Search

Background: Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults’ reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s). Methods: Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported. Results: The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45–3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20–2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18–3.31). Conclusion: Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. NCI’s support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

Implementation science (IS) has emerged in response to a striking research-to-practice gap, with the goal of accelerating and addressing the development, translation, and widespread uptake of evidence-based interventions (EBIs). Despite the promise of IS, critical gaps and opportunities remain within the field to explicitly facilitate health equity, particularly as they relate to the role of social determinants of health and structural racism. In this commentary, we propose recommendations for the field of IS to include structural racism as a more explicit focus of our work. First, we make the case for including structural racism as a construct and promote its measure­ment as a determinant within existing IS frameworks/models, laying the foundation for an empirical evidence base on mecha­nisms through which such factors influence inequitable adoption, implementation, and sustainability of EBIs. Second, we suggest considerations for both EBIs and implemen­tation strategies that directly or indirectly address structural racism and impact health equity. Finally, we call for use of methods and approaches within IS that may be more appropriate for addressing structural racism at multiple ecological levels and clinical and community settings in which we conduct IS, including community-based participatory research and stakeholder engagement. We see these as opportunities to advance the focus on health equity within IS and con­clude with a charge to the field to consider making structural racism and the disman­tling of racism an explicit part of the IS research agenda.Ethn Dis. 2021;31(Suppl 1):357-364; doi:10.18865/ed.31.S1.357

Objective:To describe US adults’ levels of support, neutrality and opposition to restricting junk food advertising to children on social media and explore associations with socio-demographic and health-related characteristics.Design:In 2020–2021, we used cross-sectional data from the National Cancer Institute’s 2020 Health Information National Trends Survey to estimate the prevalence of opinions towards advertising restrictions and correlates of neutrality and opposition using weighted multivariable logistic regression.Setting:United States.Participants:Adults aged 18+ years.Results:Among the analytic sample (n 2852), 54 % of adults were neutral or opposed to junk food advertising restrictions on social media. The odds of being neutral or opposed were higher among Non-Hispanic Black adults (v. non-Hispanic White; OR: 2·03 (95 % CI 1·26, 3·26)); those completing some college (OR: 1·68 (95 % CI 1·20, 2·34)) or high school or less (OR: 2·62 (95 % CI 1·74, 3·96)) (v. those with a college degree); those who were overweight (v. normal weight; OR: 1·42 (95 % CI: 1·05, 1·93)) and those reporting a moderate (OR: 1·45 (95 % CI 1·13, 1·88)) or conservative (OR: 1·71 (95 % CI 1·24, 2·35)) political viewpoint (v. liberal). Having strong (v. weaker) weight and diet-related cancer beliefs was associated with 53 % lower odds of being neutral or opposed to advertising restrictions (OR: 0·47 (95 % CI 0·36, 0·61)).Conclusions:The current study identified subgroups of US adults for whom targeted communication strategies may increase support for policies to improve children’s food environment.

The National Institutes of Health (NIH) has increasingly supported research in digital health technologies to advance research and deliver behavior change interventions. We highlight some of the research supported by the NIH in eHealth, mHealth, and social media as well as research resources supported by the NIH to accelerate research in this area. We also describe some of the challenges and opportunities in the digital health field and the need to balance the promise of these technologies with rigorous scientific evidence.

Background. The use of videos for patient and public health education has been widely adopted and well documented in the literature. Aims. To conduct a systematic review of empirical studies that used video-based interventions for cancer prevention and control to document study designs, settings, approaches, targeted cancer sites and behaviors, and outcomes and to identify gaps in research and practice. Method. PubMed, PsychINFO, CINAHL, SCOPUS, and Web of Science were searched for studies published in the 30-year period from 1984 to 2014. Of 1,521 articles identified, duplicates were removed, and titles and abstracts of 779 were examined for eligibility. In all, 315 articles met the inclusion criteria and were coded by three independent coders. Interrater reliability was assessed. Descriptive frequencies and proportions were calculated. Results. Studies evaluating video interventions for cancer prevention and control have increased over time. The majority used randomized controlled trial designs (54%), followed by single-group pre–posttest designs (18%). Most were delivered in health care settings (39%). Detection (30%) and treatment (16%) were the cancer control continuum stages most frequently addressed, with breast cancer (29%) being the most frequently targeted cancer site. The behavior most commonly targeted was screening/early detection (39%). Topics such as caregiving, coping, palliative care, and end of life were rarely addressed. The majority (69%) reported being successful at achieving their stated objectives, though outcomes varied across studies. Conclusions. Video interventions have been widely utilized for cancer prevention and control, with demonstrated successes. Future research should test innovative designs and new delivery platforms and should include underrepresented topics and cancer sites.

Rural communities experience disparate rates of chronic diseases and face distinct challenges in gaining access to health care. Increasing the reach of the US health information and communication technology infrastructure can support rural health by overcoming geographic and temporal health care barriers.The goal of the study is to establish statistically valid point estimates for the use of health information technology within rural versus urban populations, and to understand the degree to which structural factors may account for the overall variance in the use of these technologies.Data from the National Cancer Institute's 2017 Health Information National Trends Survey were used to estimate prevalence of Health IT engagement across rural and urban populations and model factors influencing use of online medical records.Rural residents reported similar rates of providers maintaining electronic health records and offering access to online medical records. However, rural residents with provider-maintained records were less likely to receive a provider recommendation to use online medical records and were subsequently less likely to actually access records. Observed differences in online medical record use were accounted for by variance in Internet access, access to a regular health care provider, and whether providers encouraged patients to use online records.Findings shed light on structural opportunities for overcoming geographic and temporal barriers to Health IT and extending the benefits of digital health information technologies to underserved populations.

Many health policies are designed with the intention of improving health outcomes for all. Yet implementation of policies are variable across contexts, potentially limiting its impact on population health outcomes. The potential impact of a policy to advance health equity depends both on the design and its implementation, requiring ongoing evaluation and stakeholder engagement. Despite the importance of health policies in shaping public health, health care policy implementation science remains underrepresented in research. We argue that enhanced integration of policy questions within implementation science could reduce the time lag from policy to practice and improve population health outcomes to build a body of evidence on effective policy implementation. In this commentary, we argue that approaches to studying policy implementation science should reflect the dynamic and evolving policy context, analogous to the “learning healthcare system,” to better understand and respond to systematic and multilevel impacts of policy. Several example opportunities for a learning health policy system are posed in building a broader agenda toward research and practice in policy implementation science in public health.

OBJECTIVES: The Family Life, Activity, Sun, Health and Eating (FLASHE) survey was conducted in 2014 to collect information on eating, physical activity, sedentary behaviors, and behavioral correlates from a national sample of parent-adolescent dyads in the United States. It is a publicly available data resource which can be used to research questions about psychosocial, generational, household and neighborhood correlates of health behaviors. METHODS: Data were collected from dyads of caregivers and their adolescent children (ages 12–17) (n = 1072 completed dyads) between April – October 2014. Two surveys for each respondent: one on diet-related behaviors and one on physical activity-related behaviors were collected. An additional 407 dyads wore an accelerometer for seven days and completed an activity log. A ‘geoFLASHE’ dataset used parent-provided address information for home and school to geocode these locations and compute a set of variables applied to several different neighborhood definitions, including both circular and street-network buggers with distances ranging from 400 – 1200 meters. Accelerometer variables were computed for a subset of adolescents who wore an Actigraph Gt3x+ for seven days and includes estimates from raw and activity counts data. Training webinars on dyadic analytical methods, models and applications were provided. RESULTS: The geoFLASHE dataset includes variables for neighborhood, socioeconomic status factor, factor scores for built environment characteristics (high density, older neighborhood, and short commutes), and other variables for each buffer configuration. The adolescent accelerometer dataset offers summary variables of accelerometer data and minute-level estimates of light, moderate, and vigorous activity using Crouter, Chandler, and GGIR processing methods. Additionally, training webinar, questionnaires, survey data files and codebooks are available. CONCLUSIONS: The FLASHE study data resources can be used to understand cancer-related health behaviors in family dyads. FUNDING SOURCES: FLASHE study was funded by the National Cancer Institute under contract number HHSN2612012000391 issued to Westat, Inc.

Behavior change research to promote health and prevent disease increasingly relies on a complex set of interacting characteristics across levels of influence such as biological, psychological, behavioral, interpersonal, and environmental. How to best develop health-related interventions that incorporate the individual, the macro-environment, and their interactions remains a challenge. This article considers a set of key dimensions that constitute what we refer to as the ecology of research across a broad context of multilevel research (MLR), spanning fundamental multilevel research (FMLR), multilevel intervention research (MLIR), and multilevel implementation science (MIS). With the goal of promoting improvements in MLIR, we describe the inherent interdependencies among aspects of research and consider how the growth and development of evidence and resources influence the cross-talk among researchers from different perspectives (e.g., disciplines and domains). We propose a framework that highlights opportunities to reduce barriers and address gaps in areas critical to generating an evidence base through MLR, MLIR, and MIS. Overall, we aim to support strategic decisions that can accelerate our understanding of ML health outcomes and interactions among factors within and across levels, with the goal of strengthening the effectiveness of ML interventions across health-related outcomes.

Greater attention to social factors, such as race/ethnicity, socioeconomic position, and others, are needed across the cancer continuum, including breast cancer, given differences in tumor biology and genetic variants have not completely explained the persistent Black/White breast cancer mortality disparity. In this commentary, we use examples in breast cancer risk assessment and survivorship to demonstrate how the failure to appropriately incorporate social factors into the design, recruitment, and analysis of research studies has resulted in missed opportunities to reduce persistent cancer disparities. The conclusion offers recommendations for how to better document and use information on social factors in cancer research and care by (1) increasing education and awareness about the importance of inclusion of social factors in clinical research; (2) improving testing and documentation of social factors by incorporating them into journal guidelines and reporting stratified results; and (3) including social factors to refine extant tools that assess cancer risk and assign cancer care. Implementing the recommended changes would enable more effective design and implementation of interventions and work toward eliminating cancer disparities by accounting for the social and environmental contexts in which cancer patients live and are treated.

ObjectiveThe present study aimed to examine the correlates of fruit and vegetable intake (FVI) separately among parents and their adolescents.DesignCross-sectional surveys.SettingOnline survey.SubjectsParents and adolescents completed the Family Life, Activity, Sun, Health, and Eating (FLASHE) survey through the National Cancer Institute. The survey assessed daily intake frequencies of food/beverage groups, psychosocial, parenting and sociodemographic factors. Generalized linear models were run for both parents and adolescents, for a total of six models (three each): (i) sociodemographic characteristics; (ii) psychosocial factors; (iii) parent/caregiver factors.ResultsParent participants (n 1542) were predominantly 35–59 years old (86 %), female (73 %), non-Hispanic White (71 %) or non-Hispanic Black (17 %), with household income n 805) were aged 12–14 years (50 %), non-Hispanic White (66 %) and non-Hispanic Black (15 %). Parents consumed 2·9 cups fruits and vegetables (F&V) daily, while adolescents consumed 2·2 cups daily. Educational attainment (higher education had greater FVI) and sex (men consumed more than women; all PPPPConclusionsFindings suggest factors that impact FVI among parents and their adolescent(s), which highlight the importance of the role of parent behaviour and can inform tailored approaches for increasing FVI in various settings.

Geospatial, contextual, and multilevel research is integral to cancer prevention and control. NCI-designated Cancer Centers are at the forefront of cancer research; therefore, this paper sought to review the geospatial, contextual, and multilevel research at these cancer centers. Investigators used PubMed and Web of Science to compile geospatial publications from 1971 to February 2016 with cancer center-affiliated authors. Relevant abstracts were pulled and classified by six geospatial approaches, eight geospatial scales, and eight cancer sites. The searches identified 802 geospatial, contextual, and multilevel publications with authors affiliated at 60 of the 68 NCI-designated Cancer Centers. Over 90% were published after 2000. Five cancer centers accounted for approximately 50% of total publications, and 30 cancer centers accounted for over 85% of total publications. Publications covered all geospatial approaches and scales to varying degrees, and 90% dealt with cancer. The NCI-designated Cancer Center network is increasingly pursuing geospatial, contextual, and multilevel cancer research, although many cancer centers still conduct limited to no research in this area. Expanding geospatial efforts to research programs across all cancer centers will further enrich cancer prevention and control. Similar reviews may benefit other domestic and international cancer research institutions.

Background Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults’ willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information–sharing behaviors. Objective This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults’ willingness to share wearable data with health care providers and family or friends. Methods Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings.

FDA's Menu Labeling Final Rule requires covered establishments provide calorie information on menus or menu boards, among other requirements. This study describes correlates of noticing and using menu calorie information in a nationally representative sample of U.S. adults before implementation of the Final Rule in May 2018. Data from the 2018 National Cancer Institute Health Information National Trends Survey was used to assess noticing menu calorie information, using menu calorie information to change menu ordering behavior, and knowledge of daily calorie needs. Regression analysis of weighted data tested associations between individual characteristics and noticing and using menu calorie information. Nearly half of adults (44%) reported noticing menu calorie information. Women, younger individuals, those who seek health information, individuals with a BMI ≥ 30, and those with higher education or higher income were more likely to report noticing menu calorie information. Among adults who reported noticing menu calorie information, three-quarters responded by ordering less (e.g., fewer calories), which equates to about one-third of the population. About 36% of women and 42% of men lacked calorie knowledge. Men with, versus without, calorie knowledge were twice as likely to report noticing menu calorie information (adjusted OR 2.23 95% CI 1.51, 3.29). Findings suggest behavioral response to menu calorie information varies and most individuals who notice the information respond by ordering less in ways that could reduce caloric intake. Future analyses could compare noticing and using menu calorie information before and after menu labeling implementation to assess the effect of policy on population behaviors.

Background Communication about physical activity (PA) frames PA and influences what it means to people, including the role it plays in their lives. To the extent that PA messages can be designed to reflect outcomes that are relevant to what people most value experiencing and achieving in their daily lives, the more compelling and effective they will be. Aligned with self-determination theory, this study investigated proximal goals and values that are salient in everyday life and how they could be leveraged through new messaging to better support PA participation among women. The present study was designed to examine the nature of women’s daily goals and priorities and investigate women’s PA beliefs, feelings, and experiences, in order to identify how PA may compete with or facilitate women’s daily goals and priorities. Preliminary recommendations are proposed for designing new PA messages that align PA with women’s daily goals and desired experiences to better motivate participation. Methods Eight focus groups were conducted with White, Black, and Hispanic/Latina women aged 22–49, stratified by amount of self-reported PA (29 low active participants, 11 high active participants). Respondents discussed their goals, values, and daily priorities along with beliefs, feelings about and experiences being physically active. Data were collected, coded, and analyzed using a thematic analysis strategy to identify emergent themes. Results Many of the goals and values that both low and high active participants discussed as desiring and valuing map on to key principles of self-determination theory. However, the discussions among low active participants suggested that their beliefs, feelings, experiences, and definitions of PA were in conflict with their proximal goals, values, and priorities, also undermining their psychological needs for autonomy, competence, and relatedness. Conclusions Findings from this study can be used to inform and evaluate new physical activity communication strategies that leverage more proximal goals, values, and experiences of happiness and success to better motivate PA among ethnically diverse low active women. Specifically, this research suggests a need to address how women’s daily goals and desired experiences may undermine PA participation, in addition to framing PA as facilitating rather than competing with their daily priorities and desired leisure-time experiences.

The National Cancer Institute established a dissemination and implementation accelerator program called Speeding Research-tested INTerventions (SPRINT) in order to expedite the translation of behavioral research into practice. The goal of SPRINT is to introduce researchers to a new method for moving their research into practice in order to increase the real-world impact of their evidence-based interventions. The goal of this article is to present case studies on three teams that have completed the SPRINT program to date. Each case study provides a description of the intervention the team came into the program with, the team’s motivation for participating in the SPRINT program, the team’s experience in the program, lessons learned from “customer discovery” interviews conducted by the team during the course, and the team’s future plans for their intervention. The case studies suggest that by focusing on behavioral researchers, SPRINT addresses an unmet need in the commercialization training space; that the definition of “success” can vary across SPRINT projects; that identifying and engaging “payors” for behavioral interventions is an ongoing challenge; and that there are potential “misalignments” between the research process and market demands. Overall, these examples show that customer discovery is a potentially useful method for making interventions more responsive to the needs of stakeholders, and that researchers can benefit from learning the “language” of business and working with individuals who have business experience before trying to move their research from the lab to the real world.

Highlights • Most U.S. adolescents do not meet current physical activity guidelines. • Built environments and neighborhood socioeconomic status may impact activity. • Examined neighborhood walkability using geocoded home addresses and Census data. • Living in areas with walkable attributes was associated with more physical activity. • Walkability and activity associations varied by neighborhood socioeconomic status., Adolescents in the U.S. do not meet current physical activity guidelines. Ecological models of physical activity posit that factors across multiple levels may support physical activity by promoting walkability, such as the neighborhood built environment and neighborhood socioeconomic status (nSES). We examined associations between neighborhood built environment factors and adolescent moderate-to-vigorous physical activity (MVPA), and whether nSES moderated associations. Data were drawn from a national sample of adolescents (12–17 years, N = 1295) surveyed in 2014. MVPA (minutes/week) were estimated from self-report validated by accelerometer data. Adolescents’ home addresses were geocoded and linked to Census data from which a nSES Index and home neighborhood factors were derived using factor analysis (high density, older homes, short auto commutes). Multiple linear regression models examined associations between neighborhood factors and MVPA, and tested interactions between quintiles of nSES and each neighborhood factor, adjusting for socio-demographics. Living in higher density neighborhoods (B(SE): 9.22 (2.78), p = 0.001) and neighborhoods with more older homes (4.42 (1.85), p = 0.02) were positively associated with adolescent MVPA. Living in neighborhoods with shorter commute times was negatively associated with MVPA (−5.11 (2.34), p = 0.03). Positive associations were found between MVPA and the high density and older homes neighborhood factors, though associations were not consistent across quintiles. In conclusion, living in neighborhoods with walkable attributes was associated with greater adolescent MVPA, though the effects were not distributed equally across nSES. Adolescents living in lower SES neighborhoods may benefit more from physical activity interventions and environmental supports that provide opportunities to be active beyond neighborhood walkability.

Little is known about the association between Internet/social media use and health information technology (HIT) engagement. This study examines patterns of social media use and HIT engagement in the U.S.A. using data from the 2013 Health Information National Trends Survey (N = 3,164). Specifically, predictors of two HIT activities (i.e., communicating with a healthcare provider using the Internet or email and tracking personal health information electronically) are examined. Persons who were females, higher education, non-Hispanic others, having a regular healthcare provider, and ages 35–44 were more likely to participate in HIT activities. After controlling for sociodemographics and health correlates, social media use was significantly associated with HIT engagement. To our knowledge, this is one of the first studies to systematically examine the use and relationships across multiple types of health-related online media.

Purpose: This study reports correlates in reported use and helpfulness of calorie information, when available, in restaurants on a national scale in the United States for demographic behavioral and health-related conditions. Design: This study is a secondary data analysis of the 2013 National Cancer Institute’s Health Information National Trends Survey data. Setting: United States. Subjects: Adults ( n = 3407). Measures: Menu labeling use and helpfulness; behavior change attempts; reported fruit, vegetable, and soda consumption; weight status; and chronic health conditions. Analysis: Trends were identified in weighted logistic and linear regression models. Results: U.S. adults who intended to lose weight (odds ratio [OR] = 5.01 [95% confidence interval 2.96, 8.46]), increase fruit (OR = 1.10 [.66, 1.84]) or vegetable consumption (OR = 2.25 [1.32, 3.83]), or reduce soda consumption (OR = 1.67 [1.11, 2.51]) were more likely to report using menu-labeling information when available. More women reported calorie information was helpful when ordering ( p < .05). Racial/ethnic and socioeconomic status disparities were identified in use (non-Hispanic [NH] blacks vs. NH whites OR = .43 [.25, .74]) and helpfulness (NH blacks vs. NH whites β = –.06 [–.44, .32]). Conclusion: Findings highlight potential subgroups to target for communication and education efforts regarding use of calorie information in restaurants. Following publication of final rules for federal menu-labeling legislation and implementation, further surveillance of public response to this information may inform message framing and educational interventions to promote use of calorie information on menu boards.

Cancer incidence and mortality display strong geographic patterns worldwide and in the United States (1, 2). The environment where individuals live, work, and play is increasingly being recognized as important across the cancer control continuum, including the risk of cancer development, detection, diagnosis, treatment, mortality, and survivorship (3–5). At the same time, emergent technological capacity in geographic information systems (GIS) and mapping, along with increasing sophistication in applied spatial methods, has resulted in a growing research community developing and applying geospatial approaches in health research (5). Through collaborative, transdisciplinary efforts, and continued data collection efforts, there is great potential to apply these emerging geospatial approaches to various aspects of cancer prevention and control to inform etiology and target interventions and implementation of efficacious risk-reducing strategies. Cancer Epidemiol Biomarkers Prev; 26(4); 472–5. ©2017 AACR. See all the articles in this CEBP Focus section, “Geospatial Approaches to Cancer Control and Population Sciences.”

Introduction The National Cancer Institute’s 2014 Family Life, Activity, Sun, Health, and Eating Study utilized a 27-item Dietary Screener tailored to adolescent eating patterns that assessed the frequency of intake of several foods and beverages in parent–adolescent dyads. This study estimated intake of fruits and vegetables (FVs), dairy, added sugars, and whole grains for screener respondents using existing, nationally representative, 24-hour dietary recall data. Methods Dietary Screener items were converted from frequency responses to daily intake. Intake (dependent variable) was estimated using regression coefficients and portion sizes of foods and beverages (independent variables) generated from the 2003–2006 National Health and Nutrition Examination Survey 2-day 24-hour recall data set. Means (SDs) were used to examine daily dietary factor intake among parent and adolescents. Analysis was conducted in 2015–2016. The analytic sample consisted of 1,732 parents (aged ≥18 years) and their adolescent aged 12–17 years (n=1,632). Results Male parents consumed 3.6 cups of FVs, 1.8 cups of dairy, 22.6 teaspoons of added sugars, and 2.1 ounces of whole grains daily; female parents consumed 2.8 cups of FVs, 1.3 cups of dairy, 14.8 teaspoons of added sugars, and 1.4 ounces of whole grains daily. Male adolescents consumed 2.2 cups of FVs, 1.9 cups of dairy, 17.9 teaspoons of added sugars, and 1.0 ounces of whole grains daily; female adolescents consumed 2.2 cups FVs, 1.6 cups of dairy, 14.2 teaspoons of added sugars, and 0.8 ounces of whole grains daily. Conclusions Utilizing a dietary screener tailored to adolescent eating patterns in parent–adolescent dyads provided estimated dietary factor intake, underscoring existing 24-hour dietary recall data can be used to calibrate dietary habits.

The National Cancer Institute developed the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to examine multiple cancer preventive behaviors within parent–adolescent dyads. The purpose of creating FLASHE was to enable the examination of physical activity, diet, and other cancer preventive behaviors and potential correlates among parent–adolescent dyads. FLASHE surveys were developed from a process involving: literature reviews, scientific input from experts in the field, cognitive testing, and usability testing. This cross-sectional, web-based study of parents and their adolescent children (aged 12–17 years) was administered between April and October 2014. The nationwide sample consisted of 1,573 parent–adolescent dyads (1,699 parents and 1,581 adolescents) who returned all FLASHE surveys. FLASHE assessed parent and adolescent reports of several intrapersonal and interpersonal domains (including psychosocial variables, parenting, and the community and home environments). On a subset of example FLASHE items across these domains, responses of parents and adolescents within the same dyads were positively and significantly correlated (r =0.32–0.63). Analyses were run in 2015–2016. FLASHE data present multiple opportunities for studying research questions among individuals or dyads, including the ability to examine similarity between parents and adolescents on many constructs relevant to cancer preventive behaviors. FLASHE data are publicly available for researchers and practitioners to help advance research on cancer preventive health behaviors.

OBJECTIVE We investigated the relative importance of nutrition label numeracy and sociodemographic characteristics in predicting health behaviors. METHODS Secondary data analysis of data collected from the National Cancer Institute's Health Information National Trends Survey (HINTS 4, cycle 3, 2013). Weighted age-adjusted ordinal logistical regression was used to evaluate sociodemographic characteristics among individuals with different nutrition label numeracy levels. Dominance analysis was conducted to rank nutrition label numeracy and sociodemographic characteristics in order of importance as predictors of health behavior. RESULTS Lower levels of nutrition label numeracy were associated with older age, black and Hispanic race/ethnicity, unemployment, being born outside of the United States, lower English proficiency, lower education achievement, lower income, and living in the South. Nutrition label numeracy and income were the most important predictors of health behaviors, accounting for about 50% of the variance in fruit consumption and level of effort, frustration, concern, and confusion experienced while seeking health information. CONCLUSIONS Nutrition label numeracy differed significantly among sociodemographic groups and was a strong predictor of health behaviors. When developing health interventions targeting dietary behaviors, disparities in nutrition label numeracy comprehension should be considered.

Increased consumption of fruits and vegetables is recommended to reduce chronic disease risk. Few studies have examined awareness of the current fruit and vegetable campaign in the United States, Fruits and Veggies-More Matters. This study assessed awareness of the Fruits and Veggies-More Matters campaign and knowledge of the 7-13 serving recommendation for fruit and vegetable consumption among adults, and determined whether these were associated with fruit and vegetable intake. Cross-sectional data from 3021 adults in the United States' National Cancer Institute's 2007 Food Attitudes and Behaviors Survey were analyzed. Few participants were aware of the Fruits and Veggies-More Matters campaign (2%) and the 7-13 recommendation (6%) for adults. More participants were aware of the former 5 A Day campaign (29%) and recommendation (30%). Thirty-nine percent reported consuming ≥5 servings of fruits and vegetables daily. Participants were more likely to consume ≥5 servings of fruits and vegetables/day if they were aware of the 5 A Day/Fruits and Veggies-More Matters campaign, and reported that the recommendation for adults was ≥5 servings/day. Findings suggest the need to increase awareness of the Fruits and Veggies-More Matters campaign, and the 7-13 recommendation among adults to support high fruit and vegetable intake.

Hispanics have lower cancer mortality rates than non-Hispanic Whites and Blacks, despite demographic profiles previously associated with higher cancer mortality. Differences in adherence to multiple cancer-preventive behaviors by acculturation may offer one explanation for this ''Hispanic paradox,'' but the relationship is not well understood. We examined this relationship using the 2000 National Health Interview Survey, which provides cross- sectional data on a nationally representative sample of US Hispanics. Multinomial logistic regression models esti- mated relationships between language use (a measure of acculturation) and patterns of adherence, by gender, to multiple cancer-preventive health behaviors using adher- ence scores. Hispanics had greater odds of adherence to multiple behaviors compared to Non-Hispanics (OR = 2.76 (2.27, 3.36)). Hispanics with greater English language use had lower odds of adherence (OR = 0.45 (0.29, 0.69)). Women were more adherent than men (P \ 0.01) and their language use was associated with patterns of behavioral adherence more so than among men. Differences by gender and language use were identified in patterns of adherence to behavioral recommendations among the Hispanic pop- ulation. Greater English language use was negatively associated with tobacco, alcohol, fruit and vegetable rec- ommendation adherence but not with exercise. Study find- ings support evidence behaviors occur in combination and contributes to understanding of the role of language use in patterns of behavioral adherence.

Addressing health disparities has been a national challenge for decades. The National Institutes of Health–sponsored Centers for Population Health and Health Disparities are the first federal initiative to support transdisciplinary multilevel research on the determinants of health disparities. Their novel research approach combines population, clinical, and basic science to elucidate the complex determinants of health disparities. The centers are partnering with community-based, public, and quasi-public organizations to disseminate scientific findings and guide clinical practice in communities. In turn, communities and public health agents are shaping the research. The relationships forged through these complex collaborations increase the likelihood that the centers’ scientific findings will be relevant to communities and contribute to reductions in health disparities.

Significant health disparities continue to persist across the cancer control continuum (prevention, detection, diagnosis, treatment, and survivorship) despite decreases in cancer mortality and morbidity rates. Public health informatics (PHI) approaches offer the potential to address and reduce cancer health disparities by addressing the underlying social determinants of health. Community engagement, through community-based participatory research (CBPR) in identification, development, evaluation, and implementation offers key advantages to enhanced sustainability, acceptability, and delivery of PHI. The CBPR approach allows community members and stakeholders to provide input from a culturally relevant perspective at each level of the development and/or use of PHIs. This chapter discusses the application of the CBPR approach to improve the use and adoption of informatics tools and platforms through two case study examples that are addressing two major social determinants of health disparities: institutional racism and information inequalities. Three common themes emerged from the two case studies that facilitated successful PHI project implementation: transparency, making data relevant, and capacity building. To ensure project success, the case studies also addressed challenges that may arise in PHIs such as digital health literacy, Internet and broadband accessibility, and PHI platform sustainability.

ObjectiveThe current study characterizes associations between physical and social contexts of self-reported primary episodes of eating/drinking and sociodemographic and obesity-related variables in US adults.DesignMultinomial logistic regression was used to analyse a nationally representative sample of adults from the 2006–2008 American Time Use Survey. Models identifying physical (where) and social (whom) contexts of primary eating/drinking episodes at the population level, controlling for demographic characteristics, weight status and time of eating, were conducted.SettingUSA.SubjectsA nationally representative sample of US adults (n21 315).ResultsEating/drinking with immediate family was positively associated with age (OR = 1·15 (95 % CI 1·04, 1·27) to 1·23 (95 % CI 1·09, 1·39)), education level (OR = 1·16 (95 % CI 1·03, 1·30) to 1·36 (95 % CI 1·21, 1·54)), obesity (OR = 1·13 (95 % CI 1·04, 1·22)), children in the household (OR = 3·39 (95 % CI 3·14, 3·66)) and time of day (OR = 1·70 (95 % CI 1·39, 2·07) to 5·73 (95 % CI 4·70, 6·99)). Eating in the workplace was negatively associated with female gender (OR = 0·65 (95 % CI 0·60, 0·70)) and children in the household (OR = 0·90 (95 % CI 0·83, 0·98)), while positively associated with non-white status (OR = 1·14 (95 % CI 1·01, 1·29) to 1·47 (95 % CI 1·32, 1·65)) and time of day (OR = 0·25 (95 % CI 0·28, 0·30) to 5·65 (95 % CI 4·66, 6·85)). Women (OR = 0·80 (95 % CI 0·74, 0·86)), those aged >34 years (OR = 0·48 (95 % CI 0·43, 0·54) to 0·83 (95 % CI 0·74, 0·93)) and respondents with children (OR = 0·69 (95 % CI 0·63, 0·75)) were less likely to eat in a restaurant/bar/retail than at home. Overweight and obese respondents had a greater odds of reporting an episode of eating in social situationsv. alone (e.g. immediate family and extended family; OR = 1·13 (95 % CI 1·04, 1·22)) and episodes occurring in restaurant/bar/retail locations (OR = 1·12 (95 % CI 1·03, 1·23) to 1·14 (95 % CI 1·05, 1·24)).ConclusionsFindings underscore the multidimensional nature of describing eating/drinking episodes. Social and physical contexts for eating/drinking and their demographic correlates suggest opportunities for tailoring interventions related to diet and may inform intervention targeting and scope.

Literature suggests racial/ethnic minorities, particularly those who are less-acculturated, have stronger fatalistic attitudes toward cancer than do non-Latino Whites. Knowledge of cancer prevention is also lower among racial/ethnic minorities. Moreover, low knowledge about cancer risk factors is often associated with fatalistic beliefs. Our study examined fatalism and cancer knowledge by race/ethnicity and explored whether race/ethnicity moderate the association of fatalism with knowledge of cancer prevention and risk factors. We analyzed data from the Health Information National Trends Survey (2008), a national probability survey, to calculate population estimates of the associations among race/ethnicity, fatalistic beliefs, and knowledge about cancer from multivariable logistic regression. Racial/ethnic minorities had higher odds of holding fatalistic beliefs and lower odds of having knowledge of cancer risk factors than non-Hispanic Whites, and important differences by acculturation among Latinos were observed. Limited evidence of the moderating effect of race/ethnicity on the relationship between fatalistic beliefs and cancer risk factor knowledge was observed. Knowledge of cancer risk factors is low among all race/ethnicities, while fatalistic beliefs about cancer are higher among racial/ethnic minorities compared with non-Hispanic Whites. Implications for cancer education efforts are discussed.

Over the past several decades, there has been burgeoning interest and investment in large transdisciplinary (TD) team science initiatives that aim to address complex societal problems. Despite this trend, TD training opportunities in the health sciences remain limited, and evaluations of these opportunities are even more uncommon due to funding constraints. We had the unique opportunity to conduct an exploratory study to examine the potential outcomes and impacts of TD training in a National Cancer Institute-supported initiative for TD research and training—the Transdisciplinary Research on Energetics and Cancer I (TREC I) initiative. This study used a retrospective mixed-methods approach leveraging secondary analysis of existing data sources to learn about TREC trainees' experiences with TREC training, TD research competencies, changes in scholarly productivity, and the associations among these domains. Results indicated that, on average, TREC trainees were satisfied with their TREC mentoring experiences and believed that TREC training processes were effective, in general. Participation in TREC training was associated with TD research competencies, including TD research orientation, positive general attitude toward TD training, development of scientific skills for TD research, and intrapersonal/interpersonal competencies for collaboration. There was also a significant increase in trainees' scholarly productivity from before to after starting in TREC training, as indicated by average annual number of publications and presentations and average number of coauthors per publication. Perceived effectiveness of TREC training was positively correlated with change in average annual number of research presentations from before to after starting in TREC training (r = 0.65, p

Recent estimates report that over one-third of children between the ages of 6- to 19-years old are now overweight or obese.1 This trend is alarming given the short- and long-term health impact of obesity. Obese youth are more likely to experience metabolic risk factors, asthma, and dental health issues as well as internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems.2 Studies have also shown that the impact of childhood obesity is witnessed throughout the lifespan and increases the risk of all-cause mortality in adulthood.3 This makes preventing obesity among youth a national public health priority. Recent attention has been placed on the role of state law governing school competitive foods as a means of addressing the childhood obesity epidemic.4–6 Competitive foods, defined as all foods and beverages sold or served outside of the reimbursable federal school meal program (FSMP),7,8 have been shown to contribute excess fat and calories to children’s diets.9–11 Emerging evidence suggests a link between strong competitive food policies, children’s diets, and healthy weight status12,13 however, not all studies have had consistent findings.14,15 More research is needed to understand whether competitive food policies influence youth behavior and health outcomes. This evidence could, in turn, help guide state policymakers, school administrators, and public health advocates on what aspects of school health policy require the most attention. The majority of this literature has focused predominantly on within-state analyses or used self-reported policy data.16–20 Riis et al21 examined the relationship between children’s weight status and state policies governing school nutrition and physical education. They found no relationship between laws governing middle or high school competitive foods and beverages and children’s weight status, and limited evidence for elementary school. However, these findings should take into account several methodological decisions. First, the Riis et al21 study categorizes states as having a strong policy for all states that require standards for competitive foods regardless of whether such standards are undefined or specified. However, prior work has empirically demonstrated that it may be more appropriate to categorize states as having a strong policy in cases where the policy is both required and standards are defined.12,13, 22 Second, the methods allowed for inclusion of school students from private schools. In the United States, nearly all public schools participate in the FSMP and are therefore required to follow federal and state policy governing this program.23 In contrast, fewer private schools participate in the FSMP. Schools that do not participate would be exempt from such standards. For this reason, other investigations have excluded students attending private schools.12 Lastly, the analysis examined competitive food and beverage laws for each location (ala carte, vending, or other venue) separately rather than as a composite score. A composite score provides a more comprehensive evaluation of the competitive food and beverage environment that children are exposed to within the school setting. Current knowledge remains limited in evaluating enacted state laws for competitive foods in a state- and nationally-representative sample. This study refines and extends the work of Riis et al21 by focusing on public middle schools only, using a comprehensive measure of competitive food and beverage laws, and adopting a more rigorous definition of policy strength. The purpose of this analysis is to determine if public middle school students living in states with strong competitive food and beverage laws had a significantly lower weight status as compared to students living in states with no or weak school competitive food and beverage laws using a nationally and state-representative sample. The focus on laws governing middle schools only is based on the prevalence of competitive foods and beverages in public middle schools, the declining strength of laws governing these competitive foods as children progress from elementary to middle to high school, and the high rates of obesity among this age (11–14 years) group.1, 24

Objectives. We examined whether public schools in states with specific and stringent physical education (PE) laws, as assessed by the Physical Education–Related State Policy Classification System (PERSPCS), available on the Classification of Laws Associated with School Students (C.L.A.S.S.) Web site, reported more weekly PE time in the most recent School Health Policies and Programs Survey (SHPPS). Methods. Schools (n = 410) were grouped by their state’s PERSPCS time requirement scores (none, nonspecific requirement, or specific requirement). Average weekly school-level PE was calculated using the SHPPS-reported PE minutes. Weighted analyses determined if PE minutes/week differed by PERSPCS group. Results. Schools in states with specific requirement laws averaged over 27 and 60 more PE minutes/week at the elementary and middle school levels, respectively, compared with schools within states with nonspecific laws and over 40 and 60 more PE minutes per week, respectively, compared with elementary and middle schools in states with no laws. High school results were nonsignificant. Conclusions. Public health guidelines recommend at least 60 minutes of daily physical activity for children, and PE may further this goal. Strong codified law with specific time requirements for PE may be an important tool contributing toward adequate PE time and daily physical activity recommendations.

Consumption of diets high in fruits and vegetables is associated with reduced risk of chronic diseases, and self-efficacy and the food environment influence consumption of fruits and vegetables. We analyzed data from 3,021 non-Hispanic white (n = 2,187) and non-Hispanic black (n = 834) US adults who responded to National Cancer Institute's 2007 Food Attitudes and Behaviors Survey to assesss self-efficacy and perception of the food environment. Adults who perceived that it was easy to obtain fruits and vegetables when they ate out reported greater self-efficacy to consume fruits and vegetables than did participants who did not have this perception (odds ratio [OR] = 1.56, 95% confidence interval [CI], 1.24-1.97). However, adults who perceived that fruits were not available at restaurants where they ate out (OR = 0.65, 95% CI, 0.50-0.86) or that other (ie, non–fast food) restaurants offered enough choices of fruits and vegetables on their menus (OR = 0.76, 95% CI, 0.61-0.97) reported lower self-efficacy to consume fruits and vegetables than did participants who did not have these perceptions. Findings suggest that perceptions about availability of fruits and vegetables in restaurants are important to promote self-efficacy for consuming fruits and vegetables among adults.

This national study examines differences between racial/ethnic groups on awareness of physical activity and reduced cancer risk and explores correlates of awareness including trust, demographic, and health characteristics within racial/ethnic groups. The 2007 Health Information and National Trends Survey (HINTS) provided data for this study. After exclusions, 6,809 adults were included in analyses. Awareness of physical activity in reduced cancer risk was the main outcome. Logistic regression models tested relationships. Non-Hispanic Blacks had a 0.71 (0.54,0.93) lower odds of being aware of physical activity in reduced cancer risk than non-Hispanic Whites. Current attempts to lose weight were associated with greater odds for awareness among non-Hispanic Blacks and Hispanics (p < .01). Among non-Hispanic Blacks, trust in traditional and Internet media was associated with greater odds of awareness (p < .01). This study is the first national study to examine racial/ethnic disparities in awareness of physical activity and cancer risk. Comparisons between racial/ethnic groups found Black-White disparities in awareness. Variables associated with awareness within racial/ethnic groups identify potential subgroups to whom communication efforts to promote awareness may be targeted.

African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women.Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included.Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks.Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26-27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research.

Background: Cancer control researchers studying Asian Americans face many challenges in utilizing/analyzing health survey data due to limited sample sizes and population heterogeneity resulting in underrepresented in many health surveys. National-level initiatives have begun to address this problem, including a recent White House initiative to increase representation of Asian Americans and Pacific Islanders in research, data-collection, and analysis on AAPI populations and subpopulations. Within public health and specifically behavioral epidemiology, identifying and triangulating sources of data on Asian Americans can illuminate facilitate better understanding of health outcomes as well as behavioral mediators and moderators impacting this population. Purpose of Study: This project examines federal and state health surveys relevant to cancer control to: 1) identify sources and types of Asian American data, 2) identify the gaps in behavioral research in Asian Americans and 3) facilitate research in Asian American cancer health disparities. Special attention is paid to measurement of cancer control and prevention, including relevant health behaviors and social determinants. Method: Publically available health surveys including Asian-Americans will be presented and discussed, including but not limited to: the National Health Interview Survey, National Health and Nutrition Examination Survey, Health Information National Trends Survey, the Tobacco Use Supplement to the Current Population Survey, and the California Health Interview Survey. The analysis identifies how Asian Americans are reported and classified and highlights behavioral constructs relevant to cancer incidence and mortality. Differences between surveys will be presented along with an applied example of how data from different surveys may be merged together to create larger sample sizes to increase analytic power. Discussion: The results of this project will demonstrate the utility of using multiple data sets to better understand cancer-related outcomes in Asian American populations. The applied example of a combined analysis will address analytic challenges and opportunities in studying populations with small sample sizes and with heterogeneous sub-groups using available nationally representative data. Finally, we will discuss ways in which the available data can illuminate gaps in behavioral research in cancer control among Asian Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A76.