Perceptions of the double value coupon program in southern Illinois.

Introduction: Purchasing produce at farmers markets represents one method by which individuals can purchase and have access to healthful and seasonal fruits. Despite the extension of nutrition assistance programs to local farmers markets, fruit and vegetables consumption has remained below the recommended guidelines, specifically in rural geographical locations. Statement of purpose: The purpose of the study was to explore the aspects of the Link Up Illinois Double Value SNAP Nutrition Incentives Program (DVCP) and its effects on food selection at rural farmers markets for individuals enrolled in nutrition assistance programs. Methods/approach: The current study uses a qualitative methodology in order to uncover barriers local health departments and farmers markets face to implementing the DVCP in their communities and to discover the perspectives of low-income individuals who utilize the DVCP. This paper explores the organizational and community member perceptions of the DVCP and its administration. Semi-structured interviews and one focus group were conducted with health educators from county health departments, DVCP stakeholders, farmers market managers, local farmers, and residents who used the DVCP. A purposeful sampling method was used, intentionally selecting individuals with lived experiences of the research objective. Data were analyzed using a three-cycle coding process, then categorized into overarching themes until thematic saturation was reached. Results: There were a total of 19 individuals who participated in the study. Five themes and four subthemes emerged from data analysis, including organizational capacity, exposure to the DVCP, purchasing power, DVCP advancements, and values. Conclusion/implications: These findings contextualize the facilitators and barriers of multiple stakeholders when implementing nutrition assistance programs at farmers markets. Other similar "double value" programs can utilize these lessons when seeking to increase participation of underrepresented populations at local farmers markets.

Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial.

Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.

We conducted a multi-site study to evaluate and improve CRC screening processes using implementation science strategies at multiple levels including the patient, provider, health center, and community. Our goals were to increase rates of guideline-recommended CRC screening, follow-up, and referral-to-care in an Appalachian, medically underserved population.

The role of sport participation on exercise self-efficacy, psychological need satisfaction, and resilience among college freshmen.

Objective: To evaluate the relationship between high school sport participation among university students and whether previous sports participation was associated with current levels of exercise-self efficacy, resilience, and psychological need satisfaction physical activity behaviors. Participants: College freshmen (n = 152) in the United States responded to an electronic survey sent out by their university. Methods: Participants completed a set of questionnaires assessing resilience, psychological need satisfaction in exercise, self-efficacy, and current PA. Results: Analysis of variance, Kruskal-Wallis H tests, independent samples t-tests, and ordinary least squares regression modeling were used. Total PA and having met moderate PA guidelines were both associated with exercise SE and PNSE. HS GPA, total PA, and being a college athlete were associated with both resilience and exercise SE. Conclusions: Sport participation may serve as an effective method for students to develop exercise SE, resilience, and PNSE. The development of these skills may support lifelong PA behaviors.

Adapting a Research and Community Capacity-Building Program to Address Rural Cancer Burden and Facilitate Partnership Development Between Rural Community Stakeholders and an Urban Comprehensive Cancer Center.

While rural-urban cancer disparities persist, the research building capacity between rural communities and high-quality cancer centers remains limited. Thus, we describe how a National Cancer Institute-designated cancer center partnered with rural community stakeholders to adapt a cancer prevention-focused research and community capacity-building workshop. The workshop's goal was to strengthen community-academic partnerships and facilitate the development of sustainable well-resourced rural cancer-focused research. Researchers from the Siteman Cancer Center partnered with community leaders from rural counties in southern Illinois. We adapted the workshop from an existing evidence-based program. We analyzed changes in knowledge and research capacity and relevance to their community work. From February to May 2019, community partners guided all elements of the workshop development. Workshop participants were mostly White race (93%), had a college degree or beyond (75%), reported living in a rural community (93%), and represented an academic, faith-based, or healthcare institution (78%). Participants' mean knowledge scores of the presented content increased significantly after each session, from 9.3 to 9.9 for session 1 (p = 0.05) and 6.8 to 9.7 (p < 0.001) for session two. Through the workshop, participant scores also increased in research capacity skills, confidence, and their understanding of conducting research in the community. The workshop, co-curated and led by rural community leaders and researchers from Siteman Cancer Center, successfully increased knowledge of and interest in building cancer research capacity. Lessons from our work can inform the implementation of similar programs that address rural cancer health through research and community capacity building between rural community partners and urban cancer centers.

Impact of social support on the dietary behaviors of international college students in the United States.

OBJECTIVE: International students in the US often adopt unhealthy dietary behaviors, perhaps due to lack of familiarity and social support. This study examined the impact of social support on international college students' dietary behaviors. PARTICIPANTS: This study surveyed international students (N = 318) from five public universities in one Midwest state. METHODS: Participants completed an electronic survey assessing self-reported eating habits and perceived social support using the Social Support for Eating Habits and the Starting the Conversation (STC) scales. Data analyses included multiple linear regression and multiple logistic regression to test the study's hypotheses. Comparisons were made to explore the impact of perceived social support on international students' dietary behaviors. RESULTS: Significant predictors of unhealthy dietary behaviors included region of origin (specifically, being from East Asia, Europe and North America) and having families that discouraged healthy eating habits. Additionally, living with immediate family members significantly decreased students' likelihood of having higher friend encouragement for healthy eating habits. Finally, the amount of time participants spent in the US significantly increased their likelihood of having more discouragement of healthy eating from their friends. CONCLUSIONS: International students' unhealthy eating habits increased when their families discouraged them from healthy eating. Interventions promoting healthy diet among international students should consider including family members to increase social support for healthy eating habits.

Medications for Opioid Use Disorder in Rural United States: A Critical Review of the Literature, 2004-2021.

BACKGROUND: The opioid epidemic continues to be problematic in the United States (US). Medications for opioid use disorder (MOUD) are a commonly used evidence-based approach to treating affected individuals, but little is known about its use in the rural US. We reviewed published literature and summarized access, barriers, and approaches to MOUD delivery in rural areas. METHODS: We conducted a search using databases in EBSCOhost, such as Academic Search Complete, Medline, and APA PsycArticles, using a priori aims. Articles published after 2004 were included if they were cross-sectional, analyzed secondary data, collected quantitative or qualitative primary data, were longitudinal or reported intervention results. Studies were excluded if they were conducted outside the US or did not present data. RESULTS: A total of 13 articles met all criteria. Themes from the articles included increase in rural areas with waivered physicians able to prescribe buprenorphine, barriers to physician prescribing, waivered physicians choosing not to prescribe, and inability to assess quality of MOUD practices in rural US settings. CONCLUSIONS: Additional studies of MOUD delivery in rural areas are needed to help explicate themes found in this review. Having a stronger understanding of prescribers operating practices and program roll-out in rural areas may help address some identified barriers and deliver a stronger quality treatment practice for individuals with substance-use disorder.

Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents.

Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.

A health communication campaign designed to improve study habits and wellness: A feasibility study.

BACKGROUND: Academic success and retention remain priorities on college campuses. Excessive cell phone use, test anxiety, and poor sleep habits are all associated with negative academic performance. OBJECTIVE: To assess college students' perceptions of a health communication campaign designed to improve study habits and wellness behaviors during exams. METHOD: Researchers used a cross-sectional research design to assess participants' (n = 264) perceptions of the study tip messages. Linear regressions were conducted to determine if the number of messages read was predictive of readiness to change. RESULTS: Nearly all participants agreed that the messages were appealing (84.4%), believable (89.8%), relevant (91.5%), provided useful information (91.5%) and a good reminder of how to study (87.1%). Students who reported reading more messages indicated a higher level of readiness to improve their study habits (F(1,219) = 8.89, p = .003, R2 = .04). CONCLUSIONS: Students found the messages useful; their intentions to study increased the more they were exposed to messages.

A Framework for Equitable Partnerships to Promote Cancer Prevention and Control in Rural Settings.

Rural populations continue to experience persistent cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination. Although the National Cancer Institute and the larger cancer research community have identified rural community partnerships as the foundation for reducing the disparities, we have identified limited application of community-based participatory research in cancer prevention and control research. Guided by the Community-Based Participatory Research Conceptual Model and our collective experience, we provide a framework for a community-cancer center partnership that focuses on promoting health equity. In this commentary, we articulate that the partnership process must foster capacity for communities and cancer centers, strive for rural representation in clinical trials and biobanking, build a pipeline for dissemination and implementation research, and create a bidirectional flow of knowledge between communities and academic institutions. Authentic partnerships with rural communities should be the ultimate goal of cancer centers, and the process described in this commentary can serve as an initial platform to build capacity and continue to strive toward that goal.

Longitudinal Assessment of a Manualized Group Treatment Program for Gambling Disorder: The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders.

Individuals with gambling disorder (GD) experience a host of negative psychosocial and physical health outcomes, yet few seek treatment. Of particular concern are individuals with co-occurring mental and behavioral health disorders, a group at higher risk for GD in the state of Ohio. To better serve this population, the Ohio Department of Mental Health and Addiction Services developed a group-based GD treatment manual for adults with co-occurring disorders. Over the course of 5 years, 353 individuals engaged in at least some of the manual's 12 weekly modules, and more than one-third (n = 122) completed the entire curriculum. Participants who completed all 12 modules completed pre-and post-tests, and after controlling for covariates, participants significantly decreased their GD symptom severity, though changes in self-esteem and gambling urges were non-significant. These findings suggest the treatment manual holds promise at reducing gambling behaviors for individuals with co-occurring disorders, but further research is warranted to explore best practices on how to intervene on the psychological antecedents to gambling in this population.

"IAmSizeSexy": A health communication body image study.

OBJECTIVE: The aim of this study was to formatively evaluate a health communication campaign on body image targeting undergraduate female students. PARTICIPANTS: A total of 331 students at a large public Midwestern university participated in the study. METHODS: Researchers used central intercept procedures to recruit students from residence halls. After viewing the campaign materials, students completed an online survey assessing their message endorsement and level of eating disorder symptomology and provided open-ended comments. RESULTS: Students appreciated the message and thought it was effective, though students with greater body image concerns were less receptive to the message. Thematic analysis indicated students perceive body image to be a relevant issue, yet they want the university to provide more attention to, and information on, the topic. CONCLUSIONS: Overall, students understood the message and found it helpful. Nevertheless, students with body image issues responded less favorably, warranting the need for secondary and tertiary prevention.

Energy drink expectancies among college students.

ObjectiveSince the late '90 s, energy drink consumption has increased. The purpose of this investigation was to examine energy drink expectancies of college students. Participants: The university registrar randomly selected fifty university classes to be surveyed. Methods: A cross-sectional research design was used to assess the prevalence of energy drink consumption and energy drink expectancies. Binary logistic regression analyses were conducted to ascertain which expectancies explained energy drink consumption. Results: The expectancy factors of 1,246 participants accounted for 25.8% of the variance in past 30-day energy drink consumption. Energy enhancement, anxiety/negative physical effects, withdrawal, and appetite suppression were each found to be significantly related to energy drink consumption. Conclusions: Energy enhancement and anxiety/negative effects were the strongest predictors of energy drink consumption among college students. The results from this study can be used to design interventions to challenge erroneous expectancies and reinforce others that promote moderation or abstinence.

Building Cancer Prevention and Control Research Capacity in Rural Appalachian Kentucky Primary Care Clinics During COVID-19: Development and Adaptation of a Multilevel Colorectal Cancer Screening Project.

This study describes the development of a colorectal cancer (CRC) screening multilevel intervention with four primary care clinics in rural Appalachian Kentucky. We also discuss barriers experienced by the clinics during COVID-19 and how clinic limitations and needs informed project modifications. Four primary care clinics were recruited, key informant interviews with clinic providers were conducted, electronic health record (EHR) capacity to collect data related to CRC screening and follow-up was assessed, and a series of meetings were held with clinic champions to discuss implementation of strategies to impact clinic CRC screening rates. Analysis of interviews revealed multilevel barriers to CRC screening. Patient-level barriers included fatalism, competing priorities, and financial and literacy concerns. The main provider- and clinic-level barriers were provider preference for colonoscopy over stool-based testing and EHR tracking concerns. Clinics selected strategies to address barriers, but the onset of COVID-19 necessitated modifications to these strategies. Due to COVID-19, changes in clinic staffing and workflow occurred, including provider furloughs, a state-mandated pause in elective procedures, and an increase in telehealth. Clinics adapted screening strategies to match changing needs, including shifting from paper to digital educational tools and using telehealth to increase annual wellness visits for screening promotion. While significant delays persist for scheduling colonoscopies, clinics were encouraged to promote stool-based tests as a primary screening modality for average-risk patients.

Perspectives of cancer prevention and control resources from stakeholders in rural southern Illinois.

PURPOSE: Rural residents have a higher cancer burden than urban residents, which is likely related to multiple socioecological factors. This study sought to investigate the perspectives of a diverse set of rural stakeholders regarding access to cancer prevention and control resources in rural southern Illinois. METHODS: Stakeholders were recruited from counties in southern Illinois and included residents (cancer survivors or caregivers), leaders of community-based organizations with health-related missions, and health care providers. Individual interviews and focus groups assessed recommended cancer prevention, control, and treatment resources; helpfulness of regional resources; and needed resources. The research team used an iterative approach to thematic analysis wherein codes were derived inductively and refined repeatedly to reveal overarching themes. FINDINGS: Forty-four stakeholders reported challenges to health care access (eg, travel distance, financial burdens, and poor quality of care) and limited access to supportive care services (lack of caregiver support and "spotty" area resources). To mitigate these barriers, local residents used a combination of individual (self-reliance and adaptive measures) and organizational (patient navigation and financial services) approaches. Finally, stakeholders reported multiple forms of cancer control and prevention communication, including formal discussions with health care providers and various types of informal social support (eg, friends and family). CONCLUSIONS: Stakeholders experienced barriers to cancer prevention and control often mitigated by a reliance on personal adaptations, nonclinical organizational supports, and informal support systems. While resources remain minimal in southern Illinois, researchers and practitioners must make efforts to leverage existing community organizations and social networks to improve cancer outcomes in this region.

Social Norms vs. fear Appeals: Mixing Alcohol with Prescription Drugs - a Message Testing Study.

OBJECTIVE: The purpose of this study was to compare the perceived effectiveness of a social norms message to a fear appeal message regarding prescription drug use and alcohol interactions among college students. Participants: Participants (n = 378) were college students enrolled at a large public Midwest university. Methods: Researchers used a cross-sectional research design to collect data from undergraduate college students. Messages were randomly assigned to one of two residence halls and were assessed using an electronic survey. Participants anonymously evaluated the messages based on their understanding, interest, creativity, believability, relevance, and usefulness using an online questionnaire. Results: Results from the General Linear Model analysis indicated a significant effect for the gender x message interaction, with females rating the fear appeal message higher than males. Significant effects were also found for the main effects of gender, message type, and Greek status. Conclusion: Overall, students preferred the fear appeal to the social norms message. Participants found the social norms message less believable than the fear appeal and indicated they understood the fear appeal better than the social norms message. However, social norm messages appeared to resonate better with abstainers than with regular alcohol users.

Development of a multilevel intervention to increase colorectal cancer screening in Appalachia.

BACKGROUND: Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. METHODS: Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. RESULTS: Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. CONCLUSIONS: Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. TRIAL REGISTRATION: Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

Racial Residential Segregation and Colorectal Cancer Mortality in the Mississippi Delta Region.

INTRODUCTION: Few studies have examined the effects of racial segregation on colorectal cancer (CRC) outcomes, and none has determined whether rurality moderates the effect of racial segregation on CRC mortality. We examined whether the effect of segregation on CRC mortality varied by rurality in the Mississippi Delta Region, an economically distressed and historically segregated region of the United States. METHODS: We used data from the US Census Bureau and the 1999-2018 Surveillance, Epidemiology, and End Results (SEER) program to estimate mixed linear regression models in which CRC mortality rates among Black and White residents in Delta Region counties (N = 252) were stratified by rurality and regressed on White-Black residential segregation indices and 4 socioeconomic control variables. RESULTS: Among Black residents, CRC mortality rates in urban counties were a function of a squared segregation term (b = 162.78, P = .01), indicating that the relationship between segregation and CRC mortality was U-shaped. Among White residents, main effects of annual household income (b = 29.01, P = .04) and educational attainment (b = 34.58, P = .03) were associated with CRC mortality rates in urban counties, whereas only annual household income (b = 19.44, P = .04) was associated with CRC mortality rates in rural counties. Racial segregation was not associated with CRC mortality rates among White residents. CONCLUSION: Our county-level analysis suggests that health outcomes related to racial segregation vary by racial, contextual, and community factors. Segregated rural Black communities may feature stronger social bonds among residents than urban communities, thus increasing interpersonal support for cancer prevention and control. Future research should explore the effect of individual-level factors on colorectal cancer mortality.

The State of Research on Faith Community Nursing in Public Health Interventions: Results from a Systematic Review.

Though faith community nurses (FCNs) serve many roles in churches and communities, little is known about their roles or effectiveness in public health interventions. This systematic review summarizes the literature on recent faith community nursing interventions, examining trends, evaluating rigor, and proposing future research directions. Articles were downloaded from PubMed and CINAHL, and 24 studies were included. Interventions addressed various health outcomes. The FCNs participated in research by recruiting participants, developing study measures, and implementing programs. Results reported mainly process evaluation and provided few outcomes. Better evaluation is needed to understand the effectiveness of FCNs in public health research.

Impact of Social Support on the Physical Activity Behaviors of International College Students in the United States.

Research has suggested that international students' transition to the United States is often correlated with less physical activity after arriving in the U.S). One reason might be related to reduced social support when living in a foreign environment. The purpose of this cross-sectional study was to assess the impact of social support on international college students' physical activity behaviors. Participants (N = 318) from five public universities in one Midwest state completed an electronic survey assessing self-reported physical activity behaviors and perceived social support for exercise (SSE). Data analyses included multiple linear regression, multinomial logistic regression, and multiple logistic regression to test the study's hypotheses. Region of origin, academic level, and friends' SSE were all significant predictors of unhealthy physical activity behaviors. Specifically, friends' SSE was positively associated with higher total physical activity behaviors (F (12, 305) = 4.2, p < .001, R 2 = .142) and was a significant predictor of participants' physical activity levels. Although research suggests international students' transition to the United States can impart negative impacts on their physical activity behaviors, we found that greater levels of friends' SSE was associated with increased physical activity behaviors. As university administrators and wellness programs explore interventions promoting positive physical activity behaviors among international students, they should consider including elements that focus specifically on friendship social support to motivate physical activity behaviors.