PEP Talk: Prostate Education Program, "Cutting Through the Uncertainty of Prostate Cancer for Black Men Using Decision Support Instruments in Barbershops".

The objective of this study was to investigate the effectiveness of using decision support instruments (DSI) to assist African-American (AA) men in making a prostate cancer (CaP) screening decision. This nonrandomized pretest-posttest comparison study assessed two DSI that were either culturally tailored or culturally nonspecific. CaP knowledge, intention to screen, and preferences were assessed before and after exposure to DSI using a convenience sample of 120 AA men aged 40 years and above. Participants interested in screening were referred to healthcare providers through a community-based patient navigator to obtain prostate-specific antigen (PSA) testing. We followed up 3 months after to determine if participants screened for CaP. CaP knowledge increased following exposure to both DSI in equivalent proportions. While similar proportions of men ultimately intended on having a PSA test following both DSI, bivariate analysis revealed that the culturally tailored DSI demonstrated a statistically significant increase in intention to screen. Participants' degree of certainty in their decision-making process with regard to CaP screening increased following the culturally tailored DSI (p < .001). The majority of participants planned on discussing CaP screening with a healthcare provider upon completion of the study. Barbershop-based health education can change the knowledge, preferences, intentions, and behaviors of this at-risk population. At 3 months follow-up, half (n = 58) of the participants underwent PSA testing, which led to the diagnosis of CaP in one participant. Community-led interventions for CaP, such as cluster-randomized designs in barbershops, are needed to better assess the efficacy of DSI in community settings.

Community perceptions and utilization of a consumer health center.

The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach.

Partnering with health care systems to assess tobacco treatment practices and beliefs among clinicians: evaluating the process.

BACKGROUND: Tobacco is a major cause of preventable illness and death. However, clinician use of an evidence-based guideline for treatment of tobacco use is low. This case study describes the process for conducting a pre-intervention assessment of clinician practices and beliefs regarding treatment of tobacco use. COMMUNITY CONTEXT: Louisiana State University Health System, one of the largest safety-net public hospital systems in the United States, consists of 10 facilities in population centers across the state of Louisiana. The system serves a large proportion of the state's underinsured and uninsured, low-income, and racial/ethnic minority populations, groups that have high rates of tobacco use. METHODS: Activities included 1) partnering with hospital administrators to generate support for conducting a clinician assessment, 2) identifying and adapting a survey tool to assess clinicians' practices and beliefs regarding treatment of tobacco use, 3) developing a survey protocol and obtaining approval from the institutional review board, and 4) administering the survey electronically, using the hospital's e-mail system. OUTCOME: Existing partnerships and system resources aided survey administration. Use of the hospital's internal e-mail system and distribution of an online survey were effective means to engage clinicians. Following notification, 43.6% of 4,508 clinicians opened their e-mail containing the invitation letter with a Web link to the survey; of these, 83.1% (1,634) completed the survey. INTERPRETATION: Partnering with stakeholders and using existing resources within the health care system are essential to successful implementation of a system-wide survey of clinician practices and beliefs regarding treatment of tobacco use.

Targeting tobacco in a community-based addiction recovery cohort: results from a computerized, brief, randomized intervention trial.

INTRODUCTION: Nearly 80% of substance dependent individuals also use tobacco, and smoking cessation efforts during treatment for other substance use is associated with similar or even improved outcomes. However, smoking cessation is not routinely addressed during treatment for substance use disorders. The present study tested a computerized brief motivational intervention (C-BMI) for smoking cessation in an understudied population: a cohort recruited from a recovery community organization (RCO) center. METHODS: Following baseline assessment, participants were randomly assigned to either a 30-minute C-BMI plus access to free nicotine replacement therapy (NRT), or an information-only control group plus NRT access. RESULTS: Reductions in CO were observed for both groups. Quit rates in the C-BMI group (5%-7%, vs. 0% for the control group) approximated those observed elsewhere for physician advice and minimal counseling. Participants in the C-BMI group were also more likely to express a desire to quit. CONCLUSIONS: Computer-delivered smoking cessation interventions within RCOs appear feasible. These organizations treat a wide variety of individuals, and C-BMIs for smoking in this context have the potential to reduce smoking-related morbidity and mortality.

The role of trust in health decision making among African American men recruited from urban barbershops.

OBJECTIVE: To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS: We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured interviews. At the completion of each interview, participants completed a brief self-administered demographic survey. The semistructured interviews were audiotaped and transcribed verbatim and then imported into a qualitative software program for organizing, sorting, and coding data. The principles of thematic analysis and template approach were used in this study. The survey data were analyzed using descriptive statistics. RESULTS: Trust was a major theme that emerged from the semistructured interviews. The men listed trust in the health care provider as the primary reason for choosing a collaborative or active role in the decision-making process. Within the theme of trust, 4 subthemes emerged: expertise, information sharing, active listening, and relationship length. Thirty-five out of the 40 men interviewed preferred an active or collaborative role in the decision-making process; only 5 preferred passive decision making. CONCLUSIONS: Trust emerged as an important factor that influenced role preference for African American men when making health care decisions in the context of the patient-provider relationship. Future studies that help identify which other factors influence health care decision-making roles among African American men may have implications for addressing health disparities among this population and improve the quality of their health care.

The role of worksite and home smoking bans in smoking cessation among U.S. employed adult female smokers.

PURPOSE: Examine the association of work and home smoking bans with quitting behaviors among employed female smokers in the United States. DESIGN: Secondary analyses using cross-sectional data from the 2006/2007 Tobacco Use Supplement to the Current Population Survey. SUBJECTS: Nationally representative sample of 7610 U.S. employed female smokers, aged 18 to 64 years, who reported working indoors. Setting . N/A. METHODS: Multivariate logistic regression analyses were conducted to examine the association of smoking ban policies (complete work and home bans, complete work ban only, complete home ban only, and no complete work or home ban) with intention to quit in the next 30 days, at least one quit attempt in the past year, and sustained abstinence of at least 3 months in the past year. RESULTS: Twenty-nine percent of women reported complete work and home smoking bans. Smoking bans were not associated with intention to quit and were marginally associated with sustained abstinence. Regardless of intention to quit, women with complete work and home bans were significantly more likely than those without complete work and home bans to report quit attempts. Among women with no intention to quit, the odds of having a quit attempt were significantly higher among women who had a complete home ban only compared with women without complete work and home bans. CONCLUSIONS: Efforts to promote quitting behaviors among employed female smokers may be facilitated by increasing rates of complete smoking bans at both work and home settings.

Acute effects of cigarillo smoking.

INTRODUCTION: Cigarillo smoking likely exposes users to many of the same toxicants (e.g., nicotine, carbon monoxide [CO]) as cigarette smoking. Yet, few controlled clinical laboratory studies evaluating of the effects of cigarillos exist. This study evaluated the cardiovascular response, toxicant exposure, subjective effects, and puffing topography of a popular cigarillo brand, Black & Mild (B&M). METHODS: Sixteen B&M smokers (M ± SD = 1.9 ± 2.5 cigarillos/day for 3.4 ± 3.5 years) participated in 2 counterbalanced conditions: lit (ACTIVE) or unlit (SHAM) B&M in which they completed two 10-puff smoking bouts (30-s interpuff intervals). RESULTS: Plasma nicotine concentrations for ACTIVE increased significantly from pre-smoking (M ± SEM = 2.0 ± 0.0 ng/ml) to 5 min after Bouts 1 (5.3 ± 0.8 ng/ml) and 2 (4.9 ± 0.9 ng/ml) but did not increase above 2.0 ± 0.0 ng/ml at any timepoint for SHAM. Heart rate increased significantly from pre- to post-smoking for ACTIVE but not for SHAM. Average expired-air CO levels, collapsed across time, were 14.3 ± 0.8 ppm for ACTIVE and 4.5 ± 0.2 ppm for SHAM. Neither condition reduced symptoms of nicotine/tobacco abstinence reliably, although ratings for some measures were significantly lower for ACTIVE than for SHAM. ACTIVE, but not SHAM, produced a variety of positive effects related to product sensory characteristics (e.g., "satisfying," "pleasant"). Smoking topography did not differ across the two conditions. CONCLUSIONS: Ten puffs from a B&M cigarillo deliver active doses of nicotine and considerable amounts of CO but do not suppress abstinence-induced withdrawal symptoms reliably. The nicotine delivery profile suggests that cigarillo smoking may promote nicotine/tobacco dependence and the CO exposure likely poses significant health risks.

Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses.

OBJECTIVE: Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African-American (AA) prostate cancer survivors and their spouses. METHODS: Twelve AA prostate cancer survivors and their spouses participated in semi-structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis. RESULTS: In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern. CONCLUSIONS: Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL.

Do men make informed decisions about prostate cancer screening? Baseline results from the "take the wheel" trial.

BACKGROUND: Baseline data from a randomized trial in 12 worksites were analyzed. Men aged 45+ (n = 812) completed surveys documenting screening history, screening preferences and decisions, CaP knowledge, decision self-efficacy, and decisional consistency. Psychosocial and demographic correlates of IDM were also assessed. RESULTS: Approximately half of the sample had a prior PSA test, although only 35% reported having made an explicit screening decision. Across the sample, CaP knowledge was low (mean = 56%), although decision self-efficacy was high (mean = 78%), and the majority of men (81%) made decisions consistent with their stated values. Compared with those who were undecided, men who made an explicit screening decision had significantly higher levels of knowledge, greater decisional self-efficacy, and were more consistent in terms of making a decision in alignment with their values. They tended to be white, have high levels of income and education, and had discussed screening with their health care provider. CONCLUSIONS: Many men undergo CaP screening without being fully informed about the decision. These findings support the need for interventions aimed at improving IDM about screening, particularly among men of color, those with lower levels of income and education, and those who have not discussed screening with their provider.

Nicotine dependence and quitting behaviors among menthol and non-menthol smokers with similar consumptive patterns.

AIMS: This study examines the associations between usual cigarette brand (i.e. menthol, non-menthol) and markers for nicotine dependence and quitting behaviors. DESIGN: The 2003 and 2006/07 Tobacco Use Supplements to the Current Population Surveys were pooled to conduct secondary data analysis. SETTING: National data were collected using in-person and telephone computer-assisted interviews by the United States Census Bureau among civilian, non-institutionalized people aged 15 years and older. PARTICIPANTS: Data were analyzed among daily current smokers aged 18+ (n = 46,273). MEASUREMENTS: The associations between usual cigarette brand and time to first cigarette within 5 and 30 minutes after waking, quit attempts in the past 12 months and length of smoking abstinence in the past 12 months were examined. Bivariate and multivariate logistic regression models were stratified by smoking intensity: ≤5, 6-10, 11-19 and 20+ cigarettes per day. FINDINGS: Menthol smokers reported a mean of 13.05 compared with 15.01 cigarettes per day among non-menthol smokers (P < 0.001). Multivariate results showed that among smokers consuming 6-10 cigarettes per day, menthol smokers were significantly more likely than non-menthol smokers to consume their first cigarette within 5 minutes after waking (odds ratio = 1.22, 95% confidence interval = 1.05,1.43). The multivariate models did not show significant associations between usual cigarette brand and quit attempts in past 12 months or duration of smoking abstinence >2 weeks in the past 12 months. CONCLUSIONS: Findings from this national survey of daily smokers demonstrate that menthol smokers in the United States who report consuming 6-10 cigarettes per day show greater signs of nicotine dependence than comparable non-menthol smokers.

A randomized trial of a computer-tailored decision aid to improve prostate cancer screening decisions: results from the Take the Wheel trial.

OBJECTIVE: To evaluate a decision aid (DA) designed to promote informed decision making for prostate cancer screening. METHODS: Twelve work sites were randomly assigned to an intervention or nonintervention comparison condition. Intervention sites received access to a computer-tailored DA at the workplace. Male employees age 45 years and above (n = 625) completed surveys at baseline and at 3-month follow-up, documenting aspects of informed decision making. RESULTS: Using an intention-to-treat analysis, men in the intervention group were significantly more likely to have made a screening decision and to have improved knowledge without increased decisional conflict, relative to men in the comparison group. These changes were observed despite the fact that only 30% of men in intervention sites used the DA. Among DA users, similar improvements were observed, although the magnitudes of changes were substantially greater, and significant improvements in decision self-efficacy were observed. CONCLUSIONS: A DA offered in the workplace promoted decision making, improved knowledge, and increased decision self-efficacy among users, without increasing decisional conflict. However, participation was suboptimal, suggesting that better methods for engaging men in workplace interventions are needed. IMPACT STATEMENT: This trial shows the efficacy of a computer-tailored DA in promoting informed decisions about prostate cancer screening. The DA was delivered through work sites, thereby providing access to resources required to participate in informed decision making without requiring a medical appointment. However, participation rates were suboptimal, and additional strategies for engaging men are needed.

Effects of a multilevel dietary intervention in religious organizations.

PURPOSE: This study examined how to improve dietary habits of individuals from the general public. DESIGN: The Eating for a Healthy Life project was a randomized trial. SETTING: The study was conducted among members of religious organizations (ROs). SUBJECTS: Participants were a sample of RO members. INTERVENTION: The intervention was a multilevel package, based on our previous experience, designed to lower fat and increase fruit and vegetable consumption. MEASURES: The Eating Behaviors Questionnaire was administered preintervention and postintervention, together with 24-hour food recalls in a randomly selected subset. Analysis. Linear mixed models were used to evaluate the study's intervention, incorporating the design effects of blocking, intraclass correlation within RO, and correlation between the preintervention and postintervention points. RESULTS: Participants (n = 2175) reported significantly healthier dietary behaviors in intervention ROs at the 12-month follow-up period, compared to participants in the comparison ROs, for a fat scale change of .08 summary scale points and an adjusted intervention effect of .06 overall. CONCLUSION: Dietary intervention through ROs is a positive and successful method of changing dietary habits.

Health decision-making preferences among African American men recruited from urban barbershops.

OBJECTIVE: To examine general health decision-making roles among African American men ages 40 to 70 recruited in barbershops in the Richmond, Virginia, metropolitan area. METHODS: We adapted the 1-item Control Preference scale to study the associations between health decision-making role preferences and demographic variables. Forty African-American men were recruited from barbershops to complete a self-administered survey. After performing descriptive statistics, we dichotomized our outcome into active vs nonactive (collaborative or passive) decision makers. Data were then analyzed using chi2, Wilcoxon-Mann-Whitney rank sum, and multiple logistic regression. RESULTS: Fifteen subjects responded that they engaged in active decision making, 20 in collaborative, and 5 in passive decision making. Almost all (86.7%) active decision makers were home owners, vs 41.7% of nonactive decision makers. Among active decision makers, 46.7% had incomes of more than $70000, vs 12.5% of nonactive decision makers. The active group reported health status that was good to excellent, while 20.8% of those in the nonactive group reported poor/fair health. CONCLUSION: African American male barbershop clients preferred an active or collaborative health decision-making role with their physician, rather than a passive role. The relationship among home ownership, income, and decision style may best be understood by considering the historical and cultural influences on gender role socialization among African American males. More comprehensive assessment of decision styles is necessary to better understand health decision making among African American male patients.

Process evaluation results from the Eating for a Healthy Life study.

PURPOSE: Conduct a process evaluation of a low-fat, high-fruit/vegetable dietary intervention in religious organizations (ROs). The purpose of this process evaluation was to explore differences in healthy eating activities between the intervention and delayed control ROs and among the intervention ROs to identify the intervention activities most associated with dietary change. METHODS: Process data were collected via phone surveys and participation logs. A 12-month follow-up phone survey was conducted with an RO representative from intervention and delayed control ROs. The survey asked about healthy eating activities. Eating for a Healthy Life staff maintained participation logs of intervention RO participation in intervention activities: advisory board meetings, volunteer activities, healthy eating sessions, social events, dietary change mailings, print advertisements, and motivational messages. We used a stepwise regression model to determine which intervention activities were associated with changes in fat- and fiber-related dietary behaviors. RESULTS: RO member participation in advisory board meetings, social activities, and healthy eating sessions were associated with healthier fat- and fiber-related dietary behaviors. Greater RO attendance at advisory board meetings and greater numbers of healthy eating sessions at the RO were associated with decreased fat-related dietary behaviors (p < or = .05). Member participation in social activities was associated with more favorable fat, fruit, and vegetable intake. CONCLUSION: We successfully delivered an increased number of healthy activities at the intervention ROs and improved dietary-related behaviors.

Recruiting African-American barbershops for prostate cancer education.

Prostate cancer is the most common cause of cancer in men and the second leading cause of cancer deaths. African-American men bear a disproportionate burden of prostate cancer diagnosis and mortality. Current guidelines for prostate cancer screening differ among various medical organizations. Therefore, it is important that African-American men have the appropriate information needed to make informed decisions about prostate cancer screening. Unfortunately, a large percentage of African-American men could potentially be excluded from receiving culturally appropriate prostate cancer education. Therefore, a study was designed to recruit and intervene with African-American men and barbershops for increasing prostate cancer screening decision-making. The purpose of this study was to learn effective strategies for recruiting African-American barbershops for prostate cancer education and to determine barbershop proprietors' willingness to allow their barbershops to be used for research. In this paper, we present the outcomes of our recruitment methods for African-American barbershops, including a comparative description of participating and nonparticipating barbershops using the iMark Data System. One-hundred percent of the surveyed proprietors reported that they would allow their clients to learn about prostate cancer. Ninety-six percent reported they would consider allowing their clients to have access to handheld computers to learn about prostate cancer. We conclude from this study that African-American barbershops in general are welcoming environments in which to implement community-based prostate cancer education and public health research.

Attitudes toward participation in breast cancer randomized clinical trials in the African American community: a focus group study.

Participation of African Americans in research trials is low. Understanding the perspectives of African American patients toward participation in clinical trials is essential to understanding the disparities in participation rates compared with whites. A qualitative study was conducted to discover attitudes of the African American community regarding willingness to participate in breast cancer screening and randomized clinical trials. Six focus groups consisting of 8 to 11 African American women (N = 58), aged 30 to 65, were recruited from local churches. Focus group sessions involved a 2-hour audio-taped discussion facilitated by 2 moderators. A breast cancer randomized clinical trial involving an experimental breast cancer treatment was discussed to identify the issues related to willingness to participate in such research studies. Six themes surrounding willingness to participate in randomized clinical trials were identified: (1) Significance of the research topic to the individual and/or community; (2) level of trust in the system; (3) understanding of the elements of the trial; (4) preference for "natural treatments" or "religious intervention" over medical care; (5) cost-benefit analysis of incentives and barriers; and (6) openness to risk versus a preference for proven treatments. The majority (80%) expressed willingness or open-mindedness to the idea of participating in the hypothetical trial. Lessons learned from this study support the selection of a culturally diverse research staff and can guide the development of research protocols, recruitment efforts, and clinical procedures that are culturally sensitive and relevant.

Factors influencing prostate cancer screening decisions among African American men.

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

The relationship between the social environment within religious organizations and intake of fat versus fruits and vegetables.

The authors explored associations of social environment with dietary behavior among participants in the Eating for a Healthy Life study, a randomized, low-fat, high-fruit-and-vegetable dietary intervention trial in religious organizations. Data in this report are from baseline telephone surveys of 1,520 persons that assessed dietary behaviors (Fat- and Fiber-Related Diet Behavior Questionnaire) and social environment (Moos Group Environment Scale). After adjusting for demographic characteristics, higher scores on the Cohesion and Order/Organization subscales were associated with higher fruit/vegetable scores (indicating higher fruit and vegetable consumption). Higher scores on the Cohesion, Leader Support, and Order/Organization subscales were also associated with lower fat scores (indicating lower fat intake). Dietary behaviors within religious organizations may be related to positive perceptions of the social environment. These results support further exploration of the potential influence of religious organizations' social environment on health behaviors and its applicability to dietary change interventions.

Theoretical foundations for interventions designed to promote informed decision making for cancer screening.

BACKGROUND: Decision aids are currently being developed and evaluated for use in cancer-screening decisional settings. PURPOSE: The purpose of this article is to review and discuss the theoretical basis of interventions to promote informed decision making in cancer screening. METHODS: We reviewed interventions cited in Briss et al. and Rimer et al. to identify their theoretical basis, intervention content, measurement strategies, and outcomes. RESULTS: Few interventions had a strong, decision-oriented conceptual basis. This was apparent in their intervention content, the measurement strategy, and the choice of outcomes for the study. CONCLUSIONS: We recommend that more research occur into the basis of decision making in cancer screening and that future interventions use this research to rigorously design and evaluate decision aids to help people make choices about cancer screening.

Correlates of fat intake behaviors in participants in the eating for a healthy life study.

OBJECTIVE: This study identified socioeconomic correlates of total dietary fat intake in the Eating for a Healthy Life Study, a community-based dietary intervention study involving religious organizations. SUBJECTS/DESIGN: To create our sampling frame for the Eating for a Healthy Life Study, a pool of religious organizations was identified from a list of religious faith organizations provided by the Church Council of Greater Seattle. Individual members were randomly selected from recruited religious organizations to complete a telephone-administered, baseline, cross-sectional survey. There were 2,507 respondents who were eligible, consenting participants. Dietary behavior was assessed using a modified version of the Fat- and Fiber-Related Diet Behavior Questionnaire. Socioeconomic status was assessed using individual demographic variables. MAIN OUTCOME MEASURES: Fat-related behaviors indicated by fat summary score and stage of change. STATISTICAL ANALYSES: A multivariable linear regression model was used to examine the association of individual demographic variables with the Fat- and Fiber-Related Diet Behavior Questionnaire-derived measure of dietary fat intake. The same individual variables were used in a multivariable logistic regression model of dietary stage of change. RESULTS: Age, race, sex, education, and self-assessed health status were found to be statistically significant correlates of fat intake. Variables associated with stage of dietary fat change included sex, education, and religious organization cohesion. CONCLUSIONS: Demographic variance is an important factor in understanding dietary fat intake.