Two-thirds of adults aged 50 years and older are adherent to recommendations for colorectal cancer screening. Provider–patient communication and characteristics of the patient–provider relationship may relate to screening behavior.
The association of provider communication quality, relationship, and colorectal cancer screening was examined within data from the 2007 Health Information National Trends Survey.
Perceived provider communication and relationship quality were associated with both adherence to colonoscopy and with ever having been screened. Predictive margins analyses indicated that increasing perceptions from lowest to highest levels of communication and relationship quality would be associated with increases in screening rates approaching 16 percentage points.
Improving provider–patient communication and relationship quality could potentially improve colorectal cancer screening behaviors among adults aged 50 years and older. Future research and clinical practice should focus on understanding the role of these factors in screening behavior and enhance the provider–patient interaction.
cancer prevention and screening; health communications; health promotion; patient education; quantitative methods
Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women’s health behaviors during women’s visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed.
cervical cancer; patient education; international health (Peru)
Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the U.S. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research (CBPR) approach. Adult Pacific Islanders (n=144) were randomly assigned to either PLP (n=72) or SBP (n=72), after completing a 3-month weight loss program. Successful weight maintenance was defined as a participants’ post-intervention weight change remaining ≤3% of their pre-intervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p≤0.05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% CI=1.06–24; p=0.02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity-disparities of Pacific Islanders and thus warrants further investigation.
weight loss maintenance; weight regain; Pacific Islanders; weight loss; ethnic minority health; obesity
The sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a randomized trial, testing dissemination strategies at 68 U.S. and Canadian ski areas in 2004-2007. All ski areas received GSS from the National Ski Areas Association through a Basic Dissemination Strategy (BDS) using conference presentations and free materials. Half of the ski areas were randomly assigned to a theory-based Enhanced Dissemination Strategy (EDS) with personal contact supporting GSS use. Use of GSS was assessed at immediate and long-term follow-up posttests by on-site observation. Use of GSS declined from the immediate (M=5.72) to the long-term follow-up (M=6.24), F[1,62]=6.95, p=.01, but EDS ski areas (M=6.53) continued to use GSS more than BDS ski areas (M=4.49), F(1,62)=5.75, p=0.02, regardless of observation, F(1,60)=0.05, p=.83. Despite declines over time, a group of ski areas had sustained high program use and active dissemination methods had sustained positive effects on GSS implementation.
Internal and external coalition functioning is an important predictor of coalition success that has been linked to perceived coalition effectiveness, coalition goal achievement, coalition ability to support evidence-based programs, and coalition sustainability. Understanding which aspects of coalition functioning best predict coalition success requires the development of valid measures of empirically unique coalition functioning constructs. The goal of the present study is to examine and refine the psychometric properties of coalition functioning constructs in the following six domains: leadership, interpersonal relationships, task focus, participation benefits/costs, sustainability planning, and community support. We used factor analysis to identify problematic items in our original measure and then piloted new items and scales to create a more robust, psychometrically sound, multidimensional measure of coalition functioning. Scales displayed good construct validity through correlations with other measures. Discussion considers the strengths and weaknesses of the refined instrument.
Coalitions; Partnerships; Communities That Care; Measurement Development; Prevention; Substance Abuse; Delinquency
Hispanic problem behavior youth are at an increased risk of engaging in HIV risk behaviors, including low condom use. However, relatively little research has examined factors that affect condom use in this population. Although research indicates that family processes, such as higher levels of family functioning and open parent–adolescent communication about sex, and condom use attitudes, norms, and control beliefs as depicted by the theory of planned behavior have an effect on condom use behaviors, the combination of the two factors has received minimal attention. The purpose of this study was to examine the effect of family functioning on condom use intentions and behaviors through communication about sex and condom use attitudes, parental norms, and control beliefs. A cross-sectional study of 171 predominately male (73.1%) sexually active Hispanic problem behavior adolescents (mean age = 14.88 years) was conducted. Structural equation modeling was used to test the study hypothesis. Findings largely support the overall model and suggest that family functioning had an indirect effect on condom use intention and behavior through communication about sex, condom use attitudes, and control beliefs. Family functioning, however, did not have an indirect effect on condom use intention and behavior through communication about sex and parental norms. Implications for prevention science and future research are discussed.
adolescents; behavioral theories; HIV/AIDS; Latino; race/ethnicity; sex behavior; theory of planned behavior
To determine the relationship between parent time demands and presence and enforcement of family rules and parent/child dyad weight status.
Dyads of one child/parent per family (n=681dyads), Twin Cities, Minnesota, 2007–2008 had measured height/weight and a survey of demographics, time demands and family rules-related questions. Parent/child dyads were classified into four healthy weight/overweight categories. Multivariate linear associations were analyzed with SAS, testing for interaction by work status and family composition (p<0.10).
In adjusted models, lack of family rules and difficulty with rule enforcement were statistically lower in dyads in which the parent/child was healthy weight compared to dyads in which the parent/child was both overweight (Difference in family rules scores=0.49, p=0.03; difference in rule enforcement scores=1.09, p=<0.01). Of parents who worked full-time, healthy weight dyads reported lower time demands than other dyads (Difference in time demands scores=1.44, p=0.01).
Family experiences of time demands and use of family rules are related to the weight status of parents and children within families.
adult; child; weight status; time demands; family rules
African Americans have a higher rate of colorectal cancer (CRC) mortality than other racial/ethnic groups. This disparity is alarming given that CRC is largely preventable through the use of endoscopy (screening colonoscopy or sigmoidoscopy), yet rates of CRC screening among African Americans is suboptimal. Only 48.9% of African Americans are screened for CRC through endoscopy or fecal occult blood testing. As such, researchers have focused their efforts on the prevention of CRC through patient navigation (PN) services for colonoscopy screening. Although PN has been successful in increasing colonoscopy screening rates, screening rates of navigated participants could still be improved. Thus, the purpose of this exploratory study was to understand why patients, who received PN services, did not complete a colonoscopy. Sixteen participants were interviewed to identify salient themes related to noncompletion of the colonoscopy procedure. Major themes identified included the following: a lack of knowledge about CRC; fear/anxiety about the procedure, including unknown expectations, fear of pain, and fear of cancer diagnosis; inadequate physician communication about CRC and the colonoscopy exam; and believing that cancer leads to death. Participants felt that greater communication and explanation from their physician might help allay their fears. Our findings also suggest that a universal approach to PN, even within culturally targeted interventions, may not be appropriate for all individuals. Future interventions should consider gender-specific navigation and combining PN with nonmedical interventions to address other identified barriers.
African American; cancer prevention and screening; health disparities; patient navigation; qualitative methods; race/ethnicity
Strength training (ST) is an important health behavior for aging women; it helps maintain strength and function and reduces risk for chronic diseases. This study assessed change in physical fitness following participation in a ST program implemented and evaluated by community leaders.
The StrongWomen Program is a nationally disseminated, research-based, community ST program active in 40 states. The Senior Fitness Test is used to assess upper and lower body strength, upper and lower body flexibility, aerobic fitness, and agility; data are collected prior to and following program participation.
For these analyses, five states provided deidentified data for 367 female participants, mean age 63 (±11) years. Attendance in approximately 10 weeks of twice-weekly classes was 69.4%. Paired t tests were used to analyze pre–post change. Significant improvements were observed (p < .01) in all Senior Fitness Test measures. Data are stratified by age-group and compared with published, age-based norms.
This study demonstrates that it is feasible for community leaders to conduct pre–post physical fitness evaluations with participants and that participants experienced improvements across several important domains of physical fitness.
aging and health; community-based participatory research; community health promotion; evaluation; health promotion; outcome evaluation; physical activity/exercise; training health professionals; women’s health
Ecodevelopmental theory is a theoretical framework used to explain the interplay among risk and protective processes associated with HIV risk behaviors among adolescents. Although ecodevelopmentally based interventions have been found to be efficacious in preventing HIV risk behaviors among Hispanic youth, this theory has not yet been directly empirically tested through a basic research study in this population. The purpose of this cross-sectional study was to empirically evaluate an ecodevelopmentally based model using structural equation modeling, with substance use and early sex initiation as the two outcomes of the ecodevelopmental chain of relationships. The sample consisted of 586 Hispanic youth (M age = 13.6; SD = 0.75) and their primary caregivers living in Miami, Florida. Adolescent, parent, and teacher reports were used. The results provided strong support for the theoretical model. More specifically, the parent–adolescent acculturation gap is indirectly related both to early sex initiation and to adolescent substance use through family functioning, academic functioning, perceived peer sexual behavior, and perceived peer substance use. Additionally, parent’s U.S. orientation is associated with adolescent substance use and adolescent sex initiation through social support for parents, parental stressors, family functioning, academic functioning, and perceived peer sexual behavior and substance use. These findings suggest that HIV risk behaviors may best be understood as associated with multiple and interrelated ecological determinants.
Hispanics; substance use; HIV; ecodevelopmental theory
This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew upon in-depth interviews with 30 women ages 21 to 45 recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers—material, economic, and social-interactional—to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices, but also the physical and social environments of stores as well.
Neighborhood; Food environment; African Americans; Nutrition; Food shopping
Evaluate similarities and differences in the self-care domain of health lifestyle among older, rural dwelling women and men.
Qualitative analysis of in-depth interview data from 62 community-dwelling older (M = 74.3 years) African and European American women and men.
Both older women and men rely heavily on over-the-counter (OTC) medications and home remedies self-care; professional health care is typically sought when self-care is not effective. However, relative to men, women were more knowledgeable about different approaches to self-care, especially home remedies, they used a wider range of self-care activities, and they placed greater priority on self-care over professional health care.
The structure of older women’s and men’s self-care domain of health lifestyle is similar. However, there are subtle differences in health lifestyle that are likely embedded in gendered role behavior and may contribute to women’s greater health complaints.
Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative (n = 71) and quantitative (n = 297) data collected in a 4-year, multimethod study among patients with hypertension and/ or diabetes, the authors explored differences in self-reported adherence to diet and exercise plans and self-reported daily diet and exercise practices across four ethnic groups—Whites, Blacks, Vietnamese, and Latinos—at a primary health care center in Massachusetts. Adherence to diet and exercise plans differed across ethnic groups even after controlling for key sociodemographic variables, with Vietnamese participants reporting the highest adherence. Food and exercise options were shaped by economic constraints as well as ethnic and cultural familiarity with certain foods and types of activity. These findings indicate that health care providers should consider ethnicity and economic status together to increase effectiveness in encouraging diverse populations with chronic disease to make healthy lifestyle changes.
adherence; chronic disease management; diet; food insecurity; physical activity/exercise; race/ethnicity
Computer-based multimedia technologies can be used to tailor health messages, but promotoras (Spanish-speaking community health workers) rarely use these tools. Promotoras delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a “low-tech” format (flipchart and video); and a “high-tech” format consisting of a tailored, interactive computer program delivered on a tablet computer. Using qualitative methods, we observed promotora training and intervention delivery, and conducted interviews with five promotoras to compare and contrast program implementation of both formats. We discuss the ways each format aided or challenged promotoras’ intervention delivery. Findings reveal that some aspects of both formats enhanced intervention delivery by tapping into Latino health communication preferences and facilitating interpersonal communication, while other aspects hindered intervention delivery. This study contributes to our understanding of how community health workers use low- and high-tech small media formats when delivering health messages to Latinos.
community health workers; tailoring; cancer screening
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men (AA MSM). The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days and willing to test for HIV. Retention exceeded 95% at 3 month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (AOR=3.03, 95%CI=1.26–7.28), condom use with male partners (AOR=2.64, 95%CI=0.95–7.36) and HIV negative/unknown status partners (AOR=3.19, 95%CI=0.98–10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV.
Active participation of community partners in research aspects of community-academic partnered projects is often assumed to have a positive impact on the outcomes of such projects. The value of community engagement in research, however, cannot be empirically determined without good measures of the level of community participation in research activities. Based on our recent evaluation of community-academic partnered projects centered around behavioral health issues, this article uses semi-structured interview and survey data to outline two complementary approaches to measuring the level of community participation in research - a “three-model” approach that differentiates between the levels of community participation and a Community Engagement in Research Index (CERI) that offers a multidimensional view of community engagement in the research process. The primary goal of this article is to present and compare these approaches, discuss their strengths and limitations, summarize the lessons learned, and offer directions for future research. We find that while the three-model approach is a simple measure of the perception of community participation in research activities, CERI allows for a more nuanced understanding by capturing multiple aspects of such participation. Although additional research is needed to validate these measures, our study makes a significant contribution by illustrating the complexity of measuring community participation in research and the lack of reliability in simple scores offered by the three-model approach.
Community Based Participatory Research; Community Participation in Research; Mixed-Methods; Community-Academic Partnerships; Evaluation
Research is lacking about what makes or breaks collaboration between researchers and HIV services providers. This study identified factors that influence providers’ levels of willingness to collaborate in HIV prevention scientific research. Survey measures were grounded in in-depth interview data and included providers’ “willingness to collaborate,” and providers’ attitudes toward researchers’ availability, benefits of research, and agency preparedness. This survey was administered to 141 providers in New York City. A hierarchical regression model showed that providers’ perceptions of researchers’ availability (p < .05), research benefits (p < .001), and agency preparedness (p < .05) were associated with providers’ willingness to engage with researchers to purse HIV prevention research. Findings indicate that researchers need to be socially and professionally available, future HIV research should benefit providers and consumers, and policy makers should help agency settings develop human and financial resources in preparation for research.
HIV prevention; provider–researcher partnership; research collaboration
Although seat belts save lives, adolescents may be disproportionately likely to omit their use. Using data from the 1997 Youth Risk Behavior Survey, a national survey of over 16,000 U.S. public and private high school students, we employed a series of logical regression analyses to examine cross-sectional associations between past-year athletic participation and regular seat belt omission. Controlling for the effects of gender, age, race, parental education, and school urbanicity, student athletes were significantly less likely than nonathletes to report seat belt omission. Separate gender-specific analyses showed that this effect was significant for girls but only marginally significant for boys; in addition, the effect was strongest for adolescents who participated on three or more school or community sports teams. Possible explanations for the relationship between athletic participation and seat belt omission, including Jessor’s problem behavior syndrome, prosocial sport subcultures, and sensation seeking, are considered.
adolescent; seat belt omission; athletic participation; gender
Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women’s ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors’ results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.
breast cancer screening; culture; minority health
This study investigates whether high-risk young adults’ perceptions of their likelihood of living to age 35 and of acquiring HIV are related to their substance abuse problems and risky sexual behaviors. The sample consists of data from the 72 and 87-month follow-up assessments of 449 juvenile offenders referred to probation in 1999 and 2000. Results indicate that believing one is likely to get HIV is associated with having more concurrent substance use problems and engaging in more risky sexual behaviors. Longitudinal analyses indicate that youth who think they are likely to get HIV are at greater risk for later substance abuse problems and risky sexual behaviors, though these results are only marginally significant. The results demonstrate that respondents are aware of some of the risks associated with their recent substance using and sexual behaviors, but that holding these perceptions does not result in a reduction of these behaviors.
School suspension may have unintended consequences in contributing to problem behaviors including school drop-out, substance use, and antisocial behavior. Tobacco use is an early-onset problem behavior, but prospective studies of the effects of suspension on tobacco use are lacking.
Longitudinal school-based survey of students drawn as a 2-stage cluster sample, administered in 2002 and 2003 in Washington State, United States and Victoria, Australia. The study uses statewide representative samples of students in Grades 7 and 9 (N = 3,599).
Rates of tobacco use were higher for Victorian than Washington State students. School suspension remained a predictor of current tobacco use at 12-month follow-up, after controlling for established risk factors including prior tobacco and other drug use for Grade 7 but not Grade 9 students.
School suspension is associated with tobacco use in early adolescence, itself an established predictor of adverse outcomes in young people. Findings suggest the need to explore process mechanisms and alternatives to school suspensions as a response to challenging student behavior in early adolescence.
adolescence; tobacco; suspension; cross-national study; longitudinal study; risk factors
Intervention and policy approaches targeting the societal factors that affect health literacy (e.g., educational systems) could have promise to improve health outcomes, but little research has investigated these factors. This study examined the associations between self-reported racial composition of prior educational and neighborhood contexts and health literacy among 1061 English- and Spanish-speaking adult community health center patients. We found that self-reported racial composition of high school was a significant predictor of health literacy among those who received schooling in the US, controlling for race/ethnicity, education, age, country of birth, and survey language. Black and Hispanic patients had significantly lower health literacy than white patients within educational strata among those schooled in the US. The findings revealed substantial disparities in health literacy. Self-reported racial composition of school context was a significant predictor of health literacy. Transdisciplinary, multi-level intervention approaches are likely to be needed to address the health literacy needs of this population.
health literacy; community health centers; health disparities; residential segregation
There is a growing emphasis on the role of organizations as settings for dissemination and implementation. Only recently has the field begun to consider features of organizations that impact on dissemination and implementation of evidence-based interventions. This manuscript identifies and evaluates available measures for 5 key organizational-level constructs: (1) leadership; (2) vision; (3) managerial relations; (4) climate; and (5) absorptive capacity. Overall the picture was the same across the five constructs—no measure was used in more than one study, many studies did not report the psychometric properties of the measures, some assessments were based on a single response per unit, and the level of the instrument and analysis did not always match. We must seriously consider the development and evaluation of a robust set of measures that will serve as the basis of building the field, allow for comparisons across organizational types and intervention topics, and allow a robust area of dissemination and implementation research to develop.
This study assessed effectiveness of an educational community intervention taught by promotoras de salud in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling approach (SEM). Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of protective health behaviors, health beliefs, contextual and social factors. Participants were 328 Hispanic adults with at least one CVD risk factor. SEM analyses assessed direct and indirect effects of intervention participation on CVD risk (Framingham score) and latent variables nutrition intake and health beliefs. The model fit was adequate (root mean square error approximation =.056 [90% confidence interval = .040, .072], comparative fit index =.967, normed fit index=.938, nonnormed fit index =.947). Intervention participation was associated with improved nutritional consumption, but not lower CVD risk. Stronger health beliefs predicted healthier nutritional habits. This project provided evidence for the adequacy of a conceptual framework that can be used to elicit new pathways towards CVD risk reduction among at-risk Hispanic populations.
Path Analysis; structural equation model; conceptual framework; Promotora; Community Health Worker; cardiovascular disease; Hispanic; Border; community; education; nutrition; promotoras de salud
This study examined factors associated with teens’ adherence to a multiple health behavior cancer preventive intervention. Analyses identified predictors of trial enrollment, run-in completion, and adherence (intervention initiation, number of sessions completed). Of 104 teens screened, 73% (n = 76) were trial-eligible. White teens were more likely to enroll than non-whites (χ2  df = 4.49, p = 0.04). Among enrolled teens, 76% (n = 50) completed the run-in; there were no differences between run-in completers and non-completers. A majority of run-in completers (70%, n = 35) initiated the intervention, though teens who initiated the intervention were significantly younger than those who did not (p < 0.05). The mean number of sessions completed was 5.7 (SD = 2.6; maximum = 8). After adjusting for age, teens with poorer session engagement (e.g., less cooperative) completed fewer sessions (B = -1.97, p = 0.003, R2 = 0.24). Implications for adolescent cancer prevention research are discussed.
adolescents; multiple health behavior change; cancer prevention; intervention adherence