Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project.

BACKGROUND: The goal of the Carolinas Cancer Education and Screening (CARES) Project was to improve colorectal cancer (CRC) screening among low-income women in subsidized housing communities in 11 cities in North and South Carolina who were traditionally underserved by cancer control efforts. METHODS: Cross-sectional samples were randomly selected from housing authority lists at 5 timepoints in this nonrandomized community-based intervention study. Face-to-face interviews focused on CRC knowledge, beliefs, barriers to screening, and screening behaviors. The intervention components were based on a previous evidence-based program. RESULTS: A total of 2098 surveys were completed. Seventy-eight percent of the respondents were African American, 62% were 65+ years, and 4% were married. At baseline, the rate of CRC screening within guidelines was 49.3% and physician recommendation was the strongest predictor (odds ratio [OR] = 21.9) of being within guidelines. There was an increase in positive beliefs about CRC screening (P = .010) and in the intention to complete CRC screening in the next 12 months (P = .053) after the intervention. The odds of being within CRC screening guidelines for women living in a city that had received the intervention were not significantly different from women living in a city that had not received the intervention (P = .496). CONCLUSIONS: Although CRC screening rates were not significantly better after the intervention, there was a positive change in beliefs about screening and intention to be screened. The results suggest that the dissemination of an evidence-based behavioral intervention may require a longer duration to engage hard-to-reach populations and change behaviors.

Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women.

INTRODUCTION: Mammography is underused by certain groups of women, in particular poor and minority women. We developed a lay health advisor (LHA) intervention based on behavioral theories and tested whether it improved mammography attendance in Robeson County, NC, a rural, low-income, triracial (white, Native American, African American) population. METHODS: A total of 851 women who had not had a mammogram within the past year were randomly assigned to the LHA intervention (n = 433) or to a comparison arm (n = 418) during 1998-2002. Rates of mammography use after 12-14 months (as verified by medical record review) were compared using a chi-square test. Baseline and follow-up (at 12-14 months) surveys were used to obtain information on demographics, risk factors, and barriers, beliefs, and knowledge about mammography. Linear regression, Mantel-Haenszel statistics, and logistic regression were used to compare barriers, beliefs, and knowledge from baseline to follow-up and to identify baseline factors associated with mammography. RESULTS: At follow-up, 42.5% of the women in the LHA group and 27.3% of those in the comparison group had had a mammogram in the previous 12 months (relative risk = 1.56, 95% confidence interval [CI] = 1.29 to 1.87). Compared with those in the comparison group, women in the LHA group displayed statistically significantly better belief scores (difference = 0.46 points on a 0-10 scale, 95% CI = 0.15 to 0.77) and reduced barriers at follow-up (difference = -0.77 points, 95% CI = -1.02 to -0.53), after adjusting for baseline scores. CONCLUSIONS: LHA interventions can improve mammography utilization. Future studies are needed to assess strategies to disseminate effective LHA interventions to underserved populations.

Measurement adequacy of the CES-D among a sample of older African-Americans.

This manuscript examines the measurement adequacy of the CES-D when applied in older African-Americans (n=227). The response distribution was skewed towards less symptomatology on all items, and the internal consistency of the CES-D was acceptable (alpha=0.86). An exploratory factor analysis revealed four underlying factors of depressive symptomatology: (1) depressive/somatic; (2) positive; (3) interpersonal; and (4) social well-being. The primary factor was a combination of depression and somatic symptoms, a commonly reported uni-dimensional factor among ethnic groups. Additionally, a fourth factor emerged that has not previously been identified, labeled 'social well-being'. This factor consisted of three items that may tap into the social interactions of the elderly: appetite, hopeful, and talk. These findings contribute to the growing body of evidence on the unique measurement properties of the CES-D across diverse populations.