Search

Objective: To test the feasibility of a dissemination strategy to increase faith communities' (FCs) adoption and implementation of a tested dietary intervention. Design: The study was a randomized, controlled trial that took place over a 9-month period. Setting: Seattle, Washington, metropolitan area. Participants: Seven FCs assigned to an intervention group and five to a comparison group. Intervention: All FCs received intervention materials, monetary support, and a Healthy Eating Coordinator (HEC), who was available to answer questions or provide assistance. Intervention FCs additionally received monthly contact from the HEC. Main Outcome Measure: The main outcome measure was the number of intervention activities the FCs reported over the intervention period. Analysis: The authors performed descriptive analyses and compared median number of activities performed by intervention and control FCs with Wilcoxon rank-sum tests. Results: Intervention FCs implemented a median of 3 intervention activities, whereas control FCs implemented a median of 0 intervention activities (P = 0.05). Conclusions and Implications: These findings indicate that regular contact from HECs is a feasible dissemination strategy for FCs. Further research is needed to determine how to improve the effectiveness of this contact.

Objective: Individuals' beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State ( n  = 1,002). Design: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models. Results: Hispanic women had a higher probability of not believing 'at all' in inheritance and physical activity as causes of obesity - an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing 'at all' in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women. Conclusions: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population.

In our Cancer Prevention Program at Washington University in Saint Louis (WUSTL), we have made extraordinary efforts to create the kind of cancer prevention and control program that is both translational and transdisciplinary in nature, to accelerate the march from basic discoveries to population change. Here we present an overview of our obesity-related research currently ongoing in our Center, paying particular attention to both the translational- transdisciplinary process and to community-based participatory research. We end with our future directions for improving obesity-related cancer outcomes research. Cancer Prev Res; 9(7); 503-8. ©2016 AACR., (©2016 American Association for Cancer Research.)

Background: Lynch syndrome confers a hereditary predisposition to colorectal and other cancers. Universal tumor screening (UTS) for Lynch syndrome is recommended by several professional societies, but the implementation can be complex. This article describes the evaluation, process development, and initiation of Lynch syndrome UTS at a tertiary referral cancer center., Methods: A multidisciplinary team developed the new process design. Issues in 5 themes were noted: timing, funding, second-opinion patients, result processing, and the role of genetics providers. A committee approach was used to examine each issue for process-improvement development., Results: The issues related to testing were addressed individually for the successful implementation of UTS at the institutional level. In the conventional-care period, 9 of 30 cases (30%) received Lynch syndrome screening, and 4 cases were referred to medical genetics. During the 6 months following the implementation of UTS, 32 of 44 patients (73%) received Lynch syndrome screening. The 13 unscreened patients all had identified reasons for nonscreening (eg, financial limitations). Ten patients were referred to medical genetics, which identified no new cases of Lynch syndrome, but a low-risk adenomatous polyposis coli (APC) variant was detected in 1 individual., Conclusions: The implementation of effective Lynch syndrome UTS can feasibly alter practice at the institutional level. This experience with the assessment and management of issues relevant to the successful implementation of a new clinical care paradigm based on emerging technology has implications for the uptake of advances across molecular oncology into clinical practice, and this is highly relevant in the current era of rapidly evolving genomic technology., (© 2015 American Cancer Society.)

Colorectal cancer screening is a life-saving intervention, but screening rates are low. The authors implemented and evaluated the Spokane Colorectal Cancer Screening Program-a novel worksite intervention to promote colorectal cancer screening that used a combination of evidence-based strategies recommended by the Guide to Community Preventive Services, as well as additional strategies. Over a period of approximately 3 months, participating worksites held one or more physician-led seminars about colorectal cancer screening for employees. They also distributed free fecal immunochemical tests at the worksite to employees 50 years and older, and they provided test results to employees and their primary care physician. The authors measured attendance at seminars, test kits taken and returned, employee awareness of the program, and colorectal cancer screening rates in participating and comparison worksites. It is estimated that 9% of eligible employees received kits at the worksite, and 4% were screened with these kits. The Spokane Colorectal Cancer Screening Program was a promising pilot test of an innovative worksite screening program that successfully translated evidence-based strategies into practical use in a brief period of time, and it merits a larger study to be able to test its effects more rigorously.

Four dimensions of perceived social support (emotional/informational, tangible, affectionate, positive social interaction) were examined as moderators of the effect of perceived breast cancer risk on distress in a cross-sectional sample of 1,366 women recruited from the general population. Heightened perceived breast cancer risk predicted higher levels of depression, but only among women who reported low levels of perceived emotional/informational, tangible, affectionate, and positive social interaction support. Tangible and positive social interaction support mitigated the negative effect of heightened risk perception on anxiety. Perceived breast cancer risk was associated with greater cancer worry, regardless of the degree of social support perception. However, this association was weaker for women who perceived greater positive social interaction support. The results suggest that women's perceptions of social support availability can protect them against some of the adverse emotional consequences of heightened breast cancer risk perceptions.

Objective: This study examined the long-term effects on women's health related quality of life (HRQOL) of involvement in decision-making about their treatment for breast cancer and about follow-up care after treatment., Methods: Using a cross-sectional survey design, a sample of breast cancer survivors from Western Washington who were 2, 5, and 10 years postdiagnosis were recruited via a cancer registry and interviewed about their HRQOL and their involvement in decision-making about their cancer treatment and follow-up care., Main Outcome Measures: HRQOL was assessed using the SF-36., Results: Multiple regression analyses examining demographic and disease characteristics revealed age, and education, but not stage of cancer at diagnosis, to be significant predictors of perceived involvement in decision-making about cancer treatment and follow-up. Controlling for demographic and disease characteristics, perceived involvement in decision-making about treatment overall, surgery, chemotherapeutic treatment, and follow-up care were each associated with improved HRQOL, including the general health and vitality subscales of the SF-36 (p < .05). Involvement in decision-making about surgery was also associated with better mental health among survivors of breast cancer. Congruence of involvement in decision-making with a patient's preferred level of involvement was also associated with improved survivor HRQOL on several subscales., Conclusions: Perceived involvement in decision-making about breast cancer treatment, and about follow-up care is associated with better HRQOL for survivors 2, 5, and 10 years postdiagnosis. Prospective studies may be warranted to determine the possible mechanisms by which perceived involvement in decision-making about aspects of treatment other than surgery type might influence survivor HRQOL., ((c) 2009 APA, all rights reserved.)

Background: Colorectal cancer screening reduces death from colorectal cancer, but screening rates are low. While research has identified barriers to screening from the patient perspective, less research has addressed screening from the physician perspective., Methods: The Washington Comprehensive Cancer Control Partnership conducted a survey of primary care physicians in Washington State to measure their knowledge, attitudes, and practices for colorectal cancer screening of average-risk patients. The survey was mailed to a simple random sample of 700 primary care physicians in Washington State. Sixty-nine percent of the eligible physicians in the sample participated., Results: Most respondents (76%) recommended one or more colorectal cancer screening tests in agreement with American Cancer Society guidelines, and 93% perceived patient anxiety about colorectal cancer screening tests to be a significant barrier to screening. Ninety percent of physicians reported using the fecal occult blood test (FOBT) as a screening test, but most did not report performing any tracking or using any mechanism to encourage their patients to complete and return FOBT kits., Conclusions: These findings suggest three intervention approaches to increase colorectal cancer screening in primary care settings: improve physicians' knowledge about current screening guidelines (especially appropriate age and screening intervals), encourage physicians to strongly recommend screening to patients, and help physicians adopt tracking systems to follow screening to completion.

Purpose/objectives: To describe a process for, response rates of, and indicated interest in recruiting patients with breast cancer and their spouses and family members from a clinical setting into behavioral and psychiatric research studies since the Health Insurance Portability and Accountability Act (HIPAA) regulations have taken effect., Data Sources: Published articles, books and book chapters, MEDLINE, government agency information and HIPAA regulatory Web sites, and survey data., Data Synthesis: Response rates among the three target groups--patients, spouses and partners, and female first-degree relatives--were 77%, 95%, and 88%, respectively. Interest was high in the three target groups, with 77%, 87%, and 65% of responding patients, spouses and partners, and female first-degree relatives, respectively., Conclusions: Taken together, these data indicate that high participation rates can be expected from patients with breast cancer and their families in clinical settings., Implications for Nursing: Regulations pose barriers to patient and family recruitment, but thoughtful systems actually can improve rates of recruitment.

Introduction: Many breast cancer survivors experience persistent physical symptoms of cancer and treatment that can decrease health-related quality of life (HRQOL). This prospective study investigated physical activity (PA), occurrence of physical symptoms, and HRQOL in a large, ethnically-diverse cohort of breast cancer survivors., Materials and Methods: Survivors (n = 545), on average 6 months post-diagnosis, were assessed in person or by mail at baseline (retrospective reports of pre-diagnosis PA), at 29 months post-diagnosis (post-diagnosis PA), and at 39 months post-diagnosis (pain, hormone symptoms, sexual interest/dysfunction, fatigue, physical subscales of HRQOL). Linear regression and analysis of covariance assessed the relationships between pre- and post-diagnosis PA and PA change after cancer with symptoms and HRQOL., Results: Greater pre-diagnosis PA was associated with better physical functioning at 39 months (betas 1.1-2.3; all p < 0.01) but was generally unrelated to symptoms. Greater post-diagnosis sports/recreational PA was related to less fatigue and better physical functioning (betas -0.146, 2.21; both p < 0.01). Increased PA after cancer was related to less fatigue and pain and better physical functioning (all p < 0.01). Significant positive associations were found for moderate to vigorous and vigorous sports/recreation PA, not household activity. Results were similar for Hispanic and non-Hispanic White women., Discussion/conclusions: Increased PA, especially after cancer, was consistently related to better physical functioning and to reduced fatigue and bodily pain, underscoring the need for PA promotion among survivors., Implications for Cancer Survivors: Survivors may be able to decrease fatigue and bodily pain and be better able to pursue daily activities through increasing recreational PA after cancer.

Purpose: Due to controversy regarding prostate cancer screening, it is imperative that African American men make informed decisions. Little is known about the role of cultural factors in decision-making for prostate cancer screening among African American men. The purposes of this study were: 1) to investigate components involved with decision-making for prostate cancer screening among African American men; and 2) to identify cultural factors that may influence screening decisions., Methods: Six focus group sessions were conducted consisting of African American men between the ages of 40 and 70., Results: Eight themes emerged from the discussions about prostate cancer screening. These themes were: 1) men's knowledge of prostate cancer and clinical services; 2) prostate cancer as a threat to manhood; 3) screening as a threat to manhood; 4) self-awareness of health and well-being; 5) value of screening; 6) convenience of prostate specific antigen (PSA) screening; 7) misunderstanding of screening controversy; 8) distrust of the medical community; and 9) shared decision-making., Conclusion: This study identifies cultural factors involved with decision-making for prostate cancer screening among African American men.

Sexual minority women (lesbian and bisexual) represent a vulnerable group regarding their breast health. The participants in this study were 150 women aged 18-74 recruited via public announcements in mainstream and sexual minority communities in the greater Seattle metropolitan area. Potential participants were recruited to participate in a randomized trial of a breast cancer risk counseling intervention for sexual minority women. The counseling intervention produced significant reductions in perceived risk of breast cancer, anxieties and fears about breast cancer at 6 and 24 months, and increases in breast screening rates at 24 months in the intervention arm, compared with the control arm participants. These data add to the growing body of knowledge on sexual minority women's health and point to areas of community action and future research.

Programmes concerned with health promotion activities frequently rely on community organisations to deliver health behaviour change interventions. This paper presents data on the recruitment of religious organisations (ROs) into a research project focused on dietary change. The authors contacted the membership list of a local multi-denominational religious umbrella organisation by mail. The recruitment process consisted of a screening survey followed by an informational meeting with RO representatives, with additional meetings as necessary. The ROs were surveyed by telephone, and the initial and follow-up meetings were held at a location convenient to the RO representatives, often the RO's building. For this paper, the unit of analysis is the RO. The ROs approached during the recruitment process were of a variety of faiths and denominations. All were located within the metropolitan area of Seattle, WA, USA. The screening survey was used to determine RO eligibility, and collect further information on the RO and its membership. The survey included questions adapted from previous RO surveys and questions developed by the project team. The recruitment strategy yielded a 26% enrollment rate of eligible ROs. In comparison to eligible ROs, those that did not meet the eligibility criteria were less stable, smaller and had a membership that was less white, less college-educated and more working class. The size of the RO and the number of years that the religious leader had been with the RO were the strongest predictors of the RO's interest in participating in the project. These data will be helpful in recruiting community organisations into health promotion programmes.

The purpose of this study was to determine the feasibility of partnering with barbershops to implement a community-based prostate cancer preparatory educational decision aid for African-American men. We used African-American newspapers to compile a list of barbershops in King County, Washington, that predominantly serve African-American men. Trained research interviewers conducted proprietor surveys and client surveys. Ninety-six percent of the proprietors surveyed reported they would allow their clients to learn about prostate cancer. Seventy-five percent reported they would consider allowing a computer to be installed to provide information about prostate cancer. Ninety-seven percent of clients reported that they would be willing to look at information about prostate cancer in their barbershops. It will be feasible to work with barbershops and their clients for a community-based prostate cancer screening decision-aid intervention for African-American men.