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1.  [No title available] 
PMCID: PMC3880645  PMID: 23963855
2.  [No title available] 
PMCID: PMC3889655  PMID: 24026303
3.  [No title available] 
PMCID: PMC3947220  PMID: 24026301
4.  [No title available] 
PMCID: PMC3947222  PMID: 23913106
5.  [No title available] 
PMCID: PMC3947232  PMID: 23918645
6.  [No title available] 
PMCID: PMC4017594  PMID: 24026302
7.  Factors Influencing Smokeless Tobacco Use in Rural Ohio Appalachia 
Journal of community health  2012;37(6):1208-1217.
Background
The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia.
Methods
Fifteen focus groups and twenty-three individual qualitative interviews were conducted with adult (n=63) and adolescent (n=53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes.
Results
ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values.
Conclusions
In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to 1) shift the perception of cultural norms regarding ST use and 2) address male social networks as vehicles in ST initiation.
doi:10.1007/s10900-012-9556-x
PMCID: PMC4298853  PMID: 22427033
Appalachia; Men; Smokeless Tobacco; Masculinity; Social Norms
8.  Food Insecurity and Other Poverty Indicators among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes 
Journal of community health  2014;39(6):1133-1139.
Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61% (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.
doi:10.1007/s10900-014-9868-0
PMCID: PMC4271730  PMID: 24705680
9.  Increasing Colorectal Cancer Screening in an Overdue Population: Participation and Cost Impacts of Adding Telephone Calls to a FIT Mailing Program 
Journal of community health  2014;39(2):239-247.
Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92% vs. 45%), there was a much higher proportion of FITs returned out of those mailed in the HII (85% vs. 14%). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.
doi:10.1007/s10900-014-9830-1
PMCID: PMC4267004  PMID: 24499966
Colorectal Cancer Screening; Fecal Immunochemical Test; Intervention; Cost Comparison
10.  Traveling Towards Disease: Transportation Barriers to Health Care Access 
Journal of community health  2013;38(5):976-993.
Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
doi:10.1007/s10900-013-9681-1
PMCID: PMC4265215  PMID: 23543372
Healthcare access; Transportation barriers; Medication access; Healthcare barriers
11.  A comparison of self-reported physical health and health conditions of American Indian/Alaskan Natives to other college students 
Journal of community health  2013;38(6):10.1007/s10900-013-9718-5.
American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8% of all college students in the US. This study examines the differences in college students’ overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues’ impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year.
doi:10.1007/s10900-013-9718-5
PMCID: PMC3823664  PMID: 23800957
American Indian/Alaska Natives; College retention; College dropout; Student health; Academic achievement; Health and wellness
12.  HPV Vaccination and Sexual Behavior in a Community College Sample 
Journal of community health  2013;38(6):10.1007/s10900-013-9710-0.
Many US parents are concerned that vaccinating daughters against human papillomavirus (HPV) will communicate implicit approval for sexual activity and be associated with early or risky sexual behavior (Scarinci et al. in J Womens Health 16(8):1224–1233, 2007; Schuler et al. in Sex Transm Infect 87:349–353, 2011) [7, 8]. The aims of this study were to understand (a) whether the HPV vaccine was associated with risky sexual behavior among a diverse sample of female adolescents and young adults, and (b) to better understand the chronology of HPV vaccination and sexual behavior. An anonymous web-based survey was used to collect data from 114 female community college students. T test and Chi square analyses were used to compare vaccinated and unvaccinated groups on age at first intercourse and proportion who had ever had sexual intercourse. Linear multiple regression was used to predict frequency of condom use and number of sexual partners in the past year, using vaccination status and demographic factors as predictors. About 38 % reported receiving at least one dose of the HPV vaccine. Many of those vaccinated (45 %) received the vaccine after having initiated sexual activity. The proportion of women who were sexually experienced did not differ by HPV vaccine status, nor did age at first intercourse, number of partners in the past year, or frequency of condom use. Current findings suggest that HPV vaccination is not associated with riskier sexual activity for the young women in this sample. Adolescents and their parents may benefit from education about the need to receive the HPV vaccine before onset of sexual activity.
doi:10.1007/s10900-013-9710-0
PMCID: PMC3823717  PMID: 23728823
HPV vaccine; Human papillomavirus; Cervical cancer prevention; College health; Sexual behavior
13.  Human Papillomavirus Knowledge and Awareness Among Vietnamese Mothers 
Journal of community health  2013;38(6):10.1007/s10900-013-9709-6.
Background
Human papillomavirus (HPV) is the most common sexually transmitted disease in the US and the primary cause of cervical cancer. Vietnamese American women have the highest incidence rates of cervical cancer but one of the lowest HPV vaccination rates. Parental knowledge is an important predictor of HPV vaccination; however, little is known about HPV knowledge in the Vietnamese American community. We aimed to describe the HPV knowledge of Vietnamese mothers in Houston, Texas and their intention to vaccinate their daughters.
Methods
We conducted face-to-face interviews with Vietnamese mothers who had daughters aged 9–26 years. We collected data on demographics, acculturation, HPV knowledge, and vaccination intention. Knowledge scores (0–5) were calculated using 5 knowledge questions. We used logistic regression to identify predictors of HPV knowledge.
Results
Participants had low levels of acculturation by report of reading (31%) and writing (23%) English well. Less than 50% of participants (n=47) had heard of HPV, and among these, the mean HPV knowledge score was 4. Although only 1 in 3 had discussed HPV with their medical provider, nearly 86% of participants who had not heard of HPV would vaccinate their daughter if their doctor had recommended it. Good written English skills and belief that the HPV vaccine was not expensive were predictors of HPV awareness.
Conclusions
HPV awareness is low among less acculturated Vietnamese mothers in Houston. Future educational efforts about the role of HPV vaccine in preventing cervical cancer should be made in their language when targeting parents of a high risk Vietnamese population.
doi:10.1007/s10900-013-9709-6
PMCID: PMC3823738  PMID: 23775032
Human papillomavirus; Vietnamese; Knowledge; Awareness
14.  Prevalence of overweight and obesity and their cardiometabolic comorbidities in Hispanic adults living in Puerto Rico 
Journal of community health  2013;38(6):10.1007/s10900-013-9726-5.
This study characterized the prevalence of overweight and obesity and assessed their cardiometabolic comorbidities in the population aged 21–79 years living in the San Juan Metropolitan Area of Puerto Rico. We analyzed data from a household survey conducted in Puerto Rico between 2005 and 2007 that used a representative sample of 840 non-institutionalized adults living in the San Juan Metropolitan Area. Body mass index categories were classified as normal weight, overweight and obese. Poisson regression model with robust variance was used to estimate the prevalence ratio to assess the association of each cardiometabolic comorbidity (hypertension, dyslipidemia, diabetes, prediabetes, systemic inflammation, prothrombotic state, and coronary heart disease) with overweight and obesity. Age-standardized prevalence of overweight and obesity was 35.9% and 41.5%, respectively, figures higher than the combined prevalence for the U.S. adult population (68.8%) but similar to all mainland Hispanics (78.8%). Men were more likely to be overweight than women (40.4% versus 33.4%), whereas more women than men were obese (43.7% versus 37.6%). Prevalence of all cardiometabolic comorbidities was significantly (p<0.05) higher among overweight and obese adults than those of normal weight after adjusting for age, sex, years of education, smoking status, alcohol consumption and physical activity. A considerable proportion of adults in this population are overweight or obese. In view of the wide-ranging effects that overweight and obesity have on health, preventive actions to avert the rise of excess body weight as well as the design of lifestyle interventions are largely needed in this population.
doi:10.1007/s10900-013-9726-5
PMCID: PMC3823746  PMID: 23846388
Overweight; Obesity; Cardiometabolic Comorbidities; Hispanics
15.  A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community 
Journal of community health  2013;38(6):1030-1041.
Asian Americans experience diabetes at a higher rate than non-Hispanic whites. Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results, yet there have been no culturally-tailored programs for diabetes prevention in the Korean community. We explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve health behaviors and promote diabetes prevention among Korean Americans using a randomized controlled trial. Between 2011 and 2012, a total of 48 Korean Americans at risk for diabetes living in New York City (NYC) participated in the intervention. Participants were allocated to treatment or control groups. A community-based participatory research approach guided development of the intervention, which consisted of 6 workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to health care. Changes over 6 months were examined for clinical measurements (weight, BMI, waist circumference, blood pressure, glucose, and cholesterol); health behaviors (physical activity, nutrition, food behaviors, diabetes knowledge, self-efficacy, and mental health); and health access (insurance and self-reported health). In this small pilot study, changes were seen in weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. Qualitative findings provide additional contextual information that inform ways in which CHWs may influence health outcomes. These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC, and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable populations.
doi:10.1007/s10900-013-9711-z
PMCID: PMC3964609  PMID: 23813322
Asian Americans; Korean Americans; Community health workers; Community-based participatory research; Diabetes prevention
16.  Estimating the Impact of Smoking Cessation During Pregnancy: The San Bernardino County Experience 
Journal of community health  2013;38(5):838-846.
We examined the relation between maternal smoking and adverse infant outcomes [low birth weight (LBW), and preterm birth (PTB)] during 2007–2008 in San Bernardino County, California—the largest county in the contiguous United States which has one of the highest rates of infant mortality in California. Using birth certificate data, we identified 1,430 mothers in 2007 and 1,355 in 2008 who smoked during pregnancy. We assessed the effect of never smoking and smoking cessation during pregnancy relative to smoking during pregnancy for the 1,843/1,798 LBW, and 3,480/3,238 PTB’s recorded for 2007/2008, respectively. To describe the effect of quitting smoking during pregnancy, we calculated the exposure impact number for smoking during pregnancy. Major findings are: (1) relative to smoking during pregnancy, significantly lower risk of LBW among never smoking mothers [OR, year: 0.56, 2007; 0.54, 2008] and for smoking cessation during pregnancy [0.57, 2007; 0.72, 2008]; (2) relative to smoking during pregnancy, significantly lower risk of PTB was found for never smoking mothers [0.68, 2007; 0.68, 2008] and for smoking cessation during pregnancy [0.69, 2007; 0.69, 2008]; (3) an exposure impact assessment indicating each LBW or PTB outcome in the county could have been prevented either by at least 35 mothers quitting smoking during pregnancy or by 25 mothers being never smokers during pre-pregnancy. Our findings identify an important burden of adverse infant outcomes due to maternal smoking in San Bernardino County that can be effectively decreased by maternal smoking cessation.
doi:10.1007/s10900-013-9687-8
PMCID: PMC4227584  PMID: 23553684
San Bernardino County; Maternal tobacco use; Smoking cessation during pregnancy; Exposure impact number
17.  Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation 
Journal of community health  2009;34(2):79-89.
We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were ≥50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor's recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options.
doi:10.1007/s10900-008-9133-5
PMCID: PMC4182868  PMID: 19082695
Colorectal cancer screening; Decision making; Gender; Race
18.  Collective efficacy and HIV prevention in South African townships 
Journal of community health  2013;38(5):885-893.
South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n=1581) and women (n=718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.
doi:10.1007/s10900-013-9694-9
PMCID: PMC3769453  PMID: 23660646
HIV/AIDS; Collective efficacy; Social Norms; South Africa
19.  Latent Tuberculosis Infection in an Urban Cohort: Screening and Treatment for Latent TB in an Urban Setting 
Journal of community health  2013;38(5):941-950.
Background
Despite its benefit for treating active tuberculosis, directly observed therapy (DOT) for latent tuberculosis infection (LTBI) has been largely understudied among challenging inner city populations.
Methods
Utilizing questionnaire data from a comprehensive mobile healthcare clinic in New Haven, CT from 2003 to July 2011, a total of 2523 completed tuberculin skin tests (TST’s) resulted in 357 new LTBIs. Multivariate logistic regression correlated covariates of the two outcomes 1) initiation of isoniazid preventative therapy (IPT) and 2) completion of 9-months IPT.
Results
Of 357 new LTBIs, 86.3% (n=308) completed screening CXRs: 90.3% (n=278) were normal and 0.3% (n=1) with active tuberculosis. Of those completing CXR screening, 44.0% (n=135) agreed to IPT: 69.6% (n=94) selected DOT, and 30.4% (n=41) selected SAT. Initiating IPT was correlated with undocumented status (AOR=3.43; p<0.001) and being born in a country of highest and third highest tuberculosis prevalence (AOR=14.09; p=0.017 and AOR=2.25; p=0.005, respectively). Those selecting DOT were more likely to be Hispanic (83.0% vs 53.7%; p<0.0001), undocumented (57.4% vs 41.5%; p=0.012), have stable housing (p=0.002), employed (p<0.0001), uninsured (p=0.014), no prior cocaine or crack use (p=0.013) and no recent incarceration (p=0.001). Completing 9-months of IPT was correlated with no recent incarceration (AOR 5.95; p=0.036) and younger age (AOR 1.03; p=0.031). SAT and DOT participants did not significantly differ for IPT duration (6.54 vs 5.68 months; p=0.216) nor 9-month completion (59.8% vs 46.3%; p=0.155).
Conclusions
In an urban mobile healthcare sample, screening completion for LTBI was high with nearly half initiating IPT. Undocumented, Hispanic immigrants from high prevalence tuberculosis countries were more likely to self-select DOT at the mobile outreach clinic, potentially because of more culturally, linguistically, and logistically accessible services and self-selection optimization phenomena (SSOP). Within a diverse, urban environment, DOT and SAT IPT models for LTBI treatment resulted in similar outcomes, yet outcomes were hampered by differential measurement bias between DOT and SAT participants.
doi:10.1007/s10900-013-9704-y
PMCID: PMC3781590  PMID: 23728822
Latent Tuberculosis; Immigrant; Foreign-Born; Directly Observed Therapy; Self-Administered Therapy; Mobile Health Care
20.  Factors influencing Breast Cancer Screening in Low-Income African Americans in Tennessee 
Journal of community health  2014;39(5):943-950.
This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n=334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P< .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P< .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.
doi:10.1007/s10900-014-9834-x
PMCID: PMC4165808  PMID: 24554393
21.  Knowledge, Attitudes, and Practices for Cervical Cancer Screening Among the Bhutanese Refugee Community in Omaha, Nebraska 
Journal of community health  2014;39(5):872-878.
Cervical cancer is the second most common cause of cancer mortality among women with the vast majority of patients in developing countries. Bhutanese refugees in the United States are from South Central Asia, the 4th leading region of the world for cervical cancer incidence. Over the past few years, Bhutanese refugees have increased significantly in Nebraska. This study evaluates current knowledge of cervical cancer and screening practices among the Bhutanese refugee women in Omaha, Nebraska. The study aimed to investigate cervical cancer and screening knowledge and perceptions about the susceptibility and severity of cervical cancer and perceived benefits and barriers to screening. Self-administered questionnaires and focus groups based on the Health Belief Model were conducted among 42 healthy women from the Bhutanese refugee community in Omaha. The study revealed a significant lack of knowledge in this community regarding cervical cancer and screening practices, with only 22.2 % reporting ever hearing of a Pap test and 13.9 % reporting ever having one. Only 33.3 % of women were in agreement with their own perceived susceptibility to cervical cancer. Women who reported ever hearing about the Pap test tended to believe more strongly about curability of the disease if discovered early than women who never heard about the test (71.4 vs. 45.0 %, for the two groups. respectively). Refugee populations in the United States are in need for tailored cancer education programs especially when being resettled from countries with high risk for cancer.
doi:10.1007/s10900-014-9906-y
PMCID: PMC4175018  PMID: 25060231
Bhutanese; Screening; Cervical cancer; Nebraska
22.  A Colorectal Cancer Screening Program in an Underserved, Ethnically Diverse Population in Chicago, IL 
Journal of community health  2013;38(4):603-608.
Objective
To describe the structure and outcomes of a colorectal cancer screening program at CommunityHealth, the largest free health clinic in Illinois.
Methods
We conducted a retrospective observational study using administrative clinical data from 2006–2011.
Results
A total of 4026 patients were eligible for colorectal cancer screening of which 2418 (60.0%) completed fecal occult blood testing (FOBT). Subsequently, 1657 patients had negative FOBT results and 1365 patients underwent on-site flexible sigmoidoscopy. Over 90% of patients had never had a prior screening examination. A majority of patients were female (61.7%) and self-identified as Mexican (37.5%) or Polish (28.2%). A total of 203 biopsies were performed resulting in the detection of 69 adenomas (5.0%) and 1 adenocarcinoma (0.1%).
Conclusions
A comprehensive colorectal cancer screening program was successfully implemented in a large community health center serving a population of diverse racial and ethnic backgrounds without prior access to screening. This program could serve as model for colorectal cancer screening in diverse, low resource communities.
doi:10.1007/s10900-013-9665-1
PMCID: PMC3706552  PMID: 23471656
colorectal cancer; screening; community health; public health
23.  Correlates of colorectal cancer screening among residents of Ohio Appalachia 
Journal of community health  2013;38(4):609-618.
There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the U.S., which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 50–75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR=1.04, 95% CI: 1.01, 1.07), had higher income ($30,000–$60,000, OR=1.92, 95% CI: 1.29, 2.86; ≥$60,000, OR=1.80, 95% CI: 1.19, 2.72), a primary care provider (OR=4.22, 95% CI: 1.33, 13.39), a recent check-up (OR=2.37, 95% CI: 1.12, 4.99), had been encouraged to be screened (OR=1.57, 95% CI: 1.11, 2.22), had been recommended by their doctor to be screened (OR=6.68, 95% CI: 3.87, 11.52), or asked their doctor to order a screening test (OR=2.24, 95% CI: 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.
doi:10.1007/s10900-013-9683-z
PMCID: PMC3706501  PMID: 23529450
colorectal cancer; screening; Appalachia; health disparities
24.  Perceptions of Patient-Provider Communication in Breast and Cervical Cancer-Related Care: A Qualitative Study of Low-Income English- and Spanish-Speaking Women 
Journal of community health  2013;38(4):707-715.
To explore patient perceptions of patient-provider communication in breast and cervical cancer-related care among low-income English- and Spanish- speaking women, we examined communication barriers and facilitators reported by patients receiving care at safety net clinics. Participants were interviewed in English or Spanish after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Following an inductive approach, interviews were coded and analyzed by the language spoken with providers and patient-provider language concordance status. Of 78 participants, 53% (n = 41) were English-speakers and 47% (n = 37) were Spanish-speakers. All English-speakers were language-concordant with providers. Of Spanish-speakers, 27% (n = 10) were Spanish-concordant; 38% (n = 14) were Spanish-discordant, requiring an interpreter; and 35% (n = 13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. English-speakers focused on communication barriers, and difficulty understanding jargon arose as a theme. Spanish-speakers emphasized communication facilitators related to Spanish language use. Themes among all Spanish-speaking sub-groups included appreciation for language support resources and preference for Spanish-speaking providers. Mixed-concordant participants accounted for the majority of Spanish-speakers who reported communication barriers. Our data suggest that, although perception of patient-provider communication may depend on the language spoken throughout the care continuum, jargon is lost when health information is communicated in Spanish. Further, the respective consistency of language concordance or interpretation may play a role in patient perception of patient-provider communication.
doi:10.1007/s10900-013-9668-y
PMCID: PMC3706461  PMID: 23553683
patient-provider communication; low-income women; cancer-related care; qualitative research
25.  The Association between Neighborhood Socioeconomic Status and Clinical Outcomes among Patients 1 Year after Hospitalization for Cardiovascular Disease 
Journal of community health  2013;38(4):690-697.
Residing in lower socioeconomic status neighborhoods is associated with increased risk of morbidity and mortality. Few studies have examined this association for cardiovascular disease (CVD) outcomes in a treated population in New York City (NYC). The purpose of this study was to determine the relationship between neighborhood level poverty and one-year clinical outcomes (rehospitalization and/or death) among hospitalized patients with CVD. Data on rehospitalization and/or death at one-year were collected from consecutive patients admitted at a university medical center in NYC from November 2009 to September 2010. NYC residents totaled 2,198. U.S. Census 2000 zip code data was used to quantify neighborhood SES into quintiles of poverty (Q1=lowest poverty to Q5=highest poverty). Univariate analyses were used to determine associations between neighborhood poverty and baseline characteristics and comorbidities. A logistic regression analysis was used to calculate odds ratios for the association between quintiles of poverty and rehospitalization/death at one year. Fifty-five percent of participants experienced adverse outcomes. Participants in Q5 (9%) were more likely to be female (odds ratio [OR]=0.49,95% confidence interval [CI] 0.33–0.73), younger (OR=0.50,95% CI 0.34–0.74), of minority race/ethnicity (OR=18.24,95% CI 11.12=29.23), and have no health insurance (OR=4.79,95% CI 2.92–7.50). Living in Q5 was significantly associated with increased comorbidities, including diabetes mellitus and hypertension, but was not a significant predictor of rehospitalization/death at one year. Among patients hospitalized with CVD, higher poverty neighborhood residence was significantly associated with a greater prevalence of comorbidities, but not of rehospitalization and/or death. Affordable, accessible resources targeted at reducing the risk of developing CVD and these comorbidities should be available in these communities.
doi:10.1007/s10900-013-9666-0
PMCID: PMC3706565  PMID: 23468321
cardiovascular disease; neighborhood; socioeconomic; prevention

Results 1-25 (154)