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Background: The North Carolina Native American Cervical Cancer Prevention Project was a 5-year, National Cancer Institute-funded trial of health education designed to increase screening for cervical cancer among Native-American women in North Carolina.Purpose: This study was conducted to evaluate the effectiveness of this education program in the Eastern-Band Cherokee target population.Methods: Cherokee tribal lands were mapped and all households (N = 2223) were listed to ensure maximum coverage of the eligible population (women, aged 18 years and older, who were enrolled tribal members). Eligible women were identified by the use of a brief questionnaire administered to an adult member of the household. Of the 1279 households with eligible women, 1020 (79.8%) agreed to participate. The intervention was an individualized health education program delivered by female Cherokee lay health educators. The participants were randomly assigned to receive or not to receive the intervention (i.e., to program and control groups, respectively) by use of the Solomon Four-Group design. Data were collected in face-to-face interviews conducted in the participant's home. Of the 996 women who were ultimately enrolled, 540 were randomly assigned to receive a pretest (preintervention) interview that involved administration of a 96-item questionnaire designed to collect data on knowledge, intentions, and behaviors related to cervical cancer; of these 540 women, 263 were randomly assigned to receive the education program. The remaining 456 women did not receive the pretest, but 218 were randomly assigned to receive the education program. Six months after receiving the education program, the women in all four groups were administered a post-test that was identical to the pretest. Logistic regression was used to assess the effects of the pretest and the educational program. All P values resulted from two-sided statistical tests.Results: Eight hundred and fifteen (81.8%) of the 996 participants completed the post-test interview. The remaining 181 women who were lost to follow-up were evenly distributed among the four study groups. At the post-test, 282 (73.2%) of the 385 women who received the education program reported having had a Pap smear following the intervention, compared with 275 (64%) of the 430 control subjects. Women who received the education program were more likely to answer all knowledge items correctly on the post-test (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.08-4.39) and to report having obtained a Pap smear in the past year (OR = 2.06, 95% CI = 1.14-3.72) than women in the control groups.Conclusion: Women who received the education program exhibited a greater knowledge about cervical cancer prevention and were more likely to have reported having had a Pap smear within the past year than women who did not receive the program. [ABSTRACT FROM AUTHOR]

Approximately one- to three-quarters of women notified of abnormal Pap test results do not receive appropriate follow-up care, dramatically elevating their risk for invasive cervical cancer. We explored barriers to and facilitators of follow-up care for women in two counties in Appalachian Kentucky, where invasive cervical cancer incidence and mortality are significantly higher than the national average. In-depth interviews were conducted among 27 Appalachian women and seven local health department personnel. Those who had been told of an atypical Pap test result tended to have one of three reactions: (1) not alarmed and generally did not obtain follow-up care; (2) alarmed and obtained follow-up care; or (3) alarmed, but did not obtain care. Each of these typologies appeared to be shaped by a differing set of three categories of influences: personal factors; procedure/provider/system factors; and ecological/community factors. Recommendations to increase appropriate follow-up care included pursuing research on explanations for these typologies and developing tailored interventions specific to women in each of the response types. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second most common female tumor worldwide, and its incidence is disproportionately high (>80%) in the developing world. In the United States, in which Papanicolaou (Pap) tests have reduced the annual incidence to approximately 11,000 cervical cancers, >60% of cases are reported to occur in medically underserved populations as part of a complex of diseases linked to poverty, race/ethnicity, and/or health disparities. Because carcinogenic human papillomavirus (HPV) infections cause virtually all cervical cancer, 2 new approaches for cervical cancer prevention have emerged: 1) HPV vaccination to prevent infections in younger women (aged < or =18 years) and 2) carcinogenic HPV detection in older women (aged > or =30 years). Together, HPV vaccination and testing, if used in an age-appropriate manner, have the potential to transform cervical cancer prevention, particularly among underserved populations. Nevertheless, significant barriers of access, acceptability, and adoption to any cervical cancer prevention strategy remain. Without understanding and addressing these obstacles, these promising new tools for cervical cancer prevention may be futile. In the current study, the delivery of cervical cancer prevention strategies to these US populations that experience a high cervical cancer burden (African-American women in South Carolina, Alabama, and Mississippi; Haitian immigrant women in Miami; Hispanic women in the US-Mexico Border; Sioux/Native American women in the Northern Plains; white women in the Appalachia; and Vietnamese-American women in Pennsylvania and New Jersey) is reviewed. The goal was to inform future research and outreach efforts to reduce the burden of cervical cancer in underserved populations. [ABSTRACT FROM AUTHOR]

Background: The addition of Western foods to the Samoan diet has greatly affected the health of the American Samoan people. The purpose of this study was to test the effectiveness of culturally tailored exercise and nutrition interventions for adults living in Tutuila, American Samoa. Method: Villages in the eastern, central, and western parts of the island of Tutuila were recruited to participate in this study. Villages were randomly assigned to one of three culturally tailored interventions: 46 individuals in one village participated in an exercise intervention, 27 individuals in another village participated in a nutrition-education intervention, and 22 individuals in a third village participated in a combined exercise and nutrition-education intervention. Participants' nutrition knowledge was measured at pre- and post-intervention stages through a questionnaire. Body Mass Index (BMI), height, and weight were assessed at baseline and again at weeks 4, 8, and 12. Differences in mean BMI over time by group, were assessed using repeated measures ANOVA with baseline BMI as a covariate. To test for differences in nutrition knowledge over time by group, pair-wise comparisons were used for the percent of correct answers at baseline and at week 12. Results: All three groups realized a significant decrease in BMI, from 1.35 in the nutrition only group to 2.27 in the exercise and nutrition group. The exercise and nutrition group also showed significant gains in ability to identify foods high in fiber and fat. Implications: This study demonstrates that decreases in BMI and increases in nutritional knowledge can be obtained through a culturally-tailored intervention, especially one that combines nutrition education and exercise. [ABSTRACT FROM AUTHOR]

Objective: To Apply the PAPM and Diffusion Theory for building a statewide coroner investigation system to further violent death prevention efforts. Methods: By utilizing a theoretically based framework and systematically tracking stage progression, individual agencies and/or state systems can replicate and sustain the process. Results: Through the incorporation of the combined models, 82 of Kentucky's 120 coroner offices currently collect the same information-no replicate information existed 4 years ago. Conclusion: This study demonstrates the utility of theory as a foundation for encouraging adoption of innovation and shows an effective way to coordinate information in a timely manner with limited cost. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. METHODS: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). RESULTS: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. CONCLUSIONS: Strategies that focus on reducing alcohol and tobacco use need to be tested. [ABSTRACT FROM AUTHOR]

Background. Cultural values of Alaska Native people acknowledge laughter as good medicine. It is heard in their words and stories. Methods. To investigate how and in what ways laughter impacts learning from the learners' perspective, cancer education course evaluations were reviewed and a survey administered. Results. 94% (235/259) of Community Health Aides and Community Health Practitioners surveyed emphasized the importance of laughter to support adult learning. Written comments are grouped into three main themes: (1) supporting a comfortable learning community, (2) relieving stress, and (3) enhancing learning. Discussion. This study demonstrates the value and significance of laughter to support people in their learning journey. [ABSTRACT FROM AUTHOR]

BACKGROUND: Village-based Community Health Aides and Community Health Practitioners (CHA/Ps) are the primary providers of health care in rural Alaska. METHODS: We discuss the development and results of a CHA/P cancer self-assessment survey, which assessed comfort with cancer knowledge and providing cancer information. RESULTS: A total of 402 responses were received from a mailed questionnaire to 477 CHA/Ps. Respondents were predominantly Alaska Native women. Using a 5-point Likert scale from don't know to very comfortable, approximately 50% of CHA/Ps reported feeling 'OK' when providing information about cancer risk factors, cancer screening, surviving cancer, and providing care and support. CHA/Ps reported feeling less comfortable with discussing cancer diagnosis, treatment, pain, and loss and grief. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cancer, a rare disease in the 1950s, is now the leading cause of death among Alaska Natives (AN). METHODS: Building on AN rich traditions of storytelling to share knowledge and wisdom, a 45 minute play, Understanding, was developed to address cancer-related issues specific to AN. RESULTS: Written audience evaluations assessed the impact of this theater-based education. After seeing the play, 327 (94.5%) people reported feeling more comfortable talking about cancer, 265 (66.1%) shared that they had learned about cancer, and 234 (61.7%) wrote healthy ways they intended to change their behavior. CONCLUSION: A postplay discussion provided an opportunity for the audience to share their stories, concerns, beliefs, and feelings. [ABSTRACT FROM AUTHOR]

Community characteristics are being recognized as important determinants for effective community-based programs. Community capacity to collaboratively identify issues, establish collective goals, and mobilize resources is built on experience with such interactions and trust among collaborators. Conceptual approaches and methods to develop community capacity rarely have been a focus of research programs, at least in part due to categorical funding, which often limits the scope and duration of interventions, thereby limiting capacity development. This approach uses multiple categorical funding sources to create sustained community programs involving multiple systems to increase capacity. Quasiexperimental evidence of increases in community capacity within two Alabama communities is presented. [ABSTRACT FROM AUTHOR]

The North Carolina Native American Cervical Cancer Prevention Project was a 5-year (1989-1995) National Cancer Institute-funded, community-based, early detection of cervical cancer intervention implemented among two Native American tribes in North Carolina: the eastern band of the Cherokee Indians and the Lumbee. The initial quantitative analysis of the intervention showed modest effects and found that the intervention had different effects in the two communities. Due to the equivocal findings, a retrospective qualitative study was conducted. The qualitative study found that two types of factors influenced the intervention's results. The first were project and intervention characteristics, and the second were community and cultural factors over which the project had no control. The community and cultural factors took two forms: enhancers, which contributed to greater intervention effect, and attenuators, which created barriers to success. Examples of each factor are presented, and implications for cervical cancer detection among Native American women are discussed. [ABSTRACT FROM AUTHOR]

Discusses the use of focus groups to attempt to reduce mortality from cervical cancer among black women in Forsyth County, North Carolina. Funding by the National Cancer Institute (NCI); Educational goals of the project; Necessity of Pap smears and followup care; Structural barriers to obtaining Pap smears such as competing financial obligation and transportation problems; More.

The article presents information about the Forsyth County Cervical Cancer Prevention Project, a community-wide cancer education program. The purpose behind the implementation of the program was to improve compliance with follow-up of abnormal cervical smears among minority patients in public health and private primary-care clinics in Forsyth County, North Carolina. It was discovered that the percentage of black women who returned for follow-up and treatment of an abnormal cervical smear increased during the time the program was in effect. The research also revealed that the increase in the percentage compliant did not begin prior to the intervention period and was maintained throughout the duration of the intervention.

Abstract Background In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening. Methods A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules. Results We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p = 0. 29), while the prevalence of having been screened in the past year increased from 17% to 35% (p < 0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices. Conclusions AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.

Abstract Background Clinic-based behavioral weight loss programs are effective in producing significant weight loss. A one-size-fits-all approach is often taken with these programs. It may be beneficial to tailor programs based on participants' baseline characteristics. Type and level of motivation may be an important factor to consider. Previous research has found that, in general, higher levels of controlled motivation are detrimental to behavior change while higher levels of autonomous motivation improve the likelihood of behavior modification. Methods This study assessed the outcomes of two internet behavioral weight loss interventions and assessed the effect of baseline motivation levels on program success. Eighty females (M (SD) age 48.7 (10.6) years; BMI 32.0 (3.7) kg/m2; 91% Caucasian) were randomized to one of two groups, a standard group or a motivation-enhanced group. Both received a 16-week internet behavioral weight loss program and attended an initial and a four-week group session. Weight and motivation were measured at baseline, four and 16 weeks. Hierarchical regression analysis was conducted to test for moderation. Results There was significant weight loss at 16-weeks in both groups (p < 0.001); however there were no between group differences (p = 0.57) (standard group 3.4 (3.6) kg; motivation-enhanced group 3.9 (3.4) kg). Further analysis was conducted to examine predictors of weight loss. Baseline controlled motivation level was negatively correlated with weight loss in the entire sample (r = -0.30; p = 0.01). Statistical analysis revealed an interaction between study group assignment and baseline level of controlled motivation. Weight loss was not predicted by baseline level of controlled motivation in the motivation-enhanced group, but was significantly predicted by controlled motivation in the standard group. Baseline autonomous motivation did not predict weight change in either group. Conclusions This research found that, in participants with high levels of baseline controlled motivation for weight loss, an intervention designed to enhance motivation for weight loss produced significantly greater weight loss than a standard behavioral weight loss intervention.

The article presents information on the use of mammography for racial and ethnic differences in death from breast cancer in the U.S. But it has been found that Non-Hispanic white women have benefited more from earlier diagnosis by mammography than African-American, Hispanic, and Asian women. A study was conducted with 1,010,515 women, who had undergone mammography at least once. Based on their race and ethnicity as well as the time interval between the most recent mammography and the previous mammography, women with breast cancer were identified and evaluated. The study concluded that racial differences in mammography use can explain some differences in the incidence of advanced-stage breast cancer and in death rates from the disease.

Background: The objective of Alabama Racial and Ethnic Approaches to Community Health 2010 is to implement and evaluate a community action plan (CAP) developed by a diverse coalition to reduce breast and cervical cancer screening disparities between African American and White women. Methods: The CAP entailed (1) establishing a core working group (CWG) in each county, (2) training CWG members to promote screenings, and (3) providing coalition members with technical assistance to write mini-grants. Results: Overall, 241 CWG members were trained. They have conducted 2800 cancer screening surveys. A total of 8 coalition members received mini-grants. Conclusion: Community capacity building can lead to a sense of ownership and empowerment. [ABSTRACT FROM AUTHOR]

Background: Nearly a quarter of Americans live in rural areas, which consistently report higher cancer mortality rates than urban and suburban areas. The worse outcome for cancer patients in these areas has been attributed in part to compliance with treatment recommendations. Southeastern Kentucky is a rural area with a low income population and barriers such as distance and lack of public transportation to access health care and compliance with treatment is a major concern. Methods: Data on patients with breast cancer treated with radiation therapy at Appalachian Regional Healthcare cancer center which serves the area of Southeastern Kentucky were collected. Age, economic status (measured by availability of medical insurance), distance of patient's residence from the hospital, were evaluated as potential predictors of compliance with recommendations to obtain radiation therapy. Data were analyzed with Fisher's exact test. Results: A total of 80 patients with breast cancer received adjuvant radiation treatment from 2008 to 2011. Of these 80 patients, 24 (30%) had Medicaid, 31 (39%) had Medicare, and 25 (31 %) had commercial health insurance. Only two (2.5%) patients did not complete treatment due to transportation. An additional 10 patients (13%) had treatment interruption due to weather, transportation or other financial reasons. In patients who completed treatment, a total of 2640 days of treatment were provided. A total of 55 (2.1 %) days of treatment were missed. Of the 10 patients who had interruption, 5 of them had Medicaid and the number of missed days by the Medicaid patients was (37/55), which is 67% of the total days missed. No statistically significant difference was detected in the number of patients missing treatment between Medicaid and other insurance types (p = 0.16). None of the factors evaluated predicted patient compliance, although a trend toward lower compliance was noted in patients who had Medicaid. Conclusion: Despite being a rural area with multiple barriers to access healthcare, the rate of full compliance (defined as completion of the entire course of radiation therapy) with adjuvant radiation therapy in breast cancer patients in Southeastern Kentucky was 97.5%, which is similar to the rates in clinical trials that generally exceed 90%. A trend toward lower compliance was noted in patients who had Medicaid although it was not statistically significant. [ABSTRACT FROM AUTHOR]