted with South Carolina (USA) residents aged 50–75 years using a 144-item instrument. Data were analyzed with SAS and Stata. Adjusted odds ratios are reported.
Results
Respondents (n = 1302) had heard of CRC screening (96%) and exhibited high levels of CRC awareness and knowledge; only 74% had ever been screened. Higher levels of knowledge were associated with a greater likelihood of having ever been screened (odds ratio: 1.05; 95% CI: 1.02–1.41; p < 0.001).
Conclusion
Results showed high levels of awareness and knowledge, but modest participation in CRC. Transforming awareness and knowledge into CRC screening participation should be a priority.
doi:10.2217/crc.12.45
PMCID: PMC4529290  PMID: 26257828
7.  Cervical cancer prevention knowledge and abnormal Pap test experiences among women living with HIV/AIDS 
Background
Cervical cancer prevention knowledge deficits persist among women living with HIV/AIDS (WLHA) despite increased risk of developing cervical dysplasia/cancer. We examined associations between WLHA’s cervical cancer prevention knowledge and abnormal Pap test history.
Methods
We recruited 145 urban and rural WLHA from Ryan White-funded clinics and AIDS service organizations located in the southeastern United States between March 2011 and April 2012. For this analysis, women who reported a history of cervical cancer (n=3) or had a complete hysterectomy (n=14), and observations with missing data (n=22) were excluded. Stata/IC 13 was used to perform cross-tabulations and chi-squared tests.
Results
Our sample included 106 predominantly non-Hispanic Black (92%) WLHA. Mean age was 46.3±10.9 years. Half (50%) had ≤ high school education. One-third (37%) had low health literacy. The majority (83%) had a Pap test <1 year ago and 84% knew that WLHA should have a Pap test every year, once two tests are normal. Many (68%) have had an abnormal Pap test. Abnormal Pap test follow-up care knowledge varied. While 86% knew follow-up care could include a repeat Pap test, only 56% knew this could also include an HPV test. Significantly more women who had an abnormal Pap test knew follow-up care could include a biopsy (p=0.001).
Conclusions
For WLHA to make informed/shared decisions about their cervical health, they need to be knowledgeable about cervical cancer care options across the cancer control continuum. Providing WLHA with prevention knowledge beyond screening recommendations seems warranted given their increased risk of developing cervical dysplasia/neoplasia.
doi:10.1007/s13187-014-0688-9
PMCID: PMC4266621  PMID: 24928481
cervical cancer; HIV-positive women; cancer prevention and screening; women’s health; cancer care continuum
8.  Digital Solutions for Informed Decision Making: An Academic-Community Partnership for the Development of a Prostate Cancer Decision Aid for African-American Men 
American journal of men's health  2015;10(3):207-219.
African-American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups, and there is a critical need to identify strategies for providing information about PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM intervention for PrCA screening would be appropriate for AA men, this formative evaluation study examined their (1) PrCA risk and screening knowledge, (2) decision-making processes for PrCA screening, (3) usage of, attitudes toward, and access to interactive communication technologies (ICTs), and (4) perceptions regarding a future novel computer-based PrCA education intervention. A purposive convenience sample of 39 AA men aged 37–66 years in the Southeastern United States were recruited through faith-based organizations to participate in one of six 90-minute focus groups and complete a 45-item descriptive survey. Participants were generally knowledgeable about PrCA; however, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes including health information seeking. Most participants were open to a novel computer-based intervention if the system was easy to use and its animated avatars were culturally appropriate. Because study participants had low exposure to IDM for PrCA, but frequently used ICTs, IDM interventions using ICTs (e.g, computers) hold promise for AA men and should be explored for feasibility and effectiveness. These interventions should aim to increase PrCA screening knowledge and stress the importance of participating in IDM with their doctor.
doi:10.1177/1557988314564178
PMCID: PMC4492917  PMID: 25563381
Technology; Prostate Cancer Screening; Informed Decision Making; Minority Health
9.  A Comparison of a Centralized Versus De-Centralized Recruitment Schema in Two Community-Based Participatory Research Studies for Cancer Prevention 
Journal of community health  2015;40(2):251-259.
Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans. One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88% recruitment rates and 71 and 66% retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5%). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs 51%, P<0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities.
doi:10.1007/s10900-014-9924-9
PMCID: PMC4315761  PMID: 25086566
African American; Recruitment; Retention; Behavioral intervention; Community based participatory research; Cancer prevention
10.  Mentoring and Training of Cancer-Related Health Disparities Researchers Committed to Community-Based Participatory Research 
Background and Objective
The National Cancer Institute’s (NCI) Community Networks Program Centers (CNPCs) provide community-based participatory research (CBPR)-oriented mentoring and training to prepare early-stage/midcareer investigators and student trainees (trainees) in disparities reduction. This paper describes the academic, mentoring, training, and work–life balance experiences of CNPC-affiliated trainees.
Methods
We used a collaborative and iterative process to develop a 57-item, web-based questionnaire completed by trainees from the 23 CNPCs between August 2012 and February 2013. Their CNPC mentors completed a 47-item questionnaire. Descriptive statistics were calculated.
Results
The final analytic sample included 189 of 269 individuals (70%) identified as active participants in CNPC research or training/mentoring. Mentors (n = 45) were mostly non-Hispanic White (77.8%) and 48.9% were male. Mentors published a median of 6 (interquartile range [IQR], 3–12) first-authored and 15 (IQR, 6–25) senior authored manuscripts, and secured 15 (IQR, 11–29) grants from the National Institutes of Health (NIH) and other sources in the previous 5 years. Most trainees (n = 144) were female (79.2%), 43.7% were underrepresented racial/ethnic minorities, and 36.8% were first-generation college graduates. Over the previous 5 years, trainees reported a median of 4 (IQR, 1–6) publications as first author and 4 (IQR, 2–8) as co-author; 27.1% reported having one or more NIH R01s. Trainees reported satisfaction with their CNPC mentor (79.1%) and confidence in demonstrating most CBPR competencies.
Conclusion
The CNPC training program consists of a scientifically productive pool of mentors and trainees. Trainees reported rates of scholarly productivity comparable to other national training programs and provided insights into relationships with mentors, academic pressures, and professional–personal life balance.
doi:10.1353/cpr.2015.0020
PMCID: PMC4703034  PMID: 26213409
Health disparities; neoplasms; mentors; education; sociology and social phenomena faculty; education; sociology and social phenomena; ethnic groups
11.  The National Cancer Institute’s Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned 
Background
We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.
Methods
Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.
Results
Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.
Implications
Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.
doi:10.1353/cpr.2015.0017
PMCID: PMC4698458  PMID: 26213401
12.  Innovative and Community-Driven Communication Practices of the South Carolina Cancer Prevention and Control Research Network 
The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) is 1 of 10 networks funded by the Centers for Disease Control and Prevention and the National Cancer Institute (NCI) that works to reduce cancer-related health disparities. In partnership with federally qualified health centers and community stakeholders, the SC-CPCRN uses evidence-based approaches (eg, NCI Research-tested Intervention Programs) to disseminate and implement cancer prevention and control messages, programs, and interventions. We describe the innovative stakeholder- and community-driven communication efforts conducted by the SC-CPCRN to improve overall health and reduce cancer-related health disparities among high-risk and disparate populations in South Carolina. We describe how our communication efforts are aligned with 5 core values recommended for dissemination and implementation science: 1) rigor and relevance, 2) efficiency and speed, 3) collaboration, 4) improved capacity, and 5) cumulative knowledge.
doi:10.5888/pcd11.140151
PMCID: PMC4112920  PMID: 25058673
13.  Dissemination of an Electronic Manual to Build Capacity for Implementing Farmers’ Markets with Community Health Centers 
Community-university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, “Building Farmacies,” describes an approach for developing capacity and sustaining a community health center-based farmers’ market that emerged through a community-university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multi-vendor, produce-only farmers’ market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a web-based survey to access the free manual. During the six-month dissemination period, 271 individuals downloaded the manual. Findings highlighted the value of translating community-based participatory research into user-friendly manuals to guide future intervention development and dissemination approaches, and demonstrate the need to include capacity building opportunities to support translation and adoption of interventions.
doi:10.1111/cts.12318
PMCID: PMC4548815  PMID: 26296392
15.  Examining connections between screening for breast, cervical and prostate cancer and colorectal cancer screening 
Colorectal cancer  2014;3(3):253-263.
SUMMARY
Aim
To compare participation in breast, cervical and prostate cancer screening with colorectal cancer (CRC) screening.
Materials & methods
This random digit-dialed survey includes participants (aged 50–75 years) from South Carolina (USA). Past participation information in fecal occult blood test, flexible sigmoidoscopy, colonoscopy, mammography, clinical breast examination, Pap test, prostate-specific antigen and digital rectal examination was obtained.Adjusted odds ratios are reported.
Results
Among European–American women, any cervical or breast cancer screening was associated with adherence to any CRC screening. Among African–American women, mammography was associated with adherence to any CRC screening. Digital rectal examination and prostate-specific antigen tests were associated with adherence to any CRC screening test among all men.
Conclusion
Future research should explore approaches inclusive of cancer screening recommendations for multiple cancer types for reduction of cancer screening disparities.
doi:10.2217/crc.14.18
PMCID: PMC4134878  PMID: 25143785
breast cancer screening; cervical cancer screening; colorectal cancer screening; health disparities; prostate cancer screening
16.  C-Reactive Protein Levels in African Americans: A Diet and Lifestyle Randomized Community Trial 
Background
Chronic Inflammation is linked to poor lifestyle behaviors and a variety of chronic diseases that are prevalent among African Americans, especially in the southeastern U.S.
Purpose
The goal of the study was to test the effect of a community-based diet, physical activity, and stress reduction intervention conducted in 2009–2012 on reducing serum C-reactive protein (CRP) in overweight and obese African-American adults.
Methods
An RCT intervention was designed jointly by members of African-American churches and academic researchers. In late 2012, regression (i.e., mixed) models were fit that included both intention-to-treat and post hoc analyses conducted to identify important predictors of intervention success. Outcomes were assessed at 3 months and 1 year.
Results
At baseline, the 159 individuals who were recruited in 13 churches and had evaluable outcome data were, on average, obese (BMI=33.1 [±7.1]) and had a mean CRP level of 3.7 (±3.9) mg/L. Reductions were observed in waist-to-hip ratio at 3 months (2%, p=0.03) and 1 year (5%, p<0.01). In female participants attending ≥60% of intervention classes, there was a significant decrease in CRP at 3 months of 0.8 mg/L (p=0.05), but no change after 1 year. No differences were noted in BMI or interleukin-6.
Conclusions
In overweight/obese, but otherwise “healthy,” African-American church members with very high baseline CRP levels, this intervention produced significant reductions in CRP at 3 and 12 months, and in waist-to-hip ratio, which is an important anthropometric predictor of overall risk of inflammation and downstream health effects.
Trial registration
This study is registered at www.clinicaltrials.gov NCT01760902.
doi:10.1016/j.amepre.2013.05.011
PMCID: PMC3779347  PMID: 24050419
17.  The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-Based Survey of Women in the Southeastern United States 
Background
The objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities.
Methods
Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus (HPV) and cervical cancer (n=918). Random-digit dial, computer-assisted telephone interviews (CATI) were used to contact eligible respondents [adult (18–70) women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12.
Findings
While FHC+ was not predictive (OR=1.17, 95% CI 0.55, 2.51), private health insurance (OR=2.35, 95% CI 1.15, 4.81) and younger age (18–30 years: OR=7.76, 95% CI 1.91, 3.16) were associated with recent Pap test behavior. Family history and cervical cancer screening associations were not detected in the sample.
Conclusions
Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.
doi:10.1016/j.whi.2013.03.003
PMCID: PMC3700594  PMID: 23722075
18.  Provider Communication and Role Modeling Related to Patients' Perceptions and Use of a Federally Qualified Health Center-based Farmers' Market 
Health promotion practice  2013;15(2):288-297.
Farmers’ markets have the potential to improve the health of underserved communities, shape people’s perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers’ market located at a federally qualified health center (FQHC). Although provider communication about diet decreased over time, communication strategies included: providing patients with “prescriptions” and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed the market had potential to improve the health of FHQC staff and patients. Provider modeling of healthy behaviors may influence patients’ food-related perceptions and dietary behaviors.
doi:10.1177/1524839913500050
PMCID: PMC3871943  PMID: 23986503
federally qualified health center; farmers’ market; diabetes; obesity prevention; patient-provider communication; communication intervention
19.  Program Planners’ Perspectives of Promotora Roles, Recruitment, and Selection 
Ethnicity & health  2012;18(3):262-279.
Objective
Program planners work with promotoras (the Spanish term for female community health workers) to reduce health disparities among underserved populations. Based on the Role-Outcomes Linkage Evaluation Model for Community Health Workers (ROLES) conceptual model, we explored how program planners conceptualized the promotora role and the approaches and strategies they used to recruit, select, and sustain promotoras.
Design
We conducted semi-structured, in-depth interviews with a purposive convenience sample of 24 program planners, program coordinators, promotora recruiters, research principal investigators, and other individuals who worked closely with promotoras on United States-based health programs for Hispanic women (ages 18 and older).
Results
Planners conceptualized the promotora role based on their personal experiences and their understanding of the underlying philosophical tenets of the promotora approach. Recruitment and selection methods reflected planners’ conceptualizations and experiences of promotoras as paid staff or volunteers. Participants described a variety of program planning and implementation methods. They focused on sustainability of the programs, the intended health behavior changes or activities, and the individual promotoras.
Conclusion
To strengthen health programs employing the promotora delivery model, job descriptions should delineate role expectations and boundaries and better guide promotora evaluations. We suggest including additional components such as information on funding sources, program type and delivery, and sustainability outcomes to enhance the ROLES conceptual model. The expanded model can be used to guide program planners in the planning, implementing, and evaluating of promotora health programs.
doi:10.1080/13557858.2012.730605
PMCID: PMC3901517  PMID: 23039847
20.  Preparing Promotoras to Deliver Health Programs for Hispanic Communities: Training Processes and Curricula 
Health promotion practice  2012;14(3):10.1177/1524839912457176.
Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of “training the trainer,” the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
doi:10.1177/1524839912457176
PMCID: PMC3876408  PMID: 22982761
community health workers; curriculum; cultural competence; interviews; content analysis
21.  Sustainability of promotora initiatives: Program planners’ perspectives 
The use of promotoras de salud is an increasingly widespread delivery approach for community-based health education and promotion programs targeting obesity-related lifestyle behaviors for Hispanic populations. Addressing a gap in the literature, this research examined the sustainability of promotora-led initiatives from the perspectives of those who plan, implement, and evaluate these programs. We conducted 24 in-depth interviews with program planners representing 22 promotora programs focused on Hispanic women’s health in ten states. Findings illustrated program planners’ opinions regarding the components, logistics, and barriers to promotora program sustainability. Several participants challenged the notion of promotora program sustainability by reframing the issue as promoting individual promotoras’ well-being and social mobility rather than maintaining their role in the program over time. Implications for community health planning, management, and policy include developing sustainability strategies during program planning stages and implementation of policies to more effectively integrate promotoras into existing healthcare systems at local, state, and national levels.
doi:10.1097/PHH.0b013e318280012a
PMCID: PMC3827959  PMID: 23295409
22.  Assessing the Influence of Health Literacy on HIV-Positive Women’s Cervical Cancer Prevention Knowledge and Behaviors 
Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥2 Pap tests during the year after HIV diagnosis (p=0.02), and less likely to have had a Pap test <1 year previously (p=0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.
doi:10.1007/s13187-013-0470-4
PMCID: PMC3769692  PMID: 23564430
Health literacy; HIV-positive women; Cervical cancer
23.  Findings from the Community Health Intervention Program in South Carolina: Implications for Reducing Cancer-Related Health Disparities 
BACKGROUND
The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities and reduce the cancer burden among high-risk populations across the state. The mini-grants project implemented evidence-based health interventions tailored to the specific needs of each community.
OBJECTIVE
To support the SC-CPCRN’s goals of moving toward greater dissemination and implementation of evidence-based programs in the community to improve public health, prevent disease, and reduce the cancer burden.
METHODS
Three community-based organizations were awarded $10,000 each to implement one of the National Cancer Institute’s evidence-based interventions. Each group had 12 months to complete their project. SC-CPCRN investigators and staff provided guidance, oversight, and technical assistance for each project. Grantees provided regular updates and reports to their SC-CPCRN liaisons to capture vital evaluation information.
RESULTS
The intended CHIP mini-grant target population reach was projected to be up to 880 participants combined. Actual combined reach of the three projects reported upon completion totaled 1,072 individuals. The majority of CHIP participants were African-American females. Participants ranged in age from 19 to 81 years. Evaluation results showed an increase in physical activity, dietary improvements, and screening participation.
CONCLUSIONS
The success of the initiative was the result of a strong community-university partnership built on trust. Active two-way communication and an honest open dialogue created an atmosphere for collaboration. Communities were highly motivated. All team members shared a common goal of reducing cancer-related health disparities and building greater public health capacity across the state.
doi:10.1007/s13187-013-0479-8
PMCID: PMC3755099  PMID: 23645547
24.  Creating a Cadre of Junior Investigators to Address the Challenges of Cancer-Related Health Disparities: Lessons Learned from the Community Networks Program 
Community-based participatory research (CBPR) initiatives such as the National Cancer Institute’s Community Networks Program (CNP) (2005–2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (9 vs. 4 in last 5 years, p=0.01), having more co-authored publications (8 vs. 3 in last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP’s training program, especially effort directed at underrepresented investigators.
doi:10.1007/s13187-012-0361-0
PMCID: PMC3407323  PMID: 22528636
25.  Reducing Cancer Disparities Through Innovative Partnerships: A Collaboration of the South Carolina Cancer Prevention and Control Research Network and Federally Qualified Health Centers 
Journal of Cancer Education  2012;27(1):59-61.
The South Carolina Cancer Prevention and Control Research Network, in partnership with the South Carolina Primary Health Care Association, and Federally Qualified Health Centers (FQHCs), aims to promote evidence-based cancer interventions in community-based primary care settings. Partnership activities include (1) examining FQHCs’ readiness and capacity for conducting research, (2) developing a cancer-focused data sharing network, and (3) integrating a farmers’ market within an FQHC. These activities identify unique opportunities for public health and primary care collaborations.
doi:10.1007/s13187-011-0272-5
PMCID: PMC3272325  PMID: 21932143
Community health centers; Evidence-based cancer interventions

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