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INTRODUCTION: Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. METHODS: Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21–65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n = 175) or an intervention (n = 176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. RESULTS: The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: −4.4 kg, 95% CI = −5.5, −3.3, p < 0.001) and 12 months (net effect: −3.8 kg, 95% CI = −5.0, −2.5, p < 0.001). Intervention participants were more likely to lose ≥ 5% of their baseline weight at 6 months (43% vs 6%, p < 0.001) and 12 months (40% vs 17%, p < 0.001). Intervention participants completing ≥ 80% of expected self-monitoring episodes (−3.5 kg); counseling calls (−3.0 kg); or self-weighing days (−4.4 kg) lost significantly more weight than less engaged intervention participants (all p < 0.01). CONCLUSIONS: A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov, NCT01827800.

The patient-centered medical home (PCMH) model is designed to improve health outcomes while containing the cost of care. However, the evidence is inconclusive.The aim of this study was to examine the associations between receipt of care consistent with the PCMH and healthcare services utilization and expenditures for non-elderly adults with mental illness in the USA.A surveillance study was conducted using self-reported data for 6908 non-elderly adults with mental illness participating in the 2007-2012 Medical Expenditure Panel Survey. Healthcare services utilization and expenditures were compared for study participants who received care consistent with the PCMH, participants with a non-PCMH usual source of care (USC), and participants without a USC.Differences in utilization and expenditures between participants who received care consistent with the PCMH and participants who had a non-PCMH USC were not statistically significant for any healthcare services category.Receipt of care consistent with the PCMH was not significantly associated with differences in healthcare services utilization or expenditures compared to having a non-PCMH USC. Research assessing whether the PCMH is cost-effective for non-elderly adults with mental illness is needed.

Background : Community-engaged data collection offers an important opportunity to build community capacity to harness the power of data and create social change. Objectives : To share lessons learned from engaging 16 adolescents and young adults from a partner community to collect data for a public opinion survey as part of a broader community-based participatory research (CBPR) project. Methods : We conducted an analysis of archival documents, process data, and an assessment of survey assistants’ experiences. Lessons Learned : High-quality data were collected from a hard-to-reach population. Survey assistants benefited from exposure to research and gained professional skills. Key challenges included conducting surveys in challenging environments and managing schedule constraints during the school year. The tremendous investment made by project partners was vital for success. Conclusions : Investments required to support engaged data collection were larger than anticipated, as were the rewards, prompting greater attention to the integration of adolescents and young adults in research efforts.

Introduction. Social support is important for behavior change, and it may be particularly important for the complexities of changing multiple risk behaviors (MRB). Research is needed to determine if participants in an MRB intervention can be encouraged to activate their social network to aid their change efforts. Methods. Healthy Directions 2, a cluster-randomized controlled trial of an intervention conducted in two urban health centers, targeted five behaviors (physical activity, fruit and vegetable intake, red meat consumption, multivitamin use, and smoking). The self-guided intervention emphasized changing MRB simultaneously, focused on self-monitoring and action planning, and encouraged participants to seek support from social network members. An MRB score was calculated for each participant, with one point being assigned for each behavioral recommendation that was not met. Analyses were conducted to identify demographic and social contextual factors (e.g., interpersonal, neighborhood, and organizational resources) associated with seeking support and to determine if type and frequency of offered support were associated with changes in MRB score. Results. Half (49.6%) of participants identified a support person. Interpersonal resources were the only contextual factor that predicted engagement of a support person. Compared to individuals who did not seek support, those who identified one support person had 61% greater reduction in MRB score, and participants identifying multiple support persons had 100% greater reduction. Conclusion. Engagement of one’s social network leads to significantly greater change across multiple risk behaviors. Future research should explore strategies to address support need for individuals with limited interpersonal resources.

To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting.HD2 was a cluster randomized trial (conducted 3/09-11/11). The primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2440). Study arms included: 1) usual care (UC); 2) HD2--a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up.At baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6 months, vs. 39% and 43% in HD2 and HD2+CC, respectively (ps≤.001); results were similar at 18 months (p≤.05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and $450 for HD2+CC.Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.

This study assessed the prevalence of smoking restrictions among households of survivors of childhood and young adult cancer who smoke. It also examined the relationship between home smoking restrictions and motivation to quit smoking, as well as other smoking, psychosocial, and environmental factors.Participants included 374 smokers who were childhood or young adult cancer survivors (between the ages of 18 and 55 years) recruited from five cancer centers to participate in a randomized smoking cessation trial. Survivors completed baseline measures about the smoking restrictions in their households, their smoking behavior, and related psychological and environmental factors, which are the focus of the current manuscript.Almost 54% of survivors reported that smoking was prohibited in their households. Living with a nonsmoking partner, having a strict smoking policy at work, and not being nicotine dependent all increased the likelihood of having a total home smoking ban. Participants who were older, smoked more cigarettes per day over the prior week, and received prior chemotherapy were less likely to reside in households that adopted total bans.Findings suggest that socio-environmental factors and current smoking behaviors are associated with complete smoking restrictions in the homes of survivors. These factors should be considered when communicating with survivors about the importance of establishing strict smoking policies in their private residences.

College student drinking continues to be a problem in the United States. Students who have violated campus alcohol policy are at particularly high risk for dangerous drinking. While Brief Alcohol Screening and Intervention for College Students (BASICS) has been found to be an effective strategy in reducing high-risk drinking and associated consequences, questions remain about ways to further reduce risk or sustain changes associated with a face-to face intervention. The purpose of this study was to assess the effectiveness of a computer-delivered personalized feedback (electronic booster) delivered to policy violators who completed a mandated BASICS program. At 3-month post-intervention, 346 participants (60.4% male and 39.6% female) were randomized to one of two conditions: assessment only ( n = 171) or electronic booster feedback ( n = 175). Follow-up assessments were given to all participants at 3, 6, and 12-month post-initial intervention. Both groups showed reductions in drinking after the in-person BASICS intervention, but no additional reductions were seen with the addition of an electronic booster session. Findings suggest that although brief motivational interventions delivered in person to mandated students have been shown to be effective with mandated students, there is no additional benefit from an electronic booster session delivered 3-month post-intervention for this population.

Prompting may promote engagement with behavior change interventions. Prompts can be delivered inexpensively via automated voice response (AVR) reminders or short message service (SMS) text messages. We examined the association between participants' characteristics and preferred reminder modality.Healthy Directions 2 is a cluster randomized controlled trial implemented in Boston, Massachusetts to promote change in multiple behavioral cancer risk factors. At baseline (2009), participants completed a survey assessing socio-demographics, health status, height/weight, and factors associated with technology. One-third of participants randomized to receive the intervention (n=598) were randomized to receive automated reminders, with participants selecting modality.28% (167/598) of participants selected SMS reminders. Controlling for clustering by primary care provider, younger participants (OR=0.97, 95% CI=(0.95, 0.99), p0.01), those most comfortable with computers (very uncomfortable OR=0.54, 95% CI=(0.29, 1.01), p≤0.05: referent group = very comfortable), and those who frequently sent/received text messages (never OR=0.09 CI=(0.04, 0.16) p0.01; 1-3 times/month OR=0.38, 95% CI=(0.15, 0.93) p=0.04: referent group=1-5 times/week) were more likely to choose SMS.Interventions should make both modalities available to ensure that more participants can benefit from prompting. Studies examining the effect of automated reminders may have reduced effectiveness or generalizability if they employ only one modality.

Many skin cancer screenings occur in non-traditional community settings, with the beach being an important setting due to beachgoers being at high risk for skin cancer. This study is a secondary analysis of data from a randomized trial of a skin cancer intervention in which participants (n = 312) had a full-body skin examination by a clinician and received a presumptive diagnosis (abnormal finding, no abnormal finding). Participants’ pursuit of follow-up was assessed post-intervention (n = 283). Analyses examined: (1) participant’s recall of screening results, and (2) whether cognitive and behavioral variables were associated with follow-up being as advised. Just 12% of participants (36/312) did not correctly recall the results of their skin examination. One-third (33%, 93/283) of participants’ follow-up was classified as being not as advised (recommend follow-up not pursued, unadvised follow-up pursued). Among participants whose follow-up was not as advised, 71% (66/93) did not seek recommended care. None of the measured behavioral and cognitive variables were significantly associated with recall of screening examination results or whether follow-up was as advised. Research is needed to determine what factors are associated with follow-up being as advised and to develop messages that increase receipt of advised follow-up care.

To identify patterns of Internet use among childhood and young adult cancer survivors who smoke.Baseline assessment data were collected from 2005 to 2008 for the Partnership for Health-2 (PFH-2) study, a web-based smoking cessation intervention for childhood and young adult cancer survivors. Participants were surveyed about their Internet access and use. Sociodemographic, clinical, and psychosocial data also were collected.Internet access and use was widespread among PFH-2 participants. However, older, less-educated, and female survivors reported less frequent Internet use, even when they had access to the Internet at home and/or at work. These associations were significant in multivariable analyses.Although the digital divide is narrowing, Internet use and engagement remains socially patterned. web-based prevention interventions are a promising method of reaching this geographically dispersed, high-risk population, but certain subgroups-particularly older and lower socioeconomic status survivors-might be missed by this approach.

We introduce PERCEPT system, an indoor navigation system for the blind and visually impaired. PERCEPT will improve the quality of life and health of the visually impaired community by enabling independent living. Using PERCEPT, blind users will have independent access to public health facilities such as clinics, hospitals, and wellness centers. Access to healthcare facilities is crucial for this population due to the multiple health conditions that they face such as diabetes and its complications. PERCEPT system trials with 24 blind and visually impaired users in a multistory building show PERCEPT system effectiveness in providing appropriate navigation instructions to these users. The uniqueness of our system is that it is affordable and that its design follows orientation and mobility principles. We hope that PERCEPT will become a standard deployed in all indoor public spaces, especially in healthcare and wellness facilities.

Introduction Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. Methods Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65 years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12 months, with study visits at baseline, 6, and 12 months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24 months. Results Participants are 68% female and on average 50.7 years old with a mean BMI of 35.9 kg/m2. Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. Conclusions Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.

OBJECTIVES: To examine adherence rates for multiple cancer screening tests, which will inform prevention efforts in community health centers (CHCs). METHODS: We report on the prevalence of screening for multiple cancers (cervical, breast, colorectal) among 43,000 patients who are predominantly Hispanic, in four CHC sites that share an integrated electronic medical record. RESULTS: Among the 20,057 patients eligible for at least one test, 43% of the population was current on all screening targets; 15,887 additional screening tests were needed among 11,526 individuals. CONCLUSIONS: Expanding use of health information technology in community health centers provides an opportunity to create an electronic infrastructure for addressing multiple screening needs from a patient-centered perspective.

People of lower-socioeconomic position (SEP) and most racial/ethnic minorities face significant communication challenges which may negatively impact their health. Previous research has shown that these groups rely heavily on interpersonal sources to share and receive health information; however, little is known about these lay sources. The purpose of this paper is to apply the concept of a market maven to the public health sector with the aims of identifying determinants of high health information mavenism among low-SEP and racial/ethnic minority groups and to assess the information they may be sharing based on their own health beliefs. Data for this study were drawn from the baseline survey (n = 325) of a US randomized control intervention study aimed at eliciting an understanding of Internet-related challenges among lower-SEP and minority individuals. Regression models were estimated to distinguish significant determinants of health information mavenism among the sample. Similarly, bivariate and logistic multivariable models were estimated to determine the association between health information mavenism and accurate health beliefs relating to diet, physical activity and smoking. The data illustrate that having a larger social network, being female and being older were important factors associated with higher mavenism scores. Additionally being a moderate consumer of general media as well as fewer years in the US and lower language acculturation were significant predictors of higher mavenism scores. Mavens were more likely than non-mavens to maintain accurate beliefs regarding diet; however, there was no distinction between physical activity and smoking beliefs between mavens and non-mavens. These results offer a unique understanding of health information mavenism which could better leverage word-of-mouth health communication efforts among lower-SEP and minority groups in order to reduce communication inequalities. Moreover, the data indicate that health information mavens may serve as an ideal point of intervention in attempts to modify health beliefs with the goal of reducing health disparities among these populations.

Background There are limited data on the effectiveness of skin cancer prevention education and early detection programs at beaches. Objectives We evaluate 4 strategies for addressing skin cancer prevention in beach settings. Methods This prospective study at 4 beaches included 4 intervention conditions: (1) education only; (2) education plus biometric feedback; (3) education plus dermatologist skin examination; or (4) education plus biometric feedback and dermatologist skin examination. Outcomes included sun protection behaviors, sunburns, and skin self-examinations. Results There was a significant increase in hat wearing, sunscreen use, and a reduction in sunburns in the education plus biometric feedback group (odds ratio = 1.97, 1.94, and 1.07, respectively), and greater improvements in knowing what to look for in skin-self examinations (odds ratio = 1.13); there were no differences in frequency of self-examinations. Skin examinations plus biometric feedback led to greater reductions in sunburns. The dermatologist examinations identified atypical moles in 28% of participants. Limitations Inclusion of only one beach per condition, use of self-report data, and a limited intervention period are limitations. Conclusions Education and biometric feedback may be more effective than education alone for impacting sun protective attitudes and behaviors in beachgoing, high-risk populations.

Social media, and specifically social networking sites (SNSs), are emerging as an important platform for communication and health information exchange. Yet, despite the increase in popularity and use, only a limited number of empirical studies document which segments of the adult population are and are not using social networking sites and with what, if any, affect on health. The purpose of this study is to identify potential communication inequalities in social networking site use among a representative sample of U.S. adults and to examine the association between SNS use and psychological well-being. We analyzed data from the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS). Thirty-five percent of online adults reported SNS use within the past 12 months, and there were no significant differences in SNS use by race/ethnicity or socioeconomic position. Younger age (p = .00) was the most significant predictor of SNS use, while being married (p = .02) and having a history of cancer (p = .02) were associated with a decreased odds of SNS use. SNS use was significantly associated with a 0.80 (p = .00) increment in psychological distress score after controlling for other factors. The absence of inequalities in adult SNS use across race/ethnicity and class offers some support for the continued use of social media to promote public health efforts; however, issues such as the persisting digital divide and potential deleterious effects of SNS use on psychological well-being need to be addressed.

Evidence is lacking regarding effective and sustainable weight loss approaches for use in the primary care setting. We conducted a 12-week randomized controlled trial to evaluate the short-term efficacy of a web-based weight loss intervention among 101 primary care patients with obesity and hypertension. Patients had access to a comprehensive website that used a moderate-intensity weight loss approach designed specifically for web-based implementation. Patients also participated in four (two in-person and two telephonic) counseling sessions with a health coach. Intent-to-treat analysis showed greater weight loss at 3 months (-2.56 kg; 95% CI -3.60, -1.53) among intervention participants (-2.28 +/- 3.21 kg), relative to usual care (0.28 +/- 1.87 kg). Similar findings were observed among intervention completers (-3.05 kg; 95% CI -4.24, -1.85). High rates of participant retention (84%) and website utilization were observed, with the greatest weight loss found among those with a high frequency of website logins (quartile 4 vs. 1: -4.16 kg; 95% CI -1.47, -6.84). The intervention's approach promoted moderate weight loss at 12 weeks, though greater weight loss was observed among those with higher levels of website utilization. Efficacious web-based weight loss interventions can be successfully offered in the primary care setting.

The primary aim of this paper was to explore whether provider's understanding of patient's social context is associated with screening uptake, independent of provider's recommendation. Baseline data were collected in 2004-2005 from a cluster randomized control trial in 12 low-income housing sites. Participants included 695 low-income, multiethnic adults aged 50 years and over who were primarily insured (97%). Provider's recommendation was significantly associated with current adherence to colorectal cancer (CRC) screening. Provider's understanding of patient's social context, as operationalized by how well participants felt that their provider knew (a) their responsibilities at work, home, or school; (b) their worries about health; and (c) them as a person and their values and beliefs, was also significantly associated with current adherence to screening, independent of provider's recommendation. Participants who reported that their provider knew them well on two or three items were significantly more likely to be current with CRC screening compared to those who reported their provider knew them well on only one or none of the items (odds ratio = 1.56; 95% confidence interval = 1.06, 2.29). Our findings indicate that provider's understanding of patient's social context, independent of provider's recommendation for CRC screening, contributed to adherence to CRC screening in this low-income, multiethnic population.

Background Although discrimination has been identified as a potential determinant of existing racial/ethnic health disparities, no studies have investigated whether racial discrimination contributes to disparities in physical activity. Purpose The primary aim of the current study was to examine the association between interpersonal racial discrimination and physical activity. Methods Baseline data were collected during 2004–2005 among a predominately black and Hispanic sample of adult residents living in 12 low-income–housing sites in Boston MA ( n =1055). Residents reported experiences of lifetime racial discrimination during interviewer-administered surveys and wore a pedometer for 5 days to measure physical activity. For analyses, performed in 2009, linear regression models with a cluster design were conducted to predict physical activity, measured as steps per day. Results Nearly 48% of participants reported ever experiencing racial discrimination, and discrimination was most commonly experienced on the street or in a public setting. No association was found between discrimination and physical activity, when examined in bivariate, multivariable, or race-stratified models. Conclusions The current results indicate that self-reported racial discrimination is not a key determinant of physical activity among residents living in low-income housing. However, additional research is warranted to address current limitations of this study.

Purpose: To examine whether knowledge of the 1995 Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) national physical activity recommendations varies by sociodemographic, behavioral, and communication-related factors. Methods: Cross-sectional analyses of 2381 participants in the 2005 Health Information National Trends Survey, a national probability sample of the US population contacted via random-digit dial. Results: Only a third of respondents were accurately knowledgeable of the CDC/ACSM physical activity recommendations. Recommendation knowledge was higher among women (OR = 1.70; 95% confidence interval (CI) = 1.35-2.14) than men, the employed compared with those not currently working (OR = 0.73; 95% CI = 0.55-0.95), foreign-born individuals (OR = 1.62; 95% CI = 1.15-2.30) compared with the US-born, and those meeting CDC/ACSM recommendations vs those who do not (OR = 0.74; 95% CI = 0.58-0.96). Conclusions: There is not widespread knowledge of the consensus national physical activity recommendations. These findings highlight the need for more effective campaigns to promote physical activity among the American public

Flaxseed is a rich source of dietary lignans. Experimental studies suggest lignans may exert breast cancer preventive effects through hormonal mechanisms. Our aim was to study the effects of flaxseed on serum sex hormones implicated in the development of breast cancer. Forty-eight postmenopausal women participated in a 12-wk preintervention-postintervention study. Participants consumed 7.5 g/day of ground flaxseed for the first 6 wk and 15.0 grams/day for an additional 6 wk. Nonsignificant declines were noted over the 12 wk (95% confidence intervals) for estradiol (pg/ml), estrone (pg/ml), and testosterone (pg/ml): -4.4 (-12.6 to 3.9), -3.3 (-7.7 to 1.2), -4.7 (-17.8 to 8.5), respectively. Changes tended to be more pronounced in overweight/obese women, particularly for estrone (-6.5, -11.9 to -1.2; P = .02). Our results suggest that dietary flaxseed may modestly lower serum levels of sex steroid hormones, especially in overweight/obese women.

Skin cancer is highly preventable, but clearly there is a critical need to focus on better ways to disseminate information about known skin cancer prevention. The U.S. Environmental Protection Agency’s (EPA) SunWise Program is one channel for reaching children, teachers, and school nurses. In a pilot study designed to increase adoption of school-based sun protection policies, 28 schools were randomly assigned to one of three groups: Control, which included the EPA’s original SunWise curriculum toolkit; SunWise Policy, which included a revised toolkit emphasizing policy; and SunWise Policy plus Technical Assistance, which included the policy toolkit and 3 technical assistance phone calls. The enhanced SunWise Policy plus Technical Assistance intervention led to more new sun protection policies. Use of study interventions for improving sun protection practices such as policy toolkits or brief counseling can be easily interwoven into school hours by school nurses and other health educators.

The manuscript examines the influence of contextual factors on whether and for whom a colon polyp diagnosis might be a teachable moment, as indicated by engagement with a proactively delivered intervention. Baseline and 8-month follow-up data were analyzed from a two-site behavioral intervention trial with patients in Massachusetts and North Carolina, USA who had recently undergone polypectomy for pre-cancerous colon polyps and were randomized to a behavior change intervention condition (N = 591). Intervention “buy-in” was used as an indicator of response consistent with the polyp identification serving as a teachable moment. Cancer worry, personal risk, health-related self-identity and other sociodemographic factors were tested to predict intervention buy-in. As predicted, those who were most worried about colon cancer were most likely to engage in the intervention. One indicator of personal risk, number of risk behaviors, was significantly and negatively associated with buy-in. Predictors of intervention buy-in and cancer worry were not consistent. We recommend that expanded measures of affect and health-related self-identity should be considered in future research to understand the motivational potential of health events for increasing engagement in effective behavior change interventions.

Background Despite its health benefits, physical inactivity is pervasive, particularly among those living in lower-income urban communities. In such settings, neighborhood safety may impact willingness to be regularly physically active. We examined the association of perceived neighborhood safety with pedometer-determined physical activity and physical activity self-efficacy. Methods and Findings Participants were 1,180 predominantly racial/ethnic minority adults recruited from 12 urban low-income housing complexes in metropolitan Boston. Participants completed a 5-d pedometer data-collection protocol and self-reported their perceptions of neighborhood safety and self-efficacy (i.e., confidence in the ability to be physically active). Gender-stratified bivariate and multivariable random effects models were estimated to account for within-site clustering. Most participants reported feeling safe during the day, while just over one-third (36%) felt safe at night. We found no association between daytime safety reports and physical activity among both men and women. There was also no association between night-time safety reports and physical activity among men (p = 0.23) but women who reported feeling unsafe (versus safe) at night showed significantly fewer steps per day (4,302 versus 5,178, p = 0.01). Perceiving one's neighborhood as unsafe during the day was associated with significantly lower odds of having high physical activity self-efficacy among both men (OR 0.40, p = 0.01) and women (OR 0.68, p = 0.02). Conclusions Residing in a neighborhood that is perceived to be unsafe at night is a barrier to regular physical activity among individuals, especially women, living in urban low-income housing. Feeling unsafe may also diminish confidence in the ability to be more physically active. Both of these factors may limit the effectiveness of physical activity promotion strategies delivered in similar settings., Garry Bennett and colleagues measured exercise levels and obtained opinions on neighborhood safety. They concluded that residing in a neighborhood perceived to be unsafe at night is a barrier to regular physical activity., Editors' Summary Background. Nowadays we are all encouraged to do more physical activity, as it has been shown that inactivity increases the risk of many medical conditions, including obesity, heart attacks, and strokes. Inactive people die younger. Previous research has shown that people on a low income and those from ethnic or racial minorities have the lowest activity levels. There are, however, many barriers to being active. It has been claimed that people who live in neighborhoods that are unsafe face particular difficulties. They might want to walk, cycle, or take other forms of outdoor exercise near their home, but they fear they would be injured as a result of a violent attack. It is usually the poorest members of society who live in unsafe areas. It is also known that those poor people who belong to minority racial or ethnic groups are particularly likely to feel unsafe. Why Was This Study Done? The researchers who did this study wanted to find out whether people in a low-income urban area in the US considered themselves to be unsafe in their neighborhood, and how much physical activity they took part in. Their aim was to establish whether there was an association between the perceived safety level and the amount of activity taken, or if the two were unrelated. Other researchers have tried to look for such an association before, but they have usually relied on how much activity people say they remember taking, not on the actual measured amount. The results from such research have been very varied and inconclusive. What Did the Researchers Do and Find? Working in one low-income district of one US city (Boston), they found over 1,000 people to participate in their study, most of whom were from ethnic minorities. They asked them the question: “How safe do you feel walking alone in your neighborhood?” Response options included “safe,” “a little unsafe,” and “unsafe.” The same question was asked about walking alone in the daylight and walking alone after dark. The people in the study also agreed to wear a pedometer for five days. This instrument measures the number of steps that the wearer takes. It is thus a much more accurate way of finding out about activity levels than asking people how much activity they think they have engaged in. Four out of five people said they did feel safe during the day, but there was no association between daytime safety and physical activity. This was the case for both men and women. Two-thirds of the people in the study felt unsafe in the night-time. There was no association between perceived night-time safety and physical activity among men, but women who reported feeling unsafe at night took around 1,000 fewer steps per day than other women. That amounts to around 20% less physical activity. What Do These Findings Mean? Even the women who felt safe at night were only taking around 5,000 steps per day, around half of what the US Surgeon General recommends for good health. So all the women in the study would benefit from more physical activity. However, the much lower amount of activity of the women who felt unsafe does suggest that a perceived lack of safety is an important factor, which could increase the risks to their health. It is interesting that the association between perceived safety and activity was not found in men and only applied to night-time safety. However, the authors argue that their findings provide preliminary evidence that perceived low neighborhood safety may serve as a barrier to physical activity in low-income areas. They discuss in the article the need for further research. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040306. • The UK National Health Service publishes the online NHS Direct Health Encyclopedia, which describes the benefits of exercise and gives recommendations • Information on exercise may also be found on MedlinePlus, a service of the US National Library of Medicine and the National Institutes of Health

To characterize the smoking-related services available to childhood cancer survivors and describe organizational characteristics that were related to institutions’ capacity to provide smoking services. Institutions affiliated with the Children’s Oncology Group were surveyed from 2003 to 2004. Of the 132 responding institutions, 85% assessed the smoking status of their cancer survivors intermittingly, but only 3% assessed smoking status at every visit, as recommended by the PHS guidelines. A minority of sites offered either smoking prevention (39%) or cessation (25%) services; 58% of sites had a mechanism in place to refer survivors for cessation services. In multivariate analyses, the most parsimonious model predicting capacity for smoking service delivery included barriers, respondents’ attitudes, complexity, and institutional stability. These data highlight an important need to improve the availability of smoking services for childhood cancer survivors. Additionally, these findings will inform the development of future interventions that are sensitive to barriers and facilitators to providing prevention services.

Pomegranate is a rich source of polyphenols. Laboratory studies suggest polyphenols may exert breast cancer preventive effects through modulation of endogenous sex hormone levels. The aim of this study was to determine the effect of pomegranate juice consumption on serum levels of estradiol, estrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG). Sixty-four healthy postmenopausal women were randomly assigned to drink 8 ounces of either 100% commercial pomegranate juice (intervention) or apple juice (control) for 3 weeks. Overall, women in the intervention group did not experience any significant decline in serum sex hormones or SHBG compared to women in the control group. In subgroup analyses restricted to 38 normal weight women, women in the intervention group compared to control group had a significant decline in estrone (pg/mL) and testosterone levels (pg/mL): pomegranate: -61.6 [95% confidence interval (CI): -175.8 to 52.6), apple: 1.1 (95% CI: -5.4 to 7.7), P = 0.05, and pomegranate: -289.1 (95% CI: -630.7 to 52.5), apple: 79.6 (95% CI: -77.8 to 236.9), P = 0.03, respectively. Because of several study limitations, results should be considered preliminary. Additional larger trials would be needed to determine effects in normal versus overweight/obese women.

In 2012, Springfield, MA received CDC funding to promote healthy behaviors and health equity via expansion of the LWS initiative. Strategies include: (1) opening a full-line grocery store, (2) incr...

To assess the impact of the aging population on the occurrence of fragility fractures, we examined hospital discharges for hip fracture among U.S. women and men aged 45 years and older from 1993 through to 2003. The number of hospitalizations declined by 5%, and age-adjusted rates fell by over 20% for both women and men during this period.Although the aging of the population should mean an increasing burden of fragility fractures, several recently published reports suggest regional declines in the incidence of hip fracture. We investigated trends in hospital discharges and utilization for hip fractures across the USA from 1993 to 2003.Hospital discharges from the Nationwide Inpatient Sample from 1993 through to 2003 were analyzed for numbers of primary diagnosis of hip fracture and associated average length of stay (LOS) and charges among women and men aged 45 years and older. Age-specific rates were constructed using national census data.Over the 11-year study period the number of hospitalizations for hip fractures decreased by 5%, from 296,000 to 281,000. The numbers of discharges declined by 16,600 (7.4%) for women and increased by 1900 (2.6%) among men. However, age-adjusted rates for both women and men fell by about 20%. Average hospital LOS was reduced by about 35% for both sexes, resulting in decreases in days of care of 42 and 33% for women and men, respectively. At the same time, average inflation-adjusted charges for each hospitalization grew by 35% for women and 38% for men, and increasing proportions of patients were discharged to continuing institutional care. During the study interval the total number of prescriptions per year for bisphosphonate anti-resorptive agents grew from under 0.5 to 30 million.Despite the increasing size of the older segment of the U.S. population, hospitalizations for hip fractures are not increasing. With declining lengths of stay there has been a reduced demand on hospital resources, although with average charges per hospitalization rising and more patients being discharged to other institutions for continuing care the economic consequences of hip fracture continue to increase.

Objectives. We evaluated the association between television viewing and pedometer-determined physical activity among predominantly racial/ethnic minority residents of low-income housing in metropolitan Boston in 2005. Methods. We used mixed models to analyze the association between reported hours of television viewing and pedometer-determined steps per day among 486 adults. We also examined whether television viewing was associated with the achievement of 10 000 steps per day. Results. There was a mean 3.6 hours of average daily television watching. In multivariable analyses, each hour of television viewing on an average day was associated with 144 (95% confidence interval [CI] = ‐276, ‐12) fewer steps per day and a decreased likelihood of accumulating 10 000 steps per day (odds ratio [OR] = 0.84; 95% CI = 0.71, 0.99). Weekday and weekend television viewing were each also associated with fewer steps per day. Conclusions. Average daily television viewing was associated with reductions in total pedometer-determined physical activity levels (approximately 520 steps per day) in this lower-income sample. As part of a comprehensive physical activity promotion plan, recommendations to reduce television viewing should be made. (Am J Public Health. 2006;96:1681‐1685. doi:10.2105/AJPH.2005.080580)

The chronic disease burden associated with physical inactivity may disproportionately affect socially disadvantaged populations. Racial and ethnic minority populations are consistently shown to be less physically active during leisure time compared with whites (1). In 2000, the prevalence of having no physical activity during leisure time was 54% among Hispanics, 52% among blacks, and 35% among whites (1). Numerous population surveys have similarly reported a positive association between leisure-time physical activity and measures of social class (8,17,22). Approximately 72% of adults with less than a ninth-grade education do not regularly participate in leisure-time physical activity, compared with 25% of college graduates (1). The methodological challenges associated with valid measurement of physical activity using self-report measures (14,16) may be magnified in studies involving lower-income populations. Few self-report measures are designed to assess activity accumulated through nonleisure sources (e.g., domestic, occupational, transportation), which may be more common and account for a larger proportion of total physical activity among lower-income populations. Individuals in lower-income populations are overrepresented in physically active occupations (i.e., construction, maintenance, housekeeping, factory work). Particularly in urban settings, individuals of lower income may have a higher likelihood of engaging in ambulatory activity for transportation purposes (e.g., walking to work, school, or a bus stop). This is a key concern, because it is largely unclear whether the recommended guidelines for daily physical activity (18) are met or exceeded by those in lower-income populations through these often unmeasured activity sources. For example, in two large, randomized intervention studies conducted among more than 4000 lower-income, multiethnic adults, our group recently found much higher, accelerometer-validated, rates of self-reported physical activity than would be expected based on the available literature (10,21). Results of these and other (5) studies highlight the need to assess total accumulated physical activity in these groups, using reliable and externally valid measurement strategies. A variety of motion sensor technologies (i.e., pedometers, accelerometers) have been developed to overcome the compromised validity associated with many self-report physical activity indexes (28). Pedometers capture the vertical accelerations associated with normal ambulation and demonstrate excellent concordance with accelerometer-derived physical activity (median correlation of 0.86), and can objectively detect gradations in walking behavior (4,11,28). Walking is the most frequently adopted type of regular physical activity (16,28), particularly among some racial and ethnic minority groups, (16) yet it is among the least reliably recalled activity types (16,28). Given their accuracy, low unit cost ($10–20), and ease of use, pending continued rigorous validation, pedometers hold great promise as measures of total physical activity among lower-income, multiethnic populations. Emerging data provide expected reference values for daily steps by a variety of sociodemographic characteristics (20,27,29). Higher daily steps are generally found among men (24,29), those of younger age (20,27,30), and the employed (7,30). Some evidence suggests that pedometer-determined daily steps are inversely associated with measures of socioeconomic position and are generally higher among whites (27). Few studies, however, have measured physical activity using pedometers in well-characterized, population-based samples that include individuals from lower-income and racial and ethnic minority groups. Given the limitations of the current literature, the primary aimof the present study was to discern patterns of pedometer-determined physical activity by a range of sociodemographic characteristics in a predominately racial and ethnic minority population of low-income housing residents.

Marriage is a ubiquitous social status that consistently is linked to health. Despite this, there has been very little theory development or related research on the extent to which couple members are jointly motivated to and actively engage in health-enhancing behaviors. In this paper we propose an integrative model, based on interdependence theory and communal coping perspectives, that explicitly considers dyadic processes as determinants of couple behavior. Our integrated model applies these constructs to consider how couple dynamics might influence adoption of risk-reducing health habits. Accordingly, we suggest that the couple's interdependence can transform motivation from doing what is in the best interest of the self (person-centered), to doing even selfless actions that are best for the continuation of the relationship (relationship-centered). In turn, this transformation can lead to enhanced motivation for the couple to cope communally or act cooperatively in adopting health-enhancing behavior change. Implications for research related to couples and health behavior change are also highlighted.

When using patient self-report of processes of care as part of measuring quality performance, validity and reliability are important considerations. In this study, the congruence of patient report of recommendations of screening follow-up care was compared with record audit data. Survey data were collected from a random sample of patients with abnormal breast (n = 230) or cervical (n = 219) cancer screening tests from four health centers. With patient consent, record audits were conducted to validate self-report. Measures of congruence for recommendations for follow-up were calculated along with sensitivity and specificity for procedure-specific recommendations. Overall congruence was higher in the mammography sample (81%) as compared to the Pap sample (61%). Predictors of overall congruence for the abnormal Pap test sample included health plan, self-reported health status, and test result. There were no significant predictors of congruence for the abnormal mammogram test sample from the potential variables collected. Raw agreement rates support using patient self-report in assessing abnormal test follow-up recommendations.

Background: This report examines the outcome data for Project PREVENT, a two-site randomized control trial designed to reduce behavioral risk factors for colorectal cancer among individuals who have been diagnosed with adenomatous colon polyps. Methods: The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone, and were randomized to either Usual Care (UC) or the PREVENT intervention, which was designed to target multiple risk factors. The intervention consisted of a telephone-delivered intervention plus tailored materials, and focused on the six primary behavioral risk factors for colorectal cancer, including red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity. Results: Participation in the PREVENT intervention was associated with a significantly greater reduction in prevalence of multiple risk factors for colorectal cancer compared with UC. Only about one third of UC participants dropped any risk factors during the study period, compared with almost half of the PREVENT participants. PREVENT participants were also significantly more likely to change more than one behavior than UC participants. Conclusions: The PREVENT intervention was effective in helping patients change multiple risk factors. These results provide further support that more comprehensive interventions that move beyond emphasis on a single risk factor are acceptable to patient populations, can result in improvements, and are cost effective.

Objectives The goals of this study were to compare women and men's understanding of screening flexible sigmoidoscopy (FS) and to identify predictors of endoscopic colorectal cancer (CRC) screening. Methods We mailed a 36-item questionnaire to asymptomatic patients aged 50 years or older who were scheduled for routine health assessments at a large multispecialty health-care group. Data collection included demographics, health behaviors, psychosocial factors, and CRC screening compliance. We followed participants for 1 year and assessed completion of endoscopic CRC screening. Both cross-sectional results examining previous screening and prospective results examining screening 1 year later were evaluated. Results 554 (54%) of 998 patients responded to the survey. Responses of 13 patients were excluded in the analyses due to unverifiable screening outcome. The majority of the respondents were white, and their average age was 62 years. Women reported significantly more embarrassment and fear about having FS than men. Women were more willing to consider having a FS if a female endoscopist performed the procedure. Of the 334 participants who were eligible to have endoscopic CRC screening, 53 (16%) had the procedure within a year. The odds of having the endoscopic procedures increased with the length of time the patients were under the care of their primary care providers and how strongly patients believed that one should have an FS even without symptoms. Conclusion Our findings suggest some unique gender-specific attitudes and beliefs that act as potential barriers for CRC screening and further support the important role of primary care providers in facilitating timely completion of screening.

Background: Developing effective programs to promote colorectal cancer (CRC) screening requires understanding of the effect of healthcare system factors on access to screening and adherence to guidelines. Methods: This study assessed the role of insurance status, type of plan, the frequency of preventive health visits, and provider recommendation on utilization of CRC screening tests using a cross-sectional, random-digit-dial survey of 1002 Massachusetts residents aged ≥50. Results: A broad definition of CRC screening status included colonoscopy or barium enema (screening or diagnostic) within 10 years, flexible sigmoidoscopy (FSIG) within 5 years, and fecal occult blood testing (FOBT) in the past year as options; 51.7% of subjects aged 50 to 64 and 61.5% of older subjects were current. The uninsured had the lowest current testing rate. Among insured participants, type of insurance had little impact on CRC testing; older subjects enrolled in HMOs had marginally higher rates, although not statistically significant. Increased frequency of preventive health visits and ever receiving a physician’s recommendation for FSIG or ever receiving FOBT cards were associated with higher rates of CRC screening among both age groups. Conclusions: Even when broad criteria are used to define current CRC screening status, a substantial proportion of the age-eligible population remains underscreened. Obtaining regular preventive care and receiving a physician’s recommendation for screening appear to be potent facilitators of screening that should be considered in designing promotional efforts.

BACKGROUND We examined the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on preschoolers PA. METHODS Preschools were randomized to SBS-PA (centers, N = 5; participants, N = 141) or unstructured free playtime (UPA) (centers, N = 5; participants, N = 150). SBS-PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross-motor playtime followed by 20 minutes of free playtime. UPA consisted of 30 minutes of unstructured free playtime. Teachers implemented both conditions for 5 days/week for 6 months. PA was assessed with accelerometers (preschool-day) and direct observation (30-minute sessions). Generalized linear mixed models were used to examine the impact of the intervention. RESULTS Regarding the 30-minute sessions, significant group main effects were observed for intervals spent at light (p < .001) and moderate-to-vigorous PA (MVPA, p < .001). Regarding the preschool-day PA, significant group by visit interaction was observed for percent time spent in total preschool-day MVPA (F (2, 254) = 3.54, p = .03). Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months. CONCLUSION SBS-PA can be implemented in classroom settings; however, further research is needed to examine its impact on preschoolers PA levels.

Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor.The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records.Internet use increased among intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups.Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.

Objectives. The relation of personal characteristics, health and lifestyle behaviors, and cancer screening practices to current colorectal cancer (CRC) screening was assessed and compared with those factors' relation to current mammography screening in women and prostate-specific antigen (PSA) screening in men. Methods. A cross-sectional random-digit-dialed telephone survey of 954 Massachusetts residents aged 50 and older was conducted. Results. The overall prevalence of current CRC screening was 55.3%. Logistic regression results indicated that family history of CRC (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.02, 3.86), receiving a regular medical checkup (OR = 3.07; 95% CI = 2.00, 4.71), current screening by mammography in women and PSA in men (OR = 4.40; 95% CI = 2.94, 6.58), and vitamin supplement use (OR = 1.87; 95% CI = 1.27, 2.77) were significant predictors of CRC screening. Conclusions. Health and lifestyle behaviors were related to increased current CRC, mammography, and PSA screening. Personal factors independently related to CRC screening were not consistent with those related to mammography and PSA screening. This lack of consistency may reflect different stages of adoption of each type of screening by clinicians and the public.

Ongoing market trends are increasing the risks that working families will be uninsured or suffer lapses in health insurance coverage, with consequent threats to access to health care. Despite strong economic growth, employer-provided health insurance coverage has continued to erode throughout the past decade. Although a record number of women and men are working, slow wage growth for lower-wage workers, a shift in work toward industries less likely to provide and pay for health benefits for families, and a shift toward temporary and parttime jobs have combined to undermine employment as a base for health insurance coverage for working families. 1'2 As a result, the nation has seen a steady increase in the number and proportion of working-age Americans without insurance throughout the 1990s: from March 1989 to March 1997, the number of uninsured increased from 33 to 42 million, a jump from 15.2% to 17.6% of the under-65 population. 3 Recent projections suggest that the number of uninsured will reach 47 million in 8 years, with one American in five uninsured. 4 The rise in the number of uninsured comes at a time when access to health care is likely to be ever more difficult to obtain for those who cannot pay. In a search to contain health costs, public and private purchasers of health insurance have turned to managed-care plans with an endorsement of intense efforts to negotiate deep discounts and reduce payments for care for the insured. Enrollment of insured beneficiaries in managed-care plans has proceeded so rapidly that 8 in 10 workers employed by medium and large employers were enrolled in some form of managed care by 1997, compared with 56% in 1992 and 29% in

Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the proportion of low-income uninsured adults is two to three times higher in states that have not expanded Medicaid eligibility beyond relatively low welfare levels. Compared with persons who have either Medicaid or private insurance, uninsured persons report more difficulties getting needed care, are less likely to have a regular provider, and rate the care they do receive as lower quality.

BackgroundSmoking among cancer survivors increases the risk of late effects and second cancers. This article reports on Partnership for Health-2 (PFH-2)—an effort to develop an effective and scalable version of Partnership for Health (PFH), which was a previously tested peer-delivered telephone counseling program that doubled smoking cessation rates among childhood cancer survivors who smoke. ObjectiveThis paper presents results from a randomized controlled trial evaluating the effectiveness of PFH-2 in targeted and tailored Web-based versus print formats. The overall goal was to determine whether the intervention outcomes in these self-guided scalable formats approximate what was found in a more intensive telephone counseling program. MethodsThis study was a randomized controlled trial with a 15-month follow-up that included 374 smokers who were survivors of childhood or young adult cancers, recruited from five survivorship clinics. Participants were randomly assigned to a Web-based or print format of the PFH intervention; all had access to free pharmacotherapy. The website was designed to provide new content at each log-on, and a peer counselor moderated a forum/chat feature. The primary outcome was smoking status at 15 months post randomization. ResultsIn total, 58.3% (77/132) of Web participants logged on at least once (mean visits 3.25). Using multiple imputation methods for missing data, there were similar rates of cessation in the two arms (print: 20/128, 15.6%; Web: 33/201, 6.4%), and no differences in quit attempts or readiness to quit. The quit rates were equivalent to those found in our previous telephone counseling intervention. There were high rates of satisfaction with both of the PFH-2 interventions. ConclusionsThe print and Web formats yielded equivalent levels of success to those found with our telephone-delivered intervention and are comparable to other Internet treatment studies. This study provides important options for survivorship programs that may not have resources for interpersonal forms of cessation counseling. Efforts to increase patient use of the interventions may result in higher cessation rates. Trial RegistrationClinicaltrials.gov NCT00588107; http://clinicaltrials.gov/ct2/show/NCT00588107 (Archived by WebCite at http://www.webcitation.org/6K1gJtFEC).

Few weight loss treatments produce clinically meaningful weight loss outcomes among black women, particularly in the primary care setting. New weight management strategies are necessary for this population. Weight gain prevention might be an effective treatment option, with particular benefits for overweight and class 1 obese black women.To compare changes in weight and cardiometabolic risk during a 12-month period among black women randomized to a primary care-based behavioral weight gain prevention intervention, relative to usual care.Two-arm randomized clinical trial (the Shape Program). We recruited patients from a 6-site community health center system. We randomized 194 overweight and class 1 obese (body mass index [calculated as weight in kilograms divided by height in meters squared], 25-34.9) premenopausal black women aged 25 to 44 years. Enrollment began on December 7, 2009; 12- and 18-month assessments were completed in February and October 2, 2012.The medium-intensity intervention included tailored behavior change goals, weekly self-monitoring via interactive voice response, monthly counseling calls, tailored skills training materials, and a gym membership.Twelve-month change in weight and body mass index and maintenance of change at 18 months.Participants had a mean age of 35.4 years, a mean weight of 81.1 kg, and a mean body mass index of 30.2 at baseline. Most were socioeconomically disadvantaged (79.7% with educational level less than a college degree; 74.3% reporting annual income$30,000). The 12-month weight change was larger among intervention participants (mean [SD], -1.0 [0.5] kg), relative to usual care (0.5 [0.5] kg; mean difference, -1.4 kg [95% CI, -2.8 to -0.1 kg]; P = .04). At month 12, 62% of intervention participants were at or below their baseline weights compared with 45% of usual-care participants (P = .03). By 18 months, intervention participants maintained significantly larger changes in weight (mean difference, -1.7 kg; 95% CI, -3.3 to -0.2 kg).A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women. A "maintain, don't gain" approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women.clinicaltrials.gov Identifier: NCT00938535.

Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention. Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey. Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their “healthy” peers. Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.