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Objectives: African American women are disproportionately impacted upon by HIV, particularly in the Southern states of the USA where the percentage of new cases of HIV and the percentage of people living with HIV in the USA are highest. This study describes the lived experiences of HIV-positive African American women based on their written stories. Design: Naturalistic qualitative design. Setting: Three organisations serving people living with HIV in a Southern state in the USA. Method: HIV-positive African American women 18 years of age and older ( N = 23) recruited from organisations working with people living with HIV were given the opportunity to write their own story following their participation in a semi-structured individual private interview. Content analysis was conducted on the written accounts. Results: Analysis of narratives written by HIV-positive African American women revealed themes of self-actualisation and self-worth. While some stories highlighted experiences of helplessness/hopelessness, most stories were more optimistic in nature, offering advice for prevention and highlighting individual efforts of advocacy and education. Stories also touched on risk/protective behaviour and women’s acknowledgement of their own responsibility in their HIV status. Conclusion: Strengths and resources are expressed in stories, as well as the acknowledgement of stressors associated with HIV. These within-culture narratives may be useful in programmes and interventions to inform culturally resonant prevention efforts and promote self-management activities among women living with HIV.

Blacks in the USA, including black men who have sex with men (MSM), tend to have stronger religious and spiritual affiliations compared with other racial/ethnic populations. HIV and STD incidence rates continue to rise among Black MSM. Using data from the CDC Brothers y Hermanos (ByHS) project, this study examined correlations between high-risk behavior, e.g., substance use and high-risk sexual behavior (e.g., condom use history, unprotected sexual intercourse, HIV infection status, and STD infection status) religiosity, spirituality, age, among Black MSM (N = 1141). This exploratory study examined whether religiosity and spirituality were associated with high-risk behavior and high-risk sexual behavior among Black MSM. Religiosity and spirituality indices were compiled from the ByHS data. The religiosity index was significantly associated with HIV infection and use of cocaine, crack, and poppers as well as marginally associated with ecstasy use. Spirituality was significantly associated with HIV infection status, STD infection status, alcohol use, and crack use. Given these relationships, current and future HIV prevention models targeting Black MSM should consider the potential importance of the roles of religiosity and spirituality in the lives of Black MSM to increase the efficacy of risk reduction interventions.

HIV infection rates continue to disproportionately affect Black men who have sex with men (Black MSM) compared to other groups. Research has shown that higher rates of substance use and higher levels of depression are positively correlated with higher sexual risk behavior, and little research has examined relationships between high levels of religiosity and spirituality prevalent in Black culture and issues of substance use and depression among Black MSM. This study did just that and found a relationship between religiosity, spirituality, and risk behavior. These relationships suggest that future HIV prevention models might incorporate religiosity and spirituality to increase the efficacy of risk reduction interventions for Black MSM.

Tanzania has the highest burden of cervical cancer in East Africa. This study aims to identify perceived barriers and facilitators that influence scale-up of regional and population-level cervical cancer screening and treatment programs in Tanzania. Convenience sampling was used to select participants for this qualitative study among 35 key informants. Twenty-eight stakeholders from public-sector health facilities, academia, government, and nongovernmental organizations completed in-depth interviews, and a seven-member municipal health management team participated in a focus group discussion. The investigation identified themes related to the infrastructure of health services for cervical cancer prevention, service delivery, political will, and sociocultural influences on screening and treatment. Decentralizing service delivery, improving access to screening and treatment, increasing the number of trained health workers, and garnering political will were perceived as key facilitators for enhancing and initiating screening and treatment services. In conclusion, participants perceived that system-level structural factors should be addressed to expand regional and population-level service delivery of screening and treatment. Implications for Practice: Tanzanian women have a high burden of cervical cancer. Understanding the perceived structural factors that may influence screening coverage for cervical cancer and availability of treatment may be beneficial for program scale-up. This study showed that multiple factors contribute to the challenge of cervical cancer screening and treatment in Tanzania. In addition, it highlighted systematic developments aimed at expanding services. This study is important because the themes that emerged from the results may help inform programs that plan to improve screening and treatment in Tanzania and potentially in other areas with high burdens of cervical cancer.

BACKGROUND Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation-induced colorectal cancer (CRC). The Children's Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at-risk survivors. METHODS Analyses included 702 five-year survivors (Childhood Cancer Survivor Study) aged ≥36 years who received ≥30 gray of abdominal, pelvic, or spinal radiotherapy. Multivariate generalized linear models were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to the Children's Oncology Group's CRC surveillance recommendations. RESULTS With a median age of 43 years (range, 36-58 years), 29.5% of the survivors (207 of 702 survivors) met surveillance recommendations. In multivariate analyses, age ≥50 years versus age 36 to 49 years (RR, 2.6; 95% CI, 2.0-3.4), reporting a routine cancer follow-up visit within 1 year before the study (RR, 1.5; 95% CI, 1.0-2.2), reporting ≥10 physician visits within the past year versus 0 to 9 visits (RR, 1.4; 95% CI, 1.1-1.7), and discussing future cancer risk with a physician at the time of the most recent follow-up visit (RR, 1.4; 95% CI, 1.1-1.7) were found to be associated with adherence to CRC surveillance recommendations. CONCLUSIONS Greater than 70% of survivors at an increased risk of CRC were not screened as recommended. Regular physician contact and discussion of screening were associated with a 60% increase in CRC surveillance. Educational interventions targeted at survivors and their primary care physicians are needed to heighten knowledge of CRC risk after radiotherapy and the importance of appropriate surveillance. Cancer 2015;121:1856–1863. © 2015 American Cancer Society.

There is a consensus about the benefits of community-based participatory research and the important role it can play in reducing cancer health disparities. Although every community-based participatory research project is unique in many ways, several fundamental issues deserve consideration. We discuss issues concerning community representation, possible tensions within community-based participatory research (CBPR) projects, and staffing CBPR projects. Flexibility, open-mindedness, transparency, and above all, caring, are characteristics that best ensure successful and rewarding outcomes.

Health issues are a concern in Alabama’s Black Belt region, which runs across the southwestern part of the state and includes some of the poorest counties in the USA. As part of a Center for Disease Control (CDC)-sponsored study, we collected data covering several cancer (e.g., prostate, breast, skin) and other health-related indicators (e.g., stress, insurance, stroke, heart disease) from 647 predominantly African-American adults over the age of 50 in 20 communities in 7 Black Belt counties in 2005 and 2006. Here, we provide an account of the state of the health of older African-Americans and compare their outcomes to those of their White counterparts in the region. African-Americans report having generally lower levels of health and were less apt to have a cancer history (ps < 0.05) than the Whites in the region. Gender differences with respect to BMIs and smoking are also evident, with women having higher BMIs but lower levels of smoking. Physicians and researchers covering or interested in generally impoverished rural areas may find our results useful for comparative purposes.

E-cigarette use has increased rapidly over the past decade. There is growing concern about e-cigarette use and advertising given limited regulation of these products. This cross-sectional study reports on data collected at baseline from hospitalized cigarette smokers (N = 944) recruited in monthly cohorts between December 2012 and September 2013. Participants were queried regarding e-cigarette awareness and use, and number and sources of e-cigarette advertisement exposures in the previous 6 months. Most Whites (99 %) reported ever hearing of an e-cigarette compared to 96 % of Blacks (p

Context A large racial disparity exists in organ donation. Objective To identify factors associated with becoming a registered organ donor among African Americans in Alabama. Methods Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods. Results The sample consisted of 22 registered organ donors and 65 nonregistered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor. Conclusion Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

INTRODUCTION E-cigarette use has surged during the past few years while the debate about the product's safety and efficacy for smoking cessation continues. Little is known about the characteristics that distinguish users from nonusers; in this study, we aimed to elucidate these characteristics among hospitalized smokers, a heretofore unstudied population. METHODS Cross-sectional data were collected from cigarette smokers via hospital bedside interviews. Participants reported e-cigarette use status, reasons for use (if used), e-cigarette advertising exposure, expected likelihood of future e-cigarette use, desire to quit smoking, and demographic characteristics. RESULTS Of the 657 English-speaking hospitalized smokers who provided data, 97% reported awareness of e-cigarettes and 46.4% reported e-cigarette use, with 20% reporting use in the previous 30 days. Previous e-cigarette use was significantly more likely among those who were White (odds ratio [OR] = 4.7; confidence interval [CI] = 3.2-6.7), were married/had a domestic partner (OR = 1.5; CI = 1.0-2.2), had more than a high school education (OR = 1.7; CI = 1.1-2.7), had e-cigarette advertising exposure (OR = 1.6; CI = 1.1-2.4), and were younger (OR = 1.3; CI = 1.1-1.5). Expected likelihood of future e-cigarette use was high and positively correlated with desire to quit smoking (Spearman's ρ = .18, p < .0001). CONCLUSIONS Rates of awareness and use of e-cigarettes may be elevated among hospitalized smokers, with more use reported among those who were White, younger, more educated, in a relationship, and exposed to e-cigarette advertising. The association between desire to quit smoking and expected likelihood of future e-cigarette use suggests that cigarette smokers may perceive e-cigarettes as a useful cessation aid.

Purpose The purpose of this study was to evaluate the effectiveness of a theory-based computer-tailored osteoporosis prevention program on calcium and vitamin D intake and osteoporosis health beliefs in young women. Additionally, this study tested whether adding bone density testing to the intervention improved the outcomes. Methods One hundred (n = 100) women aged 19 to 25 years were randomly assigned to one of 2 groups. One group (n = 50) received the computer-tailored program with brief counseling and the second group (n = 50) received the same intervention plus bone density testing of the heel (quantitative ultrasound [QUS]) feedback. Results Participants within both groups statistically significantly increased calcium and vitamin D intake from baseline to 1 month after the interventions. Both groups also experienced statistically significant decreases in perceived barriers to obtaining adequate vitamin D intake. Discussion The theory-based computer-tailored osteoporosis prevention program resulted in...

Objective: We evaluated the use of dental health services within the past year among adults at risk of diabetes in the Alabama Black Belt. Methods: Data for this cross-sectional study was collected in 2005-2006 through the Flying Sparks project. In addition to descriptive statistics and univariate analysis (Chi-square), we used multiple logistic regression analysis to examine the association between dental care use and diabetic status. Results: 1355 individuals responded the survey (mean age 51 years). 67.9% were females and 89.5% African-Americans. 16.7% reported history of diabetes. Overall, 54.5% of individuals had visited a dentist within the past year. Adults with diabetes were less likely than those without diabetes to have seen a dentist (13.4% vs 86.6%, p

Purpose: Physical therapists (PTs) have a unique opportunity to intervene in the area of health promotion. However, no instrument has been validated to measure PTs’ views on health promotion in physical therapy practice. The purpose of this study was to evaluate the content validity and testretest reliability of a health promotion survey designed for PTs. Methods: An expert panel of PTs assessed the content validity of “The Role of Health Promotion in Physical Therapy Survey” and provided suggestions for revision. Item content validity was assessed using the content validity ratio (CVR) as well as the modified kappa statistic. Therapists then participated in the test-retest reliability assessment of the revised health promotion survey, which was assessed using a weighted kappa statistic. Results: Based on feedback from the expert panelists, significant revisions were made to the original survey. The expert panel reached at least a majority consensus agreement for all items in the revised survey and the survey-CVR improved from 0.44 to 0.66. Only one item on the revised survey had substantial testretest agreement, with 55% of the items having moderate agreement and 43% poor agreement. Conclusions: All items on the revised health promotion survey demonstrated at least fair validity, but few items had reasonable testretest reliability. Further modifications should be made to strengthen the validity and improve the reliability of this survey.

Miguel Sabido's entertainment-education (EE) serial drama strategy has been applied effectively in several developing countries. However, in media-saturated industrialised countries, the full application of his serial drama strategy and EE practices has been rare, due to a number of challenges. This article 1) presents the step-by-step processes involved in the design and implementation of two localised EE radio serial drama projects: BodyLove in the State of Alabama in the US and Bay for the Seventeen in Kumamoto, Japan, and 2) discusses the lessons learned from these two cases. Although the two projects were developed and produced in very different local contexts, overarching lessons learned were that collaboration with local stakeholders using a participatory approach is key to project success, and that efforts, resources and creativity are required for evaluating EE mass media programmes in a media-saturated environment.

Background Expectancies demonstrate cross-sectional associations with e-cigarette use, but the prospective relationships between expectancies and e-cigarette use are unknown. This study examined the longitudinal associations of expectancies with e-cigarette use among hospitalized tobacco cigarette smokers. Methods E-cigarette expectancies (e-cigarette-specific Brief Smoking Consequences Questionnaire-Adult [BSCQ-A]), tobacco cigarette expectancies (tobacco-specific BSCQ-A), and number of days used e-cigarettes in the past 30 days were assessed at baseline hospitalization, 6-months post-hospitalization, and 12-months post-hospitalization among 978 hospitalized tobacco cigarette smokers. Expectancy difference scores (e-cigarette-specific expectancies minus tobacco-specific expectancies) were computed for each of the 10 BSCQ-A scales. Cross-lagged panel models tested the relationships between expectancy difference scores and number of days used e-cigarettes in the past 30 days for each of the 10 BSCQ-A scales. Results Though some models revealed partial associations between expectancies and e-cigarette use, only one yielded results consistent with hypotheses. Greater e-cigarette use at baseline predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 6 months, which then predicted greater e-cigarette use at 12 months. To a lesser degree greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at baseline predicted greater e-cigarette use at 6 months, which then predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 12 months. Conclusions Expectancies that e-cigarettes provide similar or more pleasant taste sensations as compared to tobacco cigarettes may be both a cause and consequence of e-cigarette use. Focusing on the taste experience may prove most effective in modifying e-cigarette use behavior. Implications The current study offers the first longitudinal examination of expectancies and e-cigarette use. Results suggest expectancies that e-cigarettes provide similar or more pleasant taste sensations relative to tobacco cigarettes are both a cause and consequence of e-cigarette use. Efforts that focus on the e-cigarette taste experience may prove most effective in modifying e-cigarette use behavior.

We engaged dental practices enrolled in The National Dental Practice-Based Research Network to quantify tobacco screening (ASK) and advising (ADVISE); and to identify patient and practice -characteristics associated with tobacco control. Dental practices (N = 190) distributed patient surveys that measured ASK and ADVISE. Twenty-nine percent of patients were ASKED about tobacco use during visit, 20% were identified as tobacco users, and 41% reported being ADVISED. Accounting for clustering of patients within practices, younger age and male gender were positively associated with ASK and ADVISE. Adjusting for patient age and gender, a higher proportion of non-whites in the practice, preventive services and proportion on public assistance were positively associated with ASK. Proportion of tobacco users in the practice and offering other preventive services were more strongly associated with ASK and ADVISE than other practice characteristics. Understanding variations in performance is an important step toward designing strategies for improving tobacco control in dentistry.

BACKGROUND Studies have demonstrated that African American race is a strong predictor of nondonation. However, it is often and correctly argued that African American race is a crude explanatory variable that is a surrogate marker of socioeconomic status, education, and access to health care. We hypothesized that, when controlling for these factors, African American race would cease to be a predictor of organ donation. METHODS A retrospective review of 1292 Alabama decedents who were approached for organ donation between 2006 and 2009 was performed. Multivariable logistic regression models were constructed to identify the most parsimonious model that could explain the variation in the log odds of obtaining consent. RESULTS Consent for donation was obtained from 49% of the decedents' families. Household income was a predictor of organ donor consent only in whites. Surprisingly, household income was not statistically different between consented and nonconsented African American decedents (U.S. $25,147 vs. U.S. $26,137, P=0.90). On multivariable analysis, education, urban residence, and shorter distance between the decedent's residence and donor hospital were significantly associated with obtaining consent for organ donation. On univariate analysis, the odds ratio of donor consent in whites compared with African Americans was 2.76 (95% confidence interval, 2.17-3.57). When controlling for socioeconomic status and access to health care variables, the odds ratio of donor consent increased to 4.36 (95% confidence interval, 2.88-6.61). CONCLUSIONS We interpret this result to indicate that there remains unknown but important factor(s) associated with both race and obtaining organ donor consent. Further studies are required to isolate and determine whether this factor(s) is modifiable.

A major challenge facing contemporary cancer educators is how to optimize the dissemination of breast cancer prevention and control information to African American women in the Deep South who are believed to be cancer free. The purpose of this research was to provide insight into the breast cancer information-acquisition experiences of African American women in Alabama and Mississippi and to make recommendations on ways to better reach members of this high-risk, underserved population.Focus group methodology was used in a repeated, cross-sectional research design with 64 African American women, 35 years old or older who lived in one of four urban or rural counties in Alabama and Mississippi.Axial-coded themes emerged around sources of cancer information, patterns of information acquisition, characteristics of preferred sources, and characteristics of least-preferred sources.It is important to invest in lay health educators to optimize the dissemination of breast cancer information to African American women who are believed to be cancer free in the Deep South.

Purpose. Examine the effectiveness of a community-based, multimedia intervention on medication adherence among hypertensive adults. Design. Randomized controlled trial. Setting. Rural south Alabama. Subjects. Low-income adults (N = 434) receiving medication at no charge from a public health department or a Federally Qualified Health Center. Intervention. Both interventions were home-based and delivered via computer by a community health advisor. The adherence promotion (AP) intervention focused on theoretical variables related to adherence (e.g., barriers, decisional balance, and role models). The cancer control condition received general cancer information. Measures. Adherence was assessed by pill count. Other adherence-related variables, including barriers, self-efficacy, depression, and sociodemographic variables, were collected via a telephone survey. Analysis. Chi-square analysis tested the hypothesis that a greater proportion of participants in the AP intervention are ≥80% adherent compared to the control group. General linear modeling examined adherence as a continuous variable. Results. Participants receiving the intervention did not differ from individuals in the control group (51% vs. 49% adherent, respectively; p = .67). Clinic type predicted adherence (p < .0001), as did forgetting to take medications (p = .01) and difficulty getting to the clinic to obtain medications (p < .001). Conclusions. Multilevel interventions that focus on individual behavior and community-level targets (e.g., how health care is accessed and delivered) may be needed to improve medication adherence among low-income rural residents.

Purpose: In the Alabama Black Belt, poverty is high, and the educational level is low. Studies have found increased tobacco use among individuals exposed to high levels of stress. Few studies have been conducted in this region to measure smoking status, its sociodemographic determinants, and how smoking status relates to stressful environmental conditions. Methods: A cross-sectional questionnaire survey of 1,387 individuals. Findings: Approximately 25% of the respondents currently smoked cigarettes. Females were less likely to smoke compared to males (OR, 0.29; 95% CI, 0.23-0.38). Blacks were less likely to smoke cigarettes compared to whites (OR, 0.64; 95% CI, 0.43-0.95). Compared to individuals who were employed, participants who were unemployed or retired had increased odds of smoking (OR, 1.68; 95% CI, 1.15-2.20). The odds of being a current smoker were increased in the presence of moderate level stress (OR, 2.06; 95% CI, 1.38-3.07) or when there was a high level of stress (OR, 2.21; 95% CI, 1.47-3.31). Smoking was associated with increased odds of having a moderate level (OR, 2.06; 95% CI, 1.38-3.08) and a high level of stress (OR, 2.21; 95% CI, 1.47-3.32). Females who reported moderate to high levels of stress had increased odds of being smokers compared to males. Interaction between gender and stress showed deviation from additivity. Conclusion: Our findings suggest a high rate of cigarette use in the area. Increased stress levels appear to predispose females more than males to cigarette smoking. The implications of this association may guide interventions targeted at reducing smoking and its complications.

Objective: To evaluate the construct and criterion validity of the Video Transportation Scale (VTS). Setting: Inpatient service of a safety net hospital in Birmingham, Alabama, USA. Method: We administered the VTS in the context of a randomized controlled trial of a DVD-delivered narrative-based intervention (stories) designed to encourage smoking cessation among hospitalized patients. Results: Factor analysis yielded a two-factor solution relating to engagement and attentional focus. Patients receiving the stories-based intervention had a higher score for engagement than control but stories patients and controls did not differ in reported attentional focus. The engagement factor demonstrated predictive validity in that patients with higher scores were more likely to report quitting smoking at two weeks. Conclusion: The VTS provides a rapid assessment of transportation that can be used in applied settings using video-based narratives.

Control of hypertension remains poor, and lack of adherence to medication is considered a primary reason. Few studies have examined the reasons for medication nonadherence in African American, lower-income, rural adults receiving medications at no personal cost. Moreover, our understanding of how the provider-patient relationship influences adherence in this population is limited. In this study, the authors (1) examined reasons for taking less medication than prescribed and (2) examined the association between provider-patient variables and medication adherence. A total of 434 participants (94.8% African American) were included. The most frequently endorsed reasons for taking less medication than prescribed were not having blood pressure medicine when it was time to take a dose (36%), running out of medicine (35%), bothered by side effects (29%), and a change in one’s daily routine (27%). Nonadherent individuals were significantly more likely to report discomfort with asking the health provider questions (74% vs 63%), were more likely to report that health care visits were stressful (25% vs 16%), and exhibited more depressive symptoms (58% vs 45%). Adherent patients had lower blood pressure (systolic: 133±15.8 mm Hg vs 138±17.6 mm Hg, P value=.002; diastolic: 80±9.8 mm Hg vs 83±11 mm Hg, P value=.003) than individuals who were less adherent. Clinicians providing care to rural, poor hypertensive patients should routinely assess self-management behaviors, logistical barriers, and emotional health. Creating clinical encounters that minimize the stressful nature of the visit and encourage patient question-asking behavior may also be important for the optimal management of hypertension.

The purpose of this study was to develop a model to interpret the degree that parasocial interaction affects entertainment-education radio drama listeners' levels of self-efficacy and practices pertaining to physical exercise. The study utilized a concurrent triangulation mixed methods design. The quantitative strand tested the hypothesized model via path analysis on survey data collected from 105 participants. The qualitative strand developed a grounded theory based on interviews of 18 individuals. The final composite model was developed utilizing triangulation and complementarity in the integration process. Empirical evidence and theoretical discussion supported the processes of integration. Limitations and implications are also addressed.

Longitudinal studies have been conducted to evaluate correlates of stage of change movement among adult smokers but no studies were found to be conducted among adolescent smokers. This study used longitudinal data to examine adolescents' abstinence self-efficacy over 10-week and six-month periods and determined whether stage transitions were associated with concomitant changes or baseline values in perceived abstinence self-efficacy, nicotine dependence and motivation to quit. From baseline to 10-weeks results showed a change in motivation to quit and baseline stage were significantly associated with stage progression and regression. Additionally, intervention school status was significantly associated with stage progression. On the other hand, baseline score for nicotine dependence predicted stage regression not progression. Adolescents' becoming more or less 'ready' to quit smoking are influenced by their nicotine dependence and motivation to quit.

This study investigates correlates of smoking behaviors among 290 students in a Mississippi Delta middle school and how these adolescents identify their own smoking behaviors. Self-identified "regular smokers" were more socially exposed to smoking, and reported more indications of habitual smoking than "non-smokers," "once in a while smokers" and "ex-smokers." These differences could lead to intervention studies that, in addition to traditionally categorized regular smokers, recruit adolescent smokers who do not identify themselves as regular smokers, but who nevertheless exhibit behaviors characteristic of regular smokers.

Background Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300). Results Differences in smoking cessation outcomes between the intervention (stories DVD + routine clinical treatment) and control (routine clinical treatment) arms were compared using self-report and carbon monoxide measurement at 6-months. Compared to control, individuals who viewed the intervention stories DVD reported greater intentions to quit. Although continuous quitting marginally favored the intervention, our main result did not reach statistical significance (p = 0.16). Conclusion Narrative communication via storytelling to promote smoking cessation among African-Americans in the South is one method to communicate smoking cessation. Results suggest this may not be sufficient as a stand-alone augmentation of routine clinical treatment for continuous smoking cessation. Smoking cessation efforts need to continually assess different means of communicating to smokers about quitting. Clinical Trials Registration: The ClinicalTrials.gov Identifier is NCT00101491. This trial was registered January 10, 2005

In response to calls to improve public health education and our own desire to provide a more relevant educational experience to our Master of Public Health students, the University of Alabama at Birmingham (UAB) School of Public Health designed, developed, and instituted a fully integrated public health core curriculum in the fall of 2001. This curriculum combines content from discipline-specific courses in biostatistics, environmental health, epidemiology, health administration, and the social and behavioral sciences, and delivers it in a 15 credit hour, team-taught course designed in modules covering such topics as tobacco, infectious diseases, and emergency preparedness. Weekly skills-building sessions increase student competence in data analysis and interpretation, communication, ethical decision-making, community-based interventions, and policy and program planning. Evaluations affirm that the integrated core is functioning as intended: as a means to provide critical content in the core disciplines in their applied context. As public health education continues to be debated, the UAB public health integrated core curriculum can serve as one model for providing quality instruction that is highly relevant to professional practice.

Background. African American women are more likely to be diagnosed at later stages of breast cancer. Methods. A total of 15 residents participated in a program to increase their self-efficacy in communication skills relevant to understanding and responding to African American cultural issues associated with mammography screening. Results. Physicians reported increasing confidence in their ability to elicit barriers to mammography; assess cultural beliefs and norms; assess perceived health benefits and emotional adjustment; engage in emotional talk; motivate; and negotiate and build partnerships with patients. Conclusions. A brief program can increase physician communication skills to meet the needs of a diverse population.

Cocaine use, marijuana use, alcohol use, and polysubstance use (e.g., alcohol and cocaine, alcohol and marifuana) are associated with high-risk sexual behavior and higher rates of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). The purpose of this study was to examine readiness for using condoms among three groups (cocaine users, noncocaine drug users, and non-drug users) of African Americans living in low-income urban settings. African Americans in this sample differed in sex risk behaviors according to their drug use status. Noncocaine drug users reported higher levels of sex risk behaviors than non-drug users, and cocaine users reported the highest levels of risk. Cocaine users also reported lower levels of condom use with their main and nonmain sexual partners than both other groups. Results of multivariate analyses indicate that, compared to the other two groups, cocaine users are at earlier stages of readiness for condom use with main partners. Cocaine users have accurate perceptions of their HIV risk, but are more likely to factor into their decisions for using condoms cost and the trouble that it takes to get condoms. Different approaches to sexually transmitted disease and human immunodeficiency virus prevention will be necessary to meet the needs of these three different subgroups.

The objectives of the current study were to compare hospitalized smokers' expectancies for electronic cigarettes (e-cigarettes) against their expectancies for tobacco cigarettes and evaluate relationships between e-cigarette expectancies and intention to use e-cigarettes.Analysis of baseline data from a one-year longitudinal observational study. The setting was a tertiary care academic center hospital in the Southeastern U.S. Participants were 958 hospitalized tobacco cigarette smokers. A questionnaire of e-cigarette expectancies based on the Brief Smoking Consequences Questionnaire-Adult (BSCQ-A) was developed and administered along with the original, tobacco-specific, BSCQ-A. Intention to use e-cigarettes was assessed with a single 10-point Likert scale item.Participants reported significantly weaker expectancies for e-cigarettes relative to tobacco cigarettes on all 10 BSCQ-A scales. Participants held sizably weaker expectancies that e-cigarettes pose health risks (p.001, Cohen's d=-2.07), relieve negative affect (p.001, Cohen's d=-1.01), satisfy the desire for nicotine (p.001, Cohen's d=-.83), and taste pleasant (p.001, Cohen's d=-.73). Among the strongest predictors of intention to use e-cigarettes were greater expectancies that e-cigarettes taste pleasant (p.001, adjusted β=.34), relieve negative affect (p.001, adjusted β=.32), and satisfy the desire for nicotine (p.001, adjusted β=.31).Hospitalized tobacco smokers expect fewer negative and positive outcomes from e-cigarettes versus tobacco cigarettes. This suggests that e-cigarettes might be viable though imperfect substitutes for tobacco cigarettes.

Purpose: Little is known about barriers that Latinas in the United States face in preventing unintended pregnancies beyond those of language and cost. This study examined factors inhibiting contraceptive use among 18- to 30-year-old Latinas in the Midwest. Method: Individual interviews ( N = 31) were conducted in Spanish with Latinas residing across the state. The interview protocol included questions about contraceptives and unintended pregnancies. Interviews were recorded, transcribed, translated, and coded for themes related to barriers. Results: The majority of the barriers were related to communication but not English proficiency. Respondents talked about specific situations and experiences in which communication presented obstacles to using contraceptives. Discussion: While language and cost are important barriers, attention needs to be paid to the other communication issues that women face related to culture, religion, partners, family, and spontaneity. Implications: Health care providers need to address the range of communication barriers that affect Latinas’ contraceptive use.

PURPOSE: This article describes the planning, implementation, and evaluation of a 2-day conference designed to examine the factors related to the participation of African Americans in cancer clinical trials. METHODS: Pre-conference formative evaluations (e.g., focus group discussions and key informant interviews with community leaders and health providers) were conducted in several rural and urban counties in the state of Alabama to determine African Americans' perceptions of participation in clinical research. The findings from these evaluations were used to develop a conference format and agenda. The 2-day conference included: (i) a pretest of African Americans' perceptions of cancer research, participation factors, and communication and recruitment issues; (ii) individual presentations highlighting community leaders, church leaders, and researchers' perspectives regarding minority participation in research; (iii) working group discussions regarding the barriers and solutions to minority participation in research; and (iv) a posttest evaluation to measure changes in African Americans' perceptions of research. RESULTS: Several recruitment barriers and solutions were identified and reported by the working groups. Comparisons of the pretest and posttest measures showed significant (p > .05) and favorable shifts in the areas of perceptions of cancer research, participation factors, communication issues, and recruitment issues. Participation in the conference reflected a positive change in attitudes on these measures. However, the theme, “barriers that contributed to nonparticipation,” did not show any significant changes during the two testing periods. The most critical lesson that resulted from this conference was the need for researchers and community members to have open dialogue about participation in research. CONCLUSIONS: This conference demonstrated that progress can be made when all parties are at the “table” and can be heard. In this model, community members proved to be valuable resources in providing researchers with information that was vital to the success of recruitment and retention studies and trials.

Background Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. Methods Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey. Results High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users. Conclusions Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.

The Street Outreach to Drug Abusers—Community AIDS Prevention (SODA—CAP) Project implemented and evaluated an HIV-prevention intervention aimed at current drug users. The intervention was developed using social cognitive theory and the transtheoretical model of change. The outreach team assessed individuals’ stages of change for the target behaviors and they were given stage-appropriate role-model stories. The program effects were evaluated using a quasi-experimental design with a repeated, cross-sectional sampling method in which community surveys were administered at baseline, 12 and 22 months. Multivariate statistical models were developed for four outcomes (condom use with main and other partners, treatment entry, and stopping all drug and alcohol use). Exposure to intervention was a significant predictor for condom use with other partners and for stopping drug and alcohol use.

The Teenage Access Project (TAP) was supported by the Special Projects of National Significance Program to expand and ensure access to health and support services for disadvantaged, human immunodeficiency virus (HIV)-positive, and at-risk adolescent and young adult women aged 10-21 years by: (a) preventing further HIV transmission through empowerment and reduction of risk behavior, (b) providing HIV counseling and testing to increase screening of young women, and (c) facilitating referrals to medical and psychosocial services through the TAP activities. TAP served 403 young people (82% African-American and 83% young women). The basic elements of the TAP service model components were: (a) outreach to community agencies serving high-risk, disadvantaged young women; (b) My Individual Responsibility Reduces Our Risk (MIRROR), a six-module risk-reduction and empowerment activity specifically designed for young women in Jefferson County, using a small group format; and (c) the Adolescent Testing Center (ATC), a center for age and culturally appropriate HIV testing, pre- and posttest counseling, risk assessment, and referrals. HIV testing and pre- and posttest counseling were provided confidentially in both clinical and community settings. More than 200 participated in the MIRROR activity. A total of 101 young women received HIV counseling and testing services.

BACKGROUND This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community. METHODS A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the past 30 days, as well as about their depressive symptoms during the past week. RESULTS Odds ratios and logistic regressions, adjusted for age and sex, were used to assess the relationship between depressive symptoms and drug and polydrug use (drug use involving cocaine). Results showed that depressive symptoms are significantly associated with polydrug use. However, depressive symptoms were not associated with alcohol use or with the combination of alcohol and marijuana use. CONCLUSIONS Depressive symptoms are related to polydrug use involving cocaine, though the causal relationship is uncertain. Previous reports on depressive symptoms and alcohol or marijuana may be inconclusive.

Context The Organ Donor Breakthrough Collaborative recommended high-leverage changes including “master effective requesting.” Objective To measure who approaches decedent families to request organ donation and to determine whether trained specialists will solicit authorization at equal frequency regardless of donor characteristics. Methods Retrospective analysis of data from 2006 to 2009 in an organ center's donor database. Decedents were stratified into 2 groups: those that met the Organ Procurement and Transplantation Network's eligible death criteria (ED donors) and those that did not (not eligible death [NED] donors). Results Of decedents whose families were approached for authorization, 46% were ED donors and 54% were NED donors. Trained specialists solicited authorization from 76% of the total population but were more likely to solicit authorization from ED donors than NED donors (86% vs 68%, P < .001). Trained specialists were more likely to solicit authorization from donors whose cause of death was overrepresented in ED donors and donors less than 50 years old. Trained specialists were more likely than others to obtain authorization from families of all donors. Multivariable modeling demonstrated that having a trained specialist approach the decedent's family was associated with the highest odds of obtaining authorization. Conclusions Trained specialists approached most families of decedents for authorization, but disproportionately approached fewer families of NED donors. Having a trained specialist approach the decedent family has the strongest impact on obtaining donor authorization. These data suggest that fewer resources are allocated to NED donors, which may adversely affect the supply of deceased donor organs.

SUMMARY Given that poor asthma management leads to such devastating rates of morbidity and mortality in this country, efforts must be made to increase the knowledge, skills, and behaviors of persons with asthma. The suggestions and recommendations provided here represent a blend of academic opinion and practical advice on methods to implement an asthma education program. In developing an asthma education program, consideration must be given to what content should be included, how and by whom that content should be taught, and when education should take place. The identification of a key clinical staff member to take the lead in translating these and other asthma education guidelines will be a critical next step for clinicians committed to developing an effective asthma education program.

Objective Knowledge in reproductive endocrinology and infertility is fundamental to the delivery of quality women's health care. In 1991, the American Fertility Society formed a resident education committee to gather data on the current status of reproductive endocrinology and infertility training and develop an ideal curriculum. Methods Program directors and reproductive endocrinology and infertility faculty from 288 residencies in obstetrics and gynecology were surveyed about training in reproductive endocrinology and infertility; 257 (89%) of the program directors (survey I) and 203 (82%) of the reproductive endocrinology and infertility faculty (survey II) responded. An ideal curriculum has been developed from consensus discussions, review of survey data, and polling of experienced educators. The curriculum was reviewed and approved by the board of directors of both the Society for Reproductive Endocrinologists and the American Fertility Society. Results The curriculum is divided into subject matter and therapeutics, which are prioritized into three levels of knowledge: critical core curriculum, less critical material, and material with which residents should have familiarity and general knowledge. In addition, other recommendations and suggestions are made regarding the number of rotations, duration of rotations, and teaching methods. Conclusion The ideal curriculum may serve as a guide to assist program directors in the formulation of the most effective residency training in reproductive endocrinology and infertility. The curriculum can help prioritize what should be taught and where an emphasis can be placed. There is not enough time or resources to teach residents all aspects of reproductive endocrinology and infertility.

Background US Hispanics have disproportionate rates of diabetes and other chronic diseases. We used the entertainment–education approach to develop a Spanish-language radio novella aimed at reducing risk factors for diabetes, obesity, and tobacco use. The approach is based on social cognitive theory and proposes modeling as a source of vicarious learning of outcome and efficacy expectations. Community Context The Hispanic population in Alabama increased by 145% between 2000 and 2010. Nearly one-quarter of Hispanics aged 18 to 64 live below the federal poverty level, and 49% are uninsured. Several lifestyle factors lead to poor health behaviors in this community. Radio is a popular medium among Hispanic immigrants. The single local Spanish-language radio station reaches a large proportion of the local community and several communities beyond. Methods Through various methods, including workshops, review sessions, and other feedback mechanisms, we engaged stakeholders and community members in developing and evaluating a 48-episode radio novella to be broadcast as part of a variety show. We tracked participation of community members in all phases. Outcome Community members participated significantly in developing, broadcasting, and evaluating the intervention. The desired outcome — development of a culturally relevant storyline that addresses salient health issues and resonates with the community — was realized. Interpretation Our approach to community engagement can serve as a model for other organizations wishing to use community-based participatory methods in addressing Hispanic health issues. The radio novella was a unique approach for addressing health disparities among our community’s Hispanic population.

Poor adherence to recommended regimens is a substantial problem in the clinical management of adults with asthma and other chronic diseases. Research on adherence assessment is complicated by methodological difficulties including limitations associated with the use of self-report measures. In this study, psychometric techniques were used to analyze two self-report scales for assessing adherence to recommended medication and inhaler use regimens in adults with asthma. Results indicated that the two scales had standard deviations large enough to detect variation adherence, had adequate reliability, and reflected the impact of an intervention designed to improve adherence. The results supported the usefulness of these scales for research on adherence. Additional analyses indicated that the two scales could be combined if the research goal required an overall measure of adherence.

To evaluate the efficacy of a physician-targeted website to improve knowledge and self-reported behavior relevant to strabismus and amblyopia ("vision") in primary care settings.Eligible providers (filing Medicaid claims for at least eight well-child checks at ages 3 or 4 years, 1 year before study enrollment), randomly assigned to control (chlamydia and blood pressure) or vision groups, accessed four web-based educational modules, programmed to present interactive case vignettes with embedded questions and feedback. Each correct response, assigned a value of +1 to a maximum of +7, was used to calculate a summary score per provider. Responses from intervention providers (IPs) at baseline and two follow-up points were compared to responses to vision questions, taken at the end of the study, from control providers (CPs).Most IPs (57/65) responded at baseline and after the short delay (within 1 hour after baseline for 38 IPs). A subgroup (27 IPs and 42 CPs) completed all vision questions after a long delay averaging 1.8 years. Scores from IPs improved after the short delay (median score, 3 vs. 6; P = 0.0065). Compared to CPs, scores from IPs were similar at baseline (P = 0.6473) and higher after the short-term (P0.0001) and long-term (P0.05) delay.Significant improvements after the short delay demonstrate the efficacy of the website and the potential for accessible, standardized vision education. Although improvements subsided over time, the IPs' scores did not return to baseline levels and were significantly better compared to CPs tested 1 to 3 years later.

Health education programs developed in academic medical centers are not optimally disseminated to community clinical settings. Strategies are needed to translate the findings of research on health education programs into programs useful in a wide range of health care settings. Focus group techniques were used to provide data for revising a successful university-based asthma self-management program to make it more practical for use by community physicians. Physicians representing a variety of specialties attended the sessions and provided feedback on the utility of various components of the original program. The discussions revealed that many physicians felt they did not have the time or resources to conduct the original program and identified elements viewed as impractical. This physician input contributed significantly to the development of a revised program with a briefer, less costly intervention. The revised program was later evaluated by focus group participants. Eighty-eight percent of those who evaluated the revised program agreed they would be able and willing to use the program in their own practices. As a formative evaluation tool, the focus group technique made available useful information that would have been difficult to obtain through evaluation forms alone.

Assessment of social influence on health behavior is often approached through a situational context. The current study adapted an existing, theory-based instrument from another content domain to assess Perceived Social Influence on Health Behavior (PSI-HB) among African Americans, using an individual difference approach. The adapted instrument was found to have high internal reliability (α = .81—.84) and acceptable testretest reliability ( r = .68—.85). A measurement model revealed a three-factor structure and supported the theoretical underpinnings. Scores were predictive of health behaviors, particularly among women. Future research using the new instrument may have applied value assessing social influence in the context of health interventions.

African Amercians afflicted with head and neck squamous cell carcinoma (HNSCC) have a strikingly worse survival than do whites. One apparent cause is an advanced stage of presentation in African Americans. This study was designed to identify barriers to early treatment among African American men.Twenty-four African American male HNSCC survivors completed structured interviews. Interviewers elicited the participants' experiences from symptom recognition to receiving definitive care.Most participants were seen with advanced-stage HNSCC. Overall, 10% experienced barriers to obtaining early medical care, though 30% were hesitant to seek care due to perceived barriers. Definitive treatment began for 81% within 3 months of initial care seeking.Once participants sought care, most of them received definitive treatment within a reasonable time frame. To explain the advanced stage at presentation, either tumor growth rate was extremely rapid or participants sought care when the tumor was quite advanced. The themes suggested by this elicitation study require further validation.

The health disparities that negatively affect African Americans are well-documented; however, there are also many sociocultural factors that may play a protective role in health outcomes. Religious involvement is noted to be important in the African American community and to have a positive association with health outcomes. However, few studies have explained why this relationship exists. This article reports on the development and validation of instruments to assess two proposed mediators of the relationship between religiosity and health for an African American population: perceived religious influence on health behaviors and illness as punishment from a higher power . We used a systematic iterative process, including interviews and questionnaire data from African Americans who provided feedback on item wording. We also solicited input from African American pastors. In a sample of 55 African Americans, the instruments appeared to have strong internal reliability (α = .74 and .91, respectively) as well as test-retest reliability (r = .65, .84, respectively, p < .001). Evidence for construct validity is also discussed, as are recommendations for health disparities research using these instruments.