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Social networks influence health behavior and health status. Within social networks, "key players" often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, discomfort with the medical system, and misinformed perspectives on screening. Ideas to improve screening focused on increasing awareness of women's susceptibility to CRC, providing information on different screening tests, improving access, and the key role of health-care providers and key players themselves. We provide recommendations to leverage these vital community resources.

Background: Low rates of colorectal cancer (CRC) screening persist due to individual, provider, and system level barriers. Purpose: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. Methods: Focus groups of patients were conducted prior to the development of the CRC screening video, patient focus groups provided initial feedback about the video and medical personnel made recommendations prior to final video editing. Results: Patients identified CRC screening barriers and made suggestions about information to include in the video. Patients suggested using a doctor to state the importance of CRC screening, demonstrate how to complete the fecal occult blood test and that men and women from diverse ethnic groups and races could appear in the same video. Participants reviewed the video and thought it included their suggestions, was culturally appropriate and the information was easy to understand. Medical personnel suggested ways to improve the content and delivery of the information prior to final video editing. Discussion: Participants provided valuable information in the production of a video to improve patient knowledge and patient-provider communication about CRC screening. The video developed was based on the Protection Motivation Theory and addressed CRC screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. Translation to Health Education Practice: Educational videos can provide important information about CRC and CRC screening to average-risk adults. (Contains 1 table and 1 figure.)

BackgroundGay, bisexual, and other men who have sex with men experience several disparities related to human papillomavirus (HPV) infection, including high incidence rates of anal cancer. Although the HPV vaccine is currently recommended for young adults, HPV vaccine coverage is modest among young gay, bisexual, and other men who have sex with men (YGBMSM). ObjectiveWe describe the design and methods for a randomized controlled trial (RCT) to rigorously evaluate Outsmart HPV, a population-targeted, individually tailored, Web-based HPV vaccination intervention for YGBMSM. The RCT is designed to determine the efficacy of the intervention, the mechanism by which the intervention has an effect (ie, mediation), and whether efficacy varies by participant characteristics (ie, moderation). MethodsOutsmart HPV was previously developed and pilot-tested. This study is a 3-arm prospective RCT that will enroll a projected 1995 YGBMSM who are aged 18 to 25 years, live in the United States, and have not received any doses of the HPV vaccine. Participants will be recruited by means of paid advertisements on social media sites and randomized to receive (1) standard information on the Web about HPV vaccine (control group), (2) Outsmart HPV content on the Web with monthly unidirectional vaccination reminders sent via text messages, or (3) Outsmart HPV content on the Web with monthly interactive vaccination reminders sent via text messages. Participants will complete Web-based surveys at 4 time points during the study: baseline, immediately after engaging with Web-based content, 3 months after randomization, and 9 months after randomization. Primary outcomes will include both HPV vaccine initiation (ie, receipt of 1 or more doses of the HPV vaccine) and completion (receipt of all 3 doses recommended for this age range). We will examine constructs from the intervention’s theoretical framework as potential mediators and demographic and health-related characteristics as potential moderators of intervention effects. ResultsThe institutional review board at The Ohio State University has approved the study. Materials have been developed and finalized for all study groups. Recruitment for the RCT began in fall 2019. ConclusionsIf shown to be efficacious, Outsmart HPV has the potential to fill an important gap by promoting HPV vaccination among a population at increased risk of HPV infection and HPV-related disease. Trial RegistrationClinicalTrials.gov NCT04032106; http://clinicaltrials.gov/show/NCT04032106 International Registered Report Identifier (IRRID)PRR1-10.2196/16294

Purpose: Colorectal cancer (CRC) screening is recommended for average‐risk adults, yet many adults are not up‐to‐date with screening. One recommended CRC screening approach is the annual completion of a fecal immunochemical test (FIT). However, usually, fewer than half of mailed FIT tests are returned. Methods: To address barriers to FIT return, a video brochure was developed providing targeted CRC screening information and step‐by‐step FIT instructions as a component in a mailed FIT program. This pilot study occurred in 2021‐2022 and partnered with a federally qualified health center in Appalachian Ohio to send a FIT to patients who were 50‐64 years old, of average risk, and not up‐to‐date on CRC screening. Patients were randomly assigned to 1 of 3 groups that differed on materials sent with the FIT: usual care (manufacturer's instructions), a video brochure (video instructions, disposable gloves, disposable stool collection device), or an audio brochure (audio instructions, disposable gloves, disposable stool collection device). Findings: Overall, 16 of 94 patients (17%) returned the FIT, and return was higher among those sent the video brochure (28%) compared to the other 2 groups (OR: 3.1; 95% CI: 1.02, 9.2; P =.046). Two patients had positive tests and were referred for colonoscopy. Patients sent the video brochure reported the content was important, relevant, and made them think about completing the FIT. Conclusions: Using a video brochure to provide understandable information in a mailed FIT kit is a promising strategy to improve CRC screening outreach programs in rural regions. [ABSTRACT FROM AUTHOR]

Objective: The availability of cervical cancer prevention services at college health centers was compared between historically black colleges and universities (HBCUs) and non-HBCUs. Methods: Four-year, non-primarily distant learning colleges, matching HBCUs with randomly selected non-HBCUs within the same states (N = 136) were examined. Data were collected (2014-2015 academic year) on the availability of human papillomavirus (HPV) vaccine and Pap tests at college health centers. HBCUs were compared with non-HBCUs using conditional logistic regression, and correlates of offering these services were identified. Results: Many institutions did not offer HPV vaccine or Pap tests. Fewer HBCUs offered HPV vaccine (18% vs 53%) and Pap tests (50% vs 76%) compared with non-HBCUs. In multivariable analyses, HBCUs remained less likely than non-HBCUs to offer HPV vaccine (odds ratio [OR] D 0.07, 95% confidence interval [CI]: 0.02-0.26) and Pap tests (OR D 0.19, 95% CI: 0.06-0.61). Conclusions: Greater effort is needed to make cervical cancer prevention services available at colleges, especially at HBCUs.

Objectives The purpose of this qualitative study was to explore the infant safe sleep beliefs and occupational practices of lactation consultants and to determine if lactation consultants give advice to clients that is consistent with the American Academy of Pediatrics' recommendations on this topic. Methods Focus groups were conducted with certified lactation consultants in two cities in Ohio. Participants discussed the role of lactation consultants, the infant sleep advice they provide to women, their views on the American Academy of Pediatrics' infant safe sleep recommendations and related policies, and perceived benefits and barriers associated with providing infant safe sleep education as part of their work. A member-checking session was held to ensure the credibility of the findings. Results Four focus groups were conducted with 22 certified lactation consultants between September and November 2015. Major themes that emerged included: lactation consultants' beliefs regarding the importance of bedsharing for supporting breastfeeding success; their disagreement with the infant safe sleep recommendations of the American Academy of Pediatrics; their frustration with policies that restrict consultants' ability to discuss bedsharing; and the impact of infant safe sleep policies on their work and the advice they provide. Conclusions for Practice Lactation consultants interact with mothers of newborns at a critical time for infant safe sleep decision-making and may influence a woman's choices related to this topic. Women may not be receiving messages from lactation consultants that are consistent with the infant safe sleep recommendations of the American Academy of Pediatrics., Author(s): Nichole L. Michaels [sup.1] , Lara B. McKenzie [sup.1] [sup.2] [sup.3] , Sarah E. Anderson [sup.3] , Mira L. Katz [sup.3] Author Affiliations: (1) 0000 0004 0392 3476, grid.240344.5, [...]

Self-efficacy (SE) has been found to be a robust predictor of success in achieving physical activity (PA) goals. While much of the current research has focused on SE as a trait, SE as a state has received less attention. Using day-to-day measurements obtained over 84 days, we examined the relationship between state SE and PA. Postmenopausal women (n = 71) participated in a 12-week PA intervention administered via cell phone and monitored their daily PA using a pedometer. At the end of each day, they reported their state SE and number of steps. Using a longitudinal model, state SE was found to be a robust predictor of PA even after accounting for trait SE and other covariates. The findings offer insights about the temporal relationship between SE and PA over the course of an intervention, which can be of interest to researchers and intervention designers.

Objective: To examine male students' and their parents' human papillomavirus (HPV) vaccine communication in relation to males' willingness to discuss the vaccine with their health care provider and the likelihood of being vaccinated. Participants: Dyads (n = 111) of students and parents. Methods: Participants completed a HPV vaccine survey based on the risk perception attitude framework in 2009. Results: Male students' perceived susceptibility for HPV and self-efficacy to talk to their provider were directly related to their intention to discuss the HPV vaccine, and their intention was directly related to their likelihood of being vaccinated. Parents' perceived self-efficacy to talk to their son and response efficacy of the vaccine were directly related to their intention to talk to their son; however, parents' intention was not related to the likelihood of their son being vaccinated. Conclusions: College males may benefit from HPV vaccine educational programs that include communication skills training to discuss the HPV vaccine with their parents. (Contains 4 tables and 1 figure.)

Purpose: The Amish, a unique community living in Ohio Appalachia, have lower cancer incidence rates than non-Amish living in Ohio Appalachia. The purpose of this study was to examine cancer screening rates among Amish compared to non-Amish adults living in Ohio Appalachia and a national sample of adults of the same race and ethnicity in an effort to explain cancer patterns. Methods: Face-to-face interviews focusing on perception of risk, cancer screening behaviors, and screening barriers were conducted among Amish (n = 134) and non-Amish (n = 154) adults living in Ohio Appalachia. Cancer screening rates were calculated and then compared to a national sample of adults. Findings: More Ohio Appalachia non-Amish males (35.9% vs 14.5%; P = 0.022) and females (33.3% vs 12.5%; P = 0.008) reported that they would probably develop cancer in the future compared to Amish males and females. Amish adults had significantly lower prostate (13.5% vs 63.1% vs 44.6%; P less than 0.001), colorectal (males: 10.3% vs 40.0% vs 37.2%, females: 8.6% vs 31.6% vs 42.9%; P less than 0.001), cervical (48.0% vs 84.0% vs 80.0%; P less than 0.001), and female breast (24.8% vs 53.7% vs 56.9%; P less than 0.05) cancer screening rates compared to Ohio Appalachia non-Amish participants and a national sample of adults, respectively. Barriers to cancer screening were similar among the 2 Ohio groups; however, Amish males reported that prostate cancer screening was not necessary more often than did Ohio Appalachia non-Amish males (78.6% vs 16.7%; P = 0.003). Conclusions: Lower rates of cancer screening were documented among the Amish and may be a contributing factor to the reduced cancer incidence rates reported among this population.

This study examined the associations of perceived threat, perceived efficacy, and parent-child communication with the extent to which college-age women received the human papillomavirus (HPV) vaccine. Daughters and their mothers completed a survey about the HPV vaccine (N = 182 dyads). The results showed that mothers' perceived self-efficacy to talk to their daughters and mothers' response efficacy of the vaccine were indirectly related to mother-daughter communication about HPV. Further, mother-daughter communication mediated the relation between mothers' intention to talk to their daughters and daughters' HPV vaccination behavior. This study demonstrates the importance of the social context of health behavior and the role of communication in understanding maternal influence on the HPV vaccination behavior of young adult women. (Contains 3 tables and 1 figure.)

Regular physical activity is linked to a reduced risk of obesity and chronic disease. African American women bear a disproportionate burden from these conditions and many do not get the recommended amount of physical activity. Long-term success of interventions to initiate and maintain a physically active lifestyle among African American women has not been realized. By clearly elucidating the process of physical activity adoption and maintenance, effective programming could be implemented to reduce African American women's burden from chronic conditions. In-depth interviews were conducted with physically active African American women. Grounded theory, a rigorous qualitative research method used to develop theoretical explanation of human behavior grounded in data collected from those exhibiting that behavior, was used to guide the data collection and analysis process. Data derived inductively from the interviews and focus groups guided the development of a behavioral framework explaining the process of physical activity evolution. (Contains 2 tables and 2 figures.)

Purpose: The objective of this study was to estimate tobacco use prevalence among the Amish in Holmes County, Ohio, using both self-report and a biochemical marker of nicotine exposure. Methods: Amish adults (n = 134) were interviewed as part of a lifestyle study. Self-reported tobacco use was measured using standardized questions, and cotinine was measured from a saliva sample. The prevalence of smoking, total tobacco use, and misclassification were estimated separately by gender, and then compared to 2 non-Amish groups. One group was selected from 2 counties contained within the Holmes County Amish settlement (n = 154) and the other was representative of non-Hispanic whites in the United States (n = 4,099). Findings: No Amish women reported current tobacco use and only 2 reported former use. This was significantly different (P less than 0.0001) from the patterns observed among non-Amish in the settlement counties (15.7%) and US white (23.3%) women. The prevalence of tobacco use among Amish men was 17.6% and this was significantly lower than estimates from non-Amish in the settlement counties (38.8%, P = 0.04) and US white (32.2%, P = 0.005) men. No Amish women and only 2 Amish men underreported tobacco use and misclassification was similar in the comparison groups. Conclusions: Tobacco use is significantly lower among adults in the largest Amish settlement in the world compared to their non-Amish neighbors in Appalachia Ohio and US whites. A strength of this study is that self report was verified with a marker of nicotine, a critical measure to include in any study conducted in a group that stigmatizes tobacco use.

Researchers from the North Carolina BEAUTY and Health Project conducted an observational study in 10 North Carolina beauty salons to gain insight into naturally occurring conversations between cosmetologists and customers, and to assess features of the salon environment that might be used to inform the development of salon-based health promotion interventions. Results revealed that the social environment of a salon is a place where cosmetologists and customers talk openly about many subjects, including health. Information, advice, appraisal, humor, and empathy are typically shared in these health conversations. Several features of the physical environment of the salon may be mobilized to support health--access to healthy foods, snacks, and beverages; smoking restrictions; and availability of print or video materials, signs, or displays that include healthy messages. Implications for planning salon-based health promotion interventions--including the training of licensed cosmetologists to deliver health messages--are discussed in light of these findings. (Contains 4 tables.)