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Cervical cancer and Type 2 Diabetes (T2D) share common demographic risk factors. Despite this, scarce research has examined the relationship between race/ethnicity, having T2D, and cervical cancer incidence. We analyzed statewide electronic health records data between 2012 and 2019 from the OneFlorida+ Data Trust. We created a 1:4 nested case-control dataset. Each case (patient with cervical cancer) was matched with four controls (patients without cervical cancer) without replacement by year of encounter, diagnosis, and age. We used conditional logistic regression to estimate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between race/ethnicity, T2D, and cervical cancer incidence. A total of 100,739 cases and 402,956 matched controls were identified. After adjusting for sociodemographic characteristics, non-Hispanic Black women with T2D had higher odds of cervical cancer compared with non-Hispanic White women with T2D (OR: 1.58, 95% CI 1.41-1.77). Living in a rural area, having Medicaid/Medicare insurance, and having high social vulnerability were associated with higher odds of having a cervical cancer diagnosis. Our findings imply the need to address the higher burden of cervical cancer diagnosis among non-Hispanic Black women with T2D and in underserved populations.
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PURPOSE: We previously described the magnitude of rural-urban differences in the prevalence of stroke risk factors and stroke mortality. In this report, we sought to extend the understanding of rural-urban differences in the prevalence of stroke risk factors by using an enhanced definition of rural-urban status and assessing the impact of neighborhood socioeconomic status (nSES) on risk factor differences. METHODS: This analysis included 28,242 participants without a history of stroke from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants were categorized into the 6-level ordinal National Center for Health Statistics Urban-Rural Classification Scheme. The prevalence of stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy, and heart disease) was assessed across the rural-urban scale with adjustment for demographic characteristics and further adjustment for nSES score. FINDINGS: Hypertension, diabetes, and heart disease were more prevalent in rural than urban regions. Higher odds were observed for these risk factors in the most rural compared to the most urban areas (odds ratios [95% CI]: 1.25 [1.11-1.42] for hypertension, 1.15 [0.99-1.33] for diabetes, and 1.19 [1.02-1.39] for heart disease). Adjustment for nSES score partially attenuated the odds of hypertension and heart disease with rurality, completely attenuated the odds of diabetes, and unmasked an association of current smoking. CONCLUSIONS: Some of the higher stroke mortality in rural areas may be due to the higher burden of stroke risk factors in rural areas. Lower nSES contributed most notably to rural-urban differences for diabetes and smoking.
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Diabetes Mellitus , Cardiopatías , Hipertensión , Accidente Cerebrovascular , Estudios Transversales , Diabetes Mellitus/epidemiología , Cardiopatías/complicaciones , Humanos , Hipertensión/epidemiología , Prevalencia , Factores de Riesgo , Población Rural , Accidente Cerebrovascular/epidemiología , Población UrbanaRESUMEN
BACKGROUND: Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors. OBJECTIVE: This SLUMBRx study aims to address 4 topics pertinent to the adiposity-sleep hypothesis: the relationship between adiposity and sleep duration; sex-based differences in the relationship between adiposity and sleep duration; the influence of adiposity indices and sleep duration on cardiometabolic outcomes; and the role of socioecological factors as effect modifiers in the relationship between adiposity indices, sleep, and cardiometabolic outcomes. METHODS: SLUMBRx will employ a large-scale survey (n=1000), recruiting 159 participants (53 normal weight, 53 overweight, and 53 obese) to be assessed in 2 phases. RESULTS: SLUMBRx was funded by the National Institutes of Health, Heart, Lung, and Blood Institute through a K01 grant award mechanism (1K01HL145128-01A1) on July 23, 2019. Institutional Review Board (IRB) approval for the research project was sought and obtained on July 10, 2019. Phase 1 of SLUMBRx, the laboratory-based component of the study, will gather objective adiposity indices (air displacement plethysmography and anthropometrics) and cardiometabolic data (blood pressure, pulse wave velocity and pulse wave analysis, and a blood-based biomarker). Phase 2 of SLUMBRx, a 1-week, home-based component of the study, will gather sleep-related data (home sleep testing or sleep apnea, actigraphy, and sleep diaries). During phase 2, detailed demographic and socioecological data will be collected to contextualize hypothesized adiposity and sleep-associated cardiometabolic disease risk factors. Collection and analyses of these data will yield information necessary to customize future observational and intervention research. CONCLUSIONS: Precise implementation of the SLUMBRx protocol promises to provide objective and empirical data on the interaction between body composition and sleep duration. The hypotheses that will be tested by SLUMBRx are important for understanding the pathogenesis of cardiometabolic disease and for developing future public health interventions to prevent its conception and treat its consequences. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/27139.
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BACKGROUND: Acute uncomplicated cystitis is one of the most common diagnoses for which antibiotic treatment is prescribed in the outpatient setting. Despite the availability of national guidelines, there remains a wide pattern in prescriber choices for therapy. Recent data portray a picture of consistently longer durations than recommended prescribed in outpatient settings. OBJECTIVE: The objective was to evaluate the effect of a system-based intervention on adherence to guideline-recommended durations of therapy for uncomplicated cystitis in the outpatient setting. METHODS: This quasi-experimental study included women aged 18-64 years who were seen at five family medicine clinics at an academic medical centre and were prescribed targeted antibiotics for uncomplicated cystitis (nitrofurantoin monohydrate/macrocrystals 100 mg, trimethoprim-sulfamethoxazole 160/800 mg or ciprofloxacin 250 mg). The intervention involved revising or adding pre-filled, but modifiable, default prescribing instructions in the electronic health record (EHR) for the targeted antibiotics. We evaluated adherence to guideline-recommended duration of therapy as well as days of therapy (DOT) before and after the intervention. RESULTS: A total of 787 pre-intervention and 862 post-intervention cases were included. Adherence to recommended duration of therapy increased from 29.4% to 76.3% (P < 0.01). The average DOT decreased by 23% from 6.6 to 5.1 (P < 0.01). CONCLUSION: A stewardship intervention consisting of revising/adding default prescribing instructions to targeted antimicrobials in an EHR was associated with increased adherence to recommended durations of therapy for uncomplicated cystitis and reduction of unnecessary antibiotic exposure. More studies are needed to confirm effectiveness across multiple medical record platforms.
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Antibacterianos/uso terapéutico , Cistitis/tratamiento farmacológico , Duración de la Terapia , Infecciones Urinarias/tratamiento farmacológico , Adolescente , Adulto , Programas de Optimización del Uso de los Antimicrobianos , Medicina Familiar y Comunitaria , Femenino , Adhesión a Directriz , Humanos , Persona de Mediana Edad , Pacientes Ambulatorios , Pautas de la Práctica en Medicina , Adulto JovenRESUMEN
Child sexual abuse (CSA) is a common problem, and allegations of CSA require a thorough multidisciplinary investigation which includes a comprehensive medical evaluation. Although most CSA victims will have normal exams, some will have physical injuries, sexually transmitted infections (STIs), and/or other problems. We are reporting the results of the examinations of 573 children evaluated in the West Alabama Child Medical Evaluation Program (WACMEP). This is the first report of CSA exams coming from Alabama and one of a few from a smaller medical center. Most were victimized by a single, older male perpetrator who was known to the family, often related, and had unsupervised access to the child. One-fourth (24.1%) of the children had significant exam findings, including 7.5% with a STI. Females were more likely to have significant findings including most of the STIs. Other historical factors statistically linked to an increased risk of having significant exam findings included being African-American, providing a clear history of abuse, and/or reporting vulvar pain or vaginal symptoms such as discharge, itching, or bleeding. The incidence of significant findings including STIs was similar to previously reported studies from larger urban centers across the United States, United Kingdom, and New Zealand.
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Abuso Sexual Infantil/diagnóstico , Abuso Sexual Infantil/estadística & datos numéricos , Registros Médicos , Examen Físico , Alabama/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
BACKGROUND: Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA. METHODS: Two fifth-grade classes at a school (n = 19 and n = 20) were randomly assigned to an intervention or comparison group. The intervention group participated in a 4-week intervention designed to improve MVPA (wGT3X-BT accelerometer; ActiGraph, Pensacola, FL) and the related psychosocial constructs (written survey). Groups were assessed prior to and immediately following the intervention. RESULTS: There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA. CONCLUSIONS: Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.
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Ejercicio Físico/psicología , Psicología/métodos , Niño , Investigación Participativa Basada en la Comunidad , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Grupos Minoritarios , Población Rural , Poblaciones VulnerablesRESUMEN
Snarr, RL, Esco, MR, Tolusso, DV, Hallmark, AV, Earley, RL, Higginbotham, JC, Fedewa, MV, and Bishop, P. Comparison of lactate and electromyographical thresholds after an exercise bout. J Strength Cond Res 33(12): 3322-3331, 2019-The electromyographical threshold (EMGT) has been previously validated as a means to predict the work rate at which lactate threshold (LT) occurs. The reliability of these measures has yet to be examined after a bout of exercise. The purpose was to determine the agreement between electromyography (EMG) and LT after a 30-minute bout of steady-state aerobic exercise. Participants completed 2 graded exercise tests (GXT) on a cycle ergometer separated by 30 minutes of steady-state exercise. Blood lactate was measured the last 45 seconds of each stage during both GXTs, whereas EMG of the vastus lateralis was monitored continuously. Individual agreement demonstrated that pre-exercise and post-exercise LT occurred at the same work rate in 2 of 10 participants, whereas EMGT occurred at the same work rate in 6 of 10 participants. Results showed no mean difference between work rates for LT or EMG threshold for the pre-exercise GXT, but LT was significantly lower (p < 0.01) than EMGT during the post-exercise GXT. Post-GXT LT work rates were also determined to be significantly lower than pre-GXT LT (p = 0.034), whereas no differences existed in EMG thresholds. Although both LT and EMGT testing may display similar properties, they are not interchangeable. The physiological responses to increasing exercise intensity between La and EMG signaling seem to be associated, and their interaction may not be cause-effect. Because of poor individual agreement, caution should be used when determining LT through the use of EMG. Further research is needed to determine the ability of these 2 metrics to prescribe training intensities.
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Umbral Anaerobio , Electromiografía , Ejercicio Físico/fisiología , Ácido Láctico/sangre , Músculo Cuádriceps/fisiología , Adulto , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient's perception of a provider's cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.
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Competencia Cultural , Depresión/psicología , Ajuste Emocional/fisiología , Cooperación del Paciente/psicología , Participación del Paciente/psicología , Centros Médicos Académicos , Adulto , Estudios Transversales , Competencia Cultural/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Proyectos PilotoRESUMEN
Road traffic accidents (RTA) are among the leading causes of mortality in sub-Saharan Africa. Many males that drop out of school in Ghana, a population at risk for attention-deficit hyperactivity disorder (ADHD), find employment by joining driver's unions. Moreover, the vehicles of Ghanaian unionized drivers are over-represented in fatal road accidents. Untreated ADHD has been linked with higher rates of RTAs. The objectives of this cross-sectional analysis is to determine the following among unionized drivers in Ghana: 1) the prevalence of ADHD, and 2) the association between self-reported ADHD risk and driving behavior. Data comes from participants' responses (200 unionized drivers and 171 community controls) to a 6-item ADHD Self - Report Scale (ASRS), the Driving Behavior Survey (DBS), and a culturally adapted version of the Jerome Driving Questionnaire (JDQ-GH). The self-reported prevalence of ADHD was 17.6% for the unionized drivers and 7.8% for the control group (χ2=7.7, df=1, p=0.006). Also, ADHD drivers endorsed that they were more likely to pay bribes to police and having worse driving behaviors across among both unionized drivers and controls. Study findings suggest that increased awareness of ADHD and possible screening of drivers for ADHD with subsequent evaluation and treatment may result in prevention of vehicle accidents.
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Accidentes de Tránsito/psicología , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Conducción de Automóvil/psicología , Ocupaciones , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Concienciación , Cognición , Estudios Transversales , Ghana/epidemiología , Humanos , Sindicatos , Persona de Mediana Edad , Políticas , Prevalencia , Salud Pública , Riesgo , Autoinforme , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: Stroke mortality is 30% higher in the rural United States. This could be because of either higher incidence or higher case fatality from stroke in rural areas. METHODS: The urban-rural status of 23 280 stroke-free participants recruited between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) was classified using the Rural-Urban Commuting Area scheme as residing in urban, large rural town/city, or small rural town or isolated areas. The risk of incident stroke was assessed using proportional hazards analysis, and case fatality (death within 30 days of stroke) was assessed using logistic regression. Models were adjusted for demographics, traditional stroke risk factors, and measures of socioeconomic status. RESULTS: After adjustment for demographic factors and relative to urban areas, stroke incidence was 1.23-times higher (95% confidence intervals, 1.01-1.51) in large rural town/cities and 1.30-times higher (95% confidence intervals, 1.03-1.62) in small rural towns or isolated areas. Adjustment for risk factors and socioeconomic status only modestly attenuated this association, and the association became marginally nonsignificant (P=0.071). There was no association of rural-urban status with case fatality (P>0.47). CONCLUSIONS: The higher stroke mortality in rural regions seemed to be attributable to higher stroke incidence rather than case fatality. A higher prevalence of risk factors and lower socioeconomic status only modestly contributed to the increased risk of incident stroke risk in rural areas. There was no evidence of higher case fatality in rural areas.
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Población Rural/tendencias , Clase Social , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Factores de Riesgo , Accidente Cerebrovascular/economía , Estados Unidos/epidemiologíaRESUMEN
When devising strategies to combat obesity, strategies focusing on children should be utilized since health-related behaviors track into adulthood. One strategy that begins to address, and brings awareness to, the rising obesity rates and other health disparities in adults is the utilization of community health fairs. Previous literature has described how to conduct an adult health fair using a community-based participatory research (CBPR) approach, but no study has shown how to conduct a health fair for children. This article explains how a CBPR approach was used to develop a health fair focused on obesity prevention for children. A partnership between the community and a local university was formed to assist in the planning and implementation of a health fair. While the data obtained from the health fair served as a needs assessment for future projects, the health fair was also a good first step in developing relationships and trust among the partners.
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Servicios de Salud del Niño/organización & administración , Investigación Participativa Basada en la Comunidad , Exposiciones Educacionales en Salud/organización & administración , Obesidad Infantil/prevención & control , Niño , Relaciones Comunidad-Institución , Humanos , Evaluación de Necesidades , Confianza , UniversidadesRESUMEN
The overall objective of Project SHAPE (Shaping Health using Activity Photovoice and E-Video) was to improve physical activity levels of rural, medically underserved children by designing and implementing a culturally relevant physical activity intervention. This objective was met by using a community-based participatory research approach to design and implement an intervention that would positively affect the psychosocial constructs related to increasing physical activity, which, in turn, would lead to increases in the time spent in daily physical activity. This article describes the unique design of the intervention including its theoretical framework, its interrelated components, and the logistics involved.
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Investigación Participativa Basada en la Comunidad/métodos , Ejercicio Físico/fisiología , Niño , Femenino , Humanos , Masculino , Proyectos de Investigación , Población RuralRESUMEN
Developing meaningful community-based participatory relationships between researchers and the community can be challenging. The overall success of a community-based participatory relationship should be predicated on commitment and respect from empowered stakeholders. Prior to developing the technique discussed in this article, we hypothesized that the process of fostering relationships between researchers and the community was much like a social relationship: It has to develop organically and cannot be forced. To address this challenge, we developed a community-based participatory research-speed dating technique to foster relationships based on common interests, which we call CBPR-SD. This article describes the logistics of implementing CBPR-SD to foster scholarly collaborations. As part of a federally funded community-based research project, the speed dating technique was implemented for 10 researchers and 11 community leaders with a goal of developing scholarly collaborative groups who will submit applications for community-based research grants. In the end, four collaborative groups developed through CBPR-SD, three (75%) successfully submitted grant applications to fund pilot studies addressing obesity-related disparities in rural communities. Our preliminary findings suggest that CBPR-SD is a successful tool for promoting productive scholarly relationships between researchers and community leaders.
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Investigación Participativa Basada en la Comunidad/organización & administración , Relaciones Comunidad-Institución , Conducta Cooperativa , Relaciones Interprofesionales , Investigadores/organización & administración , Disparidades en el Estado de Salud , Humanos , Obesidad/epidemiología , Proyectos Piloto , Población Rural , Universidades/organización & administraciónRESUMEN
OBJECTIVES: We evaluated whether differences in cardiovascular risk factors, as assessed by the Framingham risk scores for stroke and cardiovascular disease (FSRS and FCRS), contributed to disparities in all-cause mortality across race and regional strata of USA. DESIGN: Race-region-specific FSRS and FCRS scores were computed for 30,086 REGARDS participants who were recruited between January 2003 and October 2007. They were divided across six regions of the "Eight Americas" and then compared after adjusting for race and sex. Kaplan-Meier curves and hazard ratios for all-cause mortality were estimated between regions, first adjusted for age and sex, and then for the risk scores. RESULTS: After adjustment for age, sex, FCRS, and FSRS, there was no difference in mortality among Middle-America Whites versus Low-Income White. However, mortality was lower among Middle-America Blacks (-23 %; p = 0.06) and High-Risk Urban Blacks (-24 %; p = 0.01) compared to Southern Low-Income Rural Blacks. Compared to Middle-American Whites, mortality was higher among Middle-America Blacks (+39 %; p < 0.001), High-Risk Urban Blacks (+35 %; p < 0.001) and Southern Low-Income Rural Blacks (+85 %; p < 0.001). CONCLUSION: Accounting for cardiovascular risk unmasked a greater disparity in mortality between Blacks and Whites and among Southern Rural Blacks compared to Middle-America Blacks and High-Risk Urban Blacks.
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Enfermedades Cardiovasculares/mortalidad , Grupos Raciales , Adulto , Negro o Afroamericano , Anciano , Población Negra , Estudios de Cohortes , Geografía , Humanos , Persona de Mediana Edad , Factores de Riesgo , Población Rural , Estados Unidos/epidemiología , Población BlancaRESUMEN
BACKGROUND: Research that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. METHODS: Our sample consisted of 1,656 normotensive participants at baseline (2000-2004) (mean age 47±12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005-2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. RESULTS: Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05-1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00-1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04-1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. CONCLUSIONS: Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred.
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Afecto/fisiología , Negro o Afroamericano/psicología , Hipertensión/etiología , Estrés Psicológico/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Progresión de la Enfermedad , Femenino , Humanos , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Effective childhood obesity prevention programs for preschool children are limited in number and focus on changes in the child care environment rather than the home environment. PURPOSE: The purpose of this project was to develop and test the feasibility of a home environment obesity prevention program that incorporates mindful eating strategies and Social Cognitive Theory (SCT) constructs. Home Sweet Home is specifically designed for rural parents and grandparents of preschool-age children. METHODS: HSH was developed using community-based participatory research practices and constructs from the SCT. Three community-based education sessions were delivered. Pre- and post-intervention data were collected from 47 grandparents and mothers.F. RESULTS: Three of the four selected behavioral outcomes improved between pre- and post-intervention. The number of hours engaged in sedentary behaviors and intake of "red light" foods decreased while three of four mindful eating scores increased. Graduates of the program were able to decrease the number of "red light" foods available in their homes. DISCUSSION: Improvements in mindful eating and several key behaviors were observed after a three week mindful eating/home environment intervention. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health educators should incorporate mindful eating strategies and use the SCT when designing childhood obesity prevention programs.
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Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.
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Negro o Afroamericano , Investigación Participativa Basada en la Comunidad/métodos , Conducta Cooperativa , Disparidades en el Estado de Salud , Obesidad/terapia , Apoyo a la Investigación como Asunto , Salud Rural/etnología , Alabama/epidemiología , Investigación Participativa Basada en la Comunidad/economía , Investigación Participativa Basada en la Comunidad/organización & administración , Humanos , Obesidad/etnología , Desarrollo de ProgramaRESUMEN
OBJECTIVE: Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely. METHODS: We collected intention-to-screen and medical record-verified colonoscopy information on 218 individuals who received the personalized intervention. RESULTS: Structural equation modeling showed poor main model fit (root mean square error of approximation (RMSEA) = 0.109; standardized root mean residual (SRMR) = 0.134; comparative fit index (CFI) = 0.797; Akaike information criterion (AIC) = 11,601; Bayesian information criterion (BIC) = 11,884). However, the alternative model (RMSEA = 0.070; SRMR = 0.105; CFI = 0.918; AIC = 11,186; BIC = 11,498) showed good fit. Cancer susceptibility (B = 0.319, p < 0.001) and colonoscopy self-efficacy (B = 0.364, p < 0.001) perceptions predicted intention to screen, which was significantly associated with colonoscopy uptake (B = 0.539, p < 0.001). CONCLUSIONS: Our findings provide support of the utility of Extended Parallel Process Model for designing effective interventions to motivate CRC screening in persons at increased risk when individual elements of the model are considered. Copyright © 2015 John Wiley & Sons, Ltd.
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BACKGROUND: We tested the efficacy of a remote tailored intervention Tele-Cancer Risk Assessment and Evaluation (TeleCARE) compared with a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers. METHODS: Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N = 232) or an educational brochure (N = 249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained nonadherent. Rates of medically verified colonoscopy at the 15-month follow-up were compared on the basis of group assignment and within group stratification by cost barriers. RESULTS: In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy [OR, 2.37; 95% confidence interval (CI) 1.59-3.52]. Cost was identified as a barrier in both groups (TeleCARE = 62.5%; educational brochure = 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR, 3.66; 95% CI, 1.85-7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR, 1.99; 95% CI, 1.12-3.52). CONCLUSIONS: TeleCARE increased colonoscopy regardless of cost barriers. IMPACT: Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent.