Socio-Ecologic Influences on Weight Trajectories Among Children with Obesity Living in Rural and Urban Settings.

Background: Childhood obesity is a risk factor for poor cardiovascular, metabolic, and respiratory health. The studies examining influences of socio-ecologic factors on weight trajectories using longitudinal data are limited, often examine single measures (e.g., proximity to parks), and have not examined the specific trajectories of children with obesity. Methods: We examined influences on weight among 1518 children, 6-12 years of age, who had obesity using body mass index (BMI) criteria. BMI slope trajectories were categorized as decreasing, flat, or increasing, with a median of 2.1 years of follow-up. We examined socio-ecologic exposures, stratified by rural and urban settings, using census tracts to map indices, including food access, proximity to parks, normalized difference vegetation index, and area deprivation index (ADI). We used ordinal logistic regression to examine the associations between the socio-ecologic factors and BMI trajectories. Results: Among the 1518 children, 360 (24%) had a decreasing BMI trajectory with the remainder having flat (23%) or increasing (53%) trajectories. Children in rural areas were more likely to live in high disadvantage areas, 85%, compared with urban children, 46%. In the multivariable ordinal model, living in a lower ADI census tract had a 0.78 (95% CI 0.61-0.99) lower odds of being in an increasing BMI slope group, and no other socio-ecologic factor was associated. Conclusions: The area deprivation index captures a range of resources and social context compared with the built environment indicators, which had no association with BMI trajectory. Further work examining how to develop effective interventions in high deprivation areas is warranted.

Online Scan of Campus Health Resources and HPV Vaccination Information on College and University Websites in the State of Oregon.

This study is the first to report the results of a scan of the official webpages of all public and private colleges and universities in the state of Oregon, including but not limited to student health services webpages and student handbooks, to identify available services, policies, and educational information on HPV vaccination. The purpose is to describe vaccination services (with a focus on the HPV vaccine), prevention efforts, and institutional policies on vaccination on college and university websites in Oregon. An online scan was conducted from September to November 2020 to collect and describe data from college/university websites across Oregon. Colleges/universities were obtained from the National Center for Education Statistics website. The final sample included 48 colleges/universities. Twenty colleges/universities have a health center with 11 providing the HPV vaccine on campus: most are large public universities and non-religious private colleges. A few religious private universities and one community college offer the vaccine on campus. More than half (n = 26) of Oregon colleges/universities had a webpage specifically designated for immunization information, but only 11 mentioned the HPV vaccine on their immunization webpage. Twelve colleges/universities recommend, and none require the vaccine. Information on HPV vaccination services and education was limited on college/university websites, especially on community college and religious private university websites. Most colleges/universities with a student health center recommend and offer the HPV vaccine on campus. College/university websites may be a low-cost and effective medium to increase HPV vaccination awareness, encourage immunizations, and prevent HPV-associated cancers.

Barriers and Facilitators of Colonoscopy Screening Among Latino Men in a Colorectal Cancer Screening Promotion Program.

Colorectal cancer (CRC) is the second leading cause of cancer death among Latino men in the United States, yet they have low screening rates. This study explored barriers and facilitators of colonoscopy screening among Latino participants in a CRC screening promotion program. Six focus groups were conducted, in Spanish, with 45 Latino men, of which 28 had received and 17 had not received a colonoscopy. Analysis of the discussion transcripts identified barriers to CRC screening, facilitators to CRC screening, and recommendations for health information dissemination. There was consensus among all participants that they had not received adequate information on colonoscopy screening from their health care providers. Unscreened participants wanted more details about the colonoscopy procedure and bowel preparation. Screened men were more knowledgeable than unscreened men about CRC, the colonoscopy procedure, and the benefits of early detection. Participants also expressed their fears, concerns, and perceptions of stigma in relation to colonoscopy screening. They described family and personal testimonials as facilitators to engaging in colorectal cancer screening. Findings underscore the need for ongoing research and educational efforts to address personal and cultural stigma surrounding colonoscopy and CRC, particularly in underserved communities. Study findings also highlight the danger of missing out on opportunities to increase CRC screening when colonoscopy is the primary screening option offered. Additional research is needed to ensure trust in the health care system and to examine the effectiveness of testimonials on CRC screening among Latino men.

An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.

BACKGROUND: Screening supports early detection and treatment of colorectal cancer (CRC). Provision of fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in primary care can increase CRC screening, particularly in populations experiencing health disparities. This study was conducted to describe clinical workflows for FIT/FOBT in Oregon primary care practices and to identify specific workflow processes that might be associated (alone or in combination) with higher (versus lower) CRC screening rates. METHODS: Primary care practices were rank ordered by CRC screening rates in Oregon Medicaid enrollees who turned age 50 years from January 2013 to June 2014 (i.e., newly age-eligible). Practices were recruited via purposive sampling based on organizational characteristics and CRC screening rates. Data collected were from surveys, observation visits, and informal interviews, and used to create practice-level CRC screening workflow reports. Data were analyzed using descriptive statistics, qualitative data analysis using an immersion-crystallization process, and a matrix analysis approach. RESULTS: All participating primary care practices (N=9) used visit-based workflows, and four higher performing and two lower performing used population outreach workflows to deliver FIT/FOBTs. However, higher performing practices (n=5) had more established workflows and staff to support activities. Visit-based strategies in higher performing practices included having dedicated staff identify patients due for CRC screening and training medical assistants to review FIT/FOBT instructions with patients. Population outreach strategies included having clinic staff generate lists and check them for accuracy prior to direct mailing of kits to patients. For both workflow types, higher performing clinics routinely utilized systems for patient reminders and follow-up after FIT/FOBT distribution. CONCLUSIONS: Primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Key to practices with higher CRC screening was having medical assistants discuss and review FIT/FOBT screening and instructions with patients. Findings present important workflow processes for primary care practices and may facilitate the implementation of evidence-based interventions into real-world, clinical settings.

A Cancer Education-Plus-Navigation Intervention Implemented Within a Federally Qualified Health Center and Community-Based Settings.

Despite the availability of effective cancer screening tests, Latinos are screened at lower rates than non-Hispanic Whites. We implemented and evaluated the effectiveness of an evidence-based community health worker (CHW) cancer education-plus-navigation intervention designed to increase cancer screening, knowledge of screening guidelines, and the benefit of early detection. The project included a community and clinic component and served a primarily Latino population. In collaboration with a federally qualified health center (FQHC) and three community-based organizations, bilingual/bicultural CHWs recruited men and women (not up-to-date with the cancer screening guidelines) from a FQHC and the community. Participants received education plus navigation and no-cost cancer screening tests. Together with the FQHC, we outlined eligibility criteria, project protocols, project implementation, and evaluation activities. With the community organizations, we outlined recruitment protocols-when to recruit, how to recruit, and connections with other organizations. CHWs enrolled 3045 men and women into the education-plus-navigation intervention. Overall, 71% received at least one cancer screening. Stratifying by gender, 72% of women received at least one cancer screening test whereas 63% of enrolled men received a test for colorectal cancer. Knowledge of screening guidelines and the belief in early detection also increased from baseline to follow-up. Our evidence-based education-plus-navigation intervention successfully reached large numbers of underserved men and women and yielded positive changes in cancer screening and knowledge of screening guidelines and the belief in early detection. The inclusion of a clinic and community component ensured success of the project.

Predictors of Colorectal Cancer Screening Modality Among Newly Age-Eligible Medicaid Enrollees.

INTRODUCTION: This study examines individual- and practice-level predictors of screening modality among 1,484 Medicaid enrollees who initiated colorectal cancer screening (fecal immunochemical test/fecal occult blood tests or colonoscopy) within a year of turning age 50 years. Understanding screening modality patterns for patients and health systems can help optimize colorectal cancer screening initiatives that will lead to high screening completion rates. METHODS: Multivariable logistic regression was conducted in 2019 to analyze Medicaid claims data (January 2013-June 2015) to explore predictors of colonoscopy screening (versus fecal testing). RESULTS: Overall, 64% of enrollees received a colonoscopy and 36% received a fecal immunochemical test/fecal occult blood test. Male (OR=1.21, 95% CI=1.08, 1.37) compared with female enrollees and those with 4-6 (OR=1.57, 95% CI=1.15, 2.15), 7-10 (OR=2.23, 95% CI=1.64, 3.03), and ≥11 (OR=1.79, 95% CI=1.22, 2.65) primary care visits compared with 0-3 visits had higher odds of colonoscopy screening. Non-White, non-Hispanic enrollees (OR=0.71, 95% CI=0.58, 0.87) compared with White, non-Hispanics Whites had lower odds of colonoscopy screening. Practices with an endoscopy facility within their ZIP code (OR=1.50, 95% CI=1.08, 2.08) compared with practices without a nearby endoscopy facility had higher odds of colonoscopy screening. CONCLUSIONS: Among newly age-eligible Medicaid enrollees who received colorectal cancer screening, non-White, non-Hispanic individuals were less likely and male enrollees and those with ≥4 primary care visits were more likely to undergo colonoscopy versus fecal immunochemical test/fecal occult blood test. Colonoscopy also was the more common modality among adults whose primary care clinic had an endoscopy facility in the same ZIP code. Future research is needed to fully understand patient, provider, and practice preferences regarding screening modality.

Predictors of health-related quality of life among Hispanic and non-Hispanic White breast cancer survivors in New Jersey.

PURPOSE: To examine predictors of health-related quality of life (HRQoL) in Hispanic and non-Hispanic White (NHW) breast cancer (BC) survivors. DESIGN: Cross-sectional study using survey data. PARTICIPANTS: Women diagnosed with BC at ages 21-79 years, between 2012-2014, recruited from the New Jersey State Cancer Registry. METHODS: HRQoL was assessed using the Functional Assessment Cancer Therapy (FACT-G) instrument. Descriptive statistics compared Hispanics and NHWs, and multivariate regression analyses identified predictors of HRQoL. RESULTS: HRQoL was significantly higher scores among NHW (85.7 ± 18.5) than Hispanics (79.4 ± 20.1) (p < 0.05). In multivariate analyses, comorbidities (ß: -13.3, 95%CI: -20.6, -5.92), late-stage diagnosis (ß: -5.67, 95%CI: -10.7, -0.62), lower income (ß: -13.9, 95%CI: -19.8, -7.97) and younger age at diagnosis were associated with lower HRQoL. CONCLUSION: Socio-demographic and clinic characteristics were significant predictors of HRQoL among diverse BC survivors. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY: Supportive psychosocial care interventions tailored to the needs of young, low-income BC survivors with comorbidities are needed.

Parental Mental Health Associated With Child Overweight and Obesity, Examined Within Rural and Urban Settings, Stratified by Income.

PURPOSE: Rural areas experience greater childhood obesity compared with urban areas. Differences in reported physical activity and dietary intake do not fully explain the disparity. The purpose of this study was to examine the association between parental mental health and childhood obesity within urban and rural areas. METHODS: We used data from the National Survey of Children's Health, 2016, subset to children age 10-17 with available weight data. We stratified the sample by rural and urban settings and examined whether maternal or paternal mental health was associated with child overweight or obesity, accounting for income stratum (low-income: ≤200% federal poverty line; high-income: >200% federal poverty line). We used multivariable analyses to test if associations remained after including covariates of food security, physical activity, and screen time. FINDINGS: For the 14,733 children 10-17 years of age in our sample, family income but not rurality was associated with overweight or obesity. Among high-income families, positive mental health of either the mother or the father was associated with lower odds of overweight or obesity. In multivariable models, the association between positive maternal mental health and lower odds of child overweight/obesity persisted after adjustment for family food security, child physical activity, and child screen time. For paternal mental health, the association was not significant after adjusting for these covariates. CONCLUSIONS: After stratification by income, there were no differences in childhood overweight/obesity by rurality. Both maternal and paternal mental health are associated with children's weight, though only the maternal association remains after adjusting for covariates.

Initiation of Colorectal Cancer Screening Among Medicaid Enrollees.

INTRODUCTION: Few studies have explored how individual- and practice-level factors influence colorectal cancer screening initiation among Medicaid enrollees newly age eligible for colorectal cancer screening (i.e., turning 50 years). This study explored colorectal cancer screening initiation among newly age-eligible Medicaid enrollees in Oregon. METHODS: Medicaid claims data (January 2013 to June 2015) were used to conduct multivariable logistic regression (in 2018 and 2019) to explore individual- and practice-level factors associated with colorectal cancer screening initiation among 9,032 Medicaid enrollees. RESULTS: A total of 17% of Medicaid enrollees initiated colorectal cancer screening; of these, 64% received a colonoscopy (versus fecal testing). Colorectal cancer screening initiation was positively associated with turning 50 years in 2014 (versus 2013; OR=1.21), being Hispanic (versus non-Hispanic white; OR=1.41), urban residence (versus rural; OR=1.23), and having 4 to 7 (OR=1.90) and 8 or more (OR=2.64) primary care visits compared with 1 to 3 visits in the year after turning 50 years. Having 3 or more comorbidities was inversely associated with initiation (OR=0.75). The odds of screening initiation were also higher for practices with 3 to 4 (OR=1.26) and 8 or more (OR=1.34) providers compared with 1 to 2 providers, and negatively associated with percentage of Medicaid panel age eligible for colorectal cancer screening (OR=0.92). CONCLUSIONS: Both individual- and practice-level factors are associated with disparities in colorectal cancer screening initiation among Oregon Medicaid enrollees. Future work promoting colorectal cancer screening might focus on additional barriers to the timely initiation of colorectal cancer screening and explore the effect of practice in-reach and population outreach strategies.

The Association Between Acculturation and Parental Feeding Practices in Families With Overweight and Obese Hispanic/Latino Children.

This study examines the association between acculturation and parental feeding practices in low-income Latinos. Overweight/obese children (N = 117), aged 5 to 14 years, and their parents were recruited from a rural health clinic. Findings show that more acculturated parents have greater control over their child's eating behavior (P = .04). Parents who perceive their child as having a weight problem also have more control over their child's eating behavior (P = .02). Control measured from regulation of how much and when the child should eat to offering sweets and screen time for good behavior. Results underscore the need for interventions to consider parental acculturation and perceptions of child weight.

Interventions Promoting Colorectal Cancer Screening Among Latino Men: A Systematic Review.

INTRODUCTION: Colorectal cancer, the second leading cause of cancer death in the United States, is also among the most preventable cancers. However, Latino men are less likely than non-Latino men to engage in preventive screening. Compared with 60% of non-Latino white men and women, only 42% of Latino men are up to date with colorectal cancer screening guidelines, which may result in diagnosis at advanced disease stages and increased deaths. We evaluated the literature on colorectal cancer screening interventions among Latino men to characterize intervention components effective in increasing colorectal cancer screening. METHODS: Two independent reviewers searched MEDLINE, CINAHL, and PsycINFO to identify articles on intervention studies that promote colorectal cancer screening among Latino men. Inclusion criteria were randomized controlled or comparative effectiveness trials, an outcome of any colorectal cancer screening test, published in English, US-based, results published from January 2004 through December 2016, Latino or Spanish-speaking male participants, and a minimum of one patient-level component. Two other reviewers independently assessed article quality and conducted data abstraction. RESULTS: Forty-four studies met the inclusion criteria; only 7 studies with 20% or more Latinos and 39% or more men were included in the final analyses. The most common intervention strategies included one-on-one interactions with a patient navigator and reducing structural barriers (eg, providing fecal occult blood tests). Interventions using small media produced mixed results. CONCLUSION: Although intervention studies focused on colorectal cancer screening among men of racial/ethnic minorities are scarce, our findings highlight promising strategies that were effective at increasing colorectal cancer screening among Latino men. Additional research in the area of Latino men's health is needed, especially to further develop and test theoretically grounded interventions that promote colorectal cancer screening with larger samples of men and across diverse geographic areas in the United States.

Health Care Access, Utilization, and Cancer Screening Among Low-Income Latina Women.

INTRODUCTION: Cancer screening reduces mortality rates for breast, cervical, and colon cancer. Yet cancer screening rates for Latina women are lower than for non-Latino Whites, and below Healthy People 2020 goals. Additionally, Latinos face many health care access barriers. This study examined health care access and utilization in relation to cancer screening among low-income Latina women recruited from a high-risk area and enrolled in a navigation-plus-education intervention. METHODS: Latina women considered rarely or never screened for breast, cervical, or colorectal cancer were recruited from community-based organizations and events (N = 691). We gathered self-reported survey data on insurance status, usual source of care, health care utilization, and cancer screening behavior. We conducted multivariable logistic regression models to estimate odds ratios of receipt of at least one cancer screening test. RESULTS: Overall, 28% of women received at least one cancer screening test. Results indicated that women without insurance (odds ratio [OR] = 2.08; confidence interval [CI] = 1.09, 3.98) and without a doctor's visit in the past year (OR = 2.02; CI = 1.28, 3.18), compared with their counterparts, had greater odds of receiving at least one screening test. CONCLUSION: Findings highlight the continued need to explore ways to support uninsured individuals' screening efforts and further investigate barriers among insured women who are not up-to-date with screenings.

Breast, Cervical, and Colorectal Cancer Education and Navigation: Results of a Community Health Worker Intervention.

Now that cancer has surpassed heart disease as the top cause of death for Hispanics in the United States, it is even more critical to focus on early detection of cancer in this population. We report the results of a theory-driven education-plus-navigation pilot intervention delivered by bilingual, bicultural community health workers (CHWs) with the goal of increasing cancer screening rates and knowledge among low-income Latinas. CHWs enrolled 691 eligible women, ages 18 to 75 years, considered rarely or never screened for breast, cervical, and colorectal cancer. Eligible women were scheduled for an education session and offered health care navigation support with appointment scheduling and reminder/follow-up calls. CHWs provided education to 535 (77%) eligible women, and arranged mammograms, Pap tests, or stool blood tests for 174 (25%) participants, with another 94 (14%) placed on a waiting list at a local health center. Statistically significant positive changes on knowledge of screening guidelines for breast, cervical, and colorectal cancer, and beliefs/attitudes regarding early detection were observed from pre- to posttest among eligible women who attended an educational session. Results highlight the effectiveness of CHW-directed interventions in recruiting individuals for programs, educating them, and influencing cancer knowledge and screening behavior.

The Relationship between Neighborhood Immigrant Composition, Limited English Proficiency, and Late-Stage Colorectal Cancer Diagnosis in California.

Despite the availability of effective early detection technologies, more than half (61%) of colorectal cancers in the United States and 55% in California are identified at an advanced stage. Data on colorectal cancer patients (N = 35,030) diagnosed from 2005 to 2007 were obtained from the California Cancer Registry. Multivariate analyses found a relationship among neighborhood concentration of recent immigrants, neighborhood rates of limited English proficiency, and late-stage colorectal cancer diagnosis. Hispanics living in neighborhoods with a greater percentage of recent immigrants (compared to the lowest percentage) had greater odds (OR 1.57, 95% CI 1.22, 2.02) of late-stage diagnosis whereas Hispanics living in neighborhoods with the highest percentage of limited English proficiency (compared to the lowest percentage) had lower odds (OR .71, 95% CI .51, .99) of late-stage diagnosis. These relationships were not observed for other ethnic groups. Results highlight the complex relationship among race/ethnicity, neighborhood characteristics, and colorectal cancer stage at diagnosis.

Promoting Weight Maintenance among Overweight and Obese Hispanic Children in a Rural Practice.

BACKGROUND: US Hispanic children experience a disproportionate burden of overweight and obesity. Comprehensive high-intensity behavioral programs have demonstrated effectiveness in improving weight status among obese children. However, there remains a need to develop more efficient interventions that are feasible in primary care and demonstrate effectiveness in Hispanic children. METHODS: The pilot study used a two-group randomized design. Eligible overweight (BMI between the 85th and 94th percentile for age and gender) or obese (BMI ≥95th percentile) Hispanic children and their parents (N=118 child/parent dyads) were recruited from a rural pediatric clinic and randomized to: standard care (SC; n=61 dyads) or behavioral intervention (INT; n=57 dyads). The primary outcomes-weight, waist circumference, and zBMI-were measured at baseline, 2, 6, and 18 weeks. Multivariate logistic regression was used to examine the effect of INT on the likelihood of weight maintenance adjusting for potential confounding variables. RESULTS: Significantly fewer INT children (68.5%) experienced weight gain, compared to SC children (89.7%; p=0.009). The same pattern was observed for waist circumference, where fewer INT children (44%) experienced an increase in waist circumference, compared to SC children (68.6%; p=0.02). Although a trend of improvement in favor of the INT was observed for zBMI, it was not significant. CONCLUSIONS: This study provides preliminary evidence for the feasibility of a primary-care-based approach to promoting weight maintenance among a high-risk population.

Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives.

BACKGROUND: Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer (CRC), as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives (FDRs) of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases. METHODS: A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months. RESULTS: The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months (26% in the intervention vs 18% in the control group) and the print intervention alone at 6 months (15% in the intervention vs 10% in the control group). The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans. CONCLUSIONS: Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses.

Promotora Outreach, Education and Navigation Support for HPV Vaccination to Hispanic Women with Unvaccinated Daughters.

Cervical cancer disparities persist in the predominantly Hispanic population of South Texas, and Hispanic girls are less likely to initiate and complete the three-dose human papillomavirus (HPV) vaccine series. Culturally relevant interventions are needed to eliminate these disparities and improve HPV vaccine initiation and completion. We enrolled 372 Hispanic women from South Texas' Cameron and Hidalgo counties with a daughter, aged 11-17, who had not received HPV vaccine. All participants received an HPV vaccine educational brochure in their preferred language (English or Spanish) and were invited to participate in the Entre Madre e Hija (EMH) program, a culturally relevant cervical cancer prevention program. EMH participants (n = 257) received group health education, referral and navigation support from a promotora (a trained, culturally competent community health worker). Those who declined participation in EMH received the brochure only (n = 115). Eighty-four percent of enrolled participants initiated the HPV vaccine, and no differences were observed between EMH program and brochure-only participants. Compared to brochure-only participants, EMH participants were more likely to complete the vaccine series [adjusted odds ratio (adj. OR) = 2.24, 95% CI (1.25, 4.02)]. In addition, participants who were employed and insured had lower odds of completing the vaccine series [adj. OR = 0.45, 95% CI (0.21-0.96); adj. OR = 0.36, 95% CI (0.13-0.98), respectively]. All enrolled participants had high vaccine initiation rates (>80%); however, EMH program participants were more likely to complete the vaccine series. HPV vaccine promotion efforts that include referral and navigation support in addition to education show promise.

Assessing media access and use among Latina adolescents to inform development of a physical activity promotion intervention incorporating text messaging.

Increasing physical activity (PA) during preadolescence and adolescence is critical to reversing the obesity epidemic. A recent report described the promising role of eHealth--the use of new media for purposes of health promotion--in reducing and preventing childhood obesity. This study assessed access/use of various media (cell phones, computers, gaming systems, Internet) among adolescent Latino girls and examined the relationship between PA and media access/use. A convenience sample of 110 Latino girls ages 11 to 14 was recruited from Girl Scouts of Southwest Texas and other groups. The media survey was self-administered (April-July 2010) on personal digital assistants. Of the girls, 55% reported owning a cell phone and spending 40 (SD = 4.2) hours per week talking, texting, listening to music, and browsing the Internet. Cell phone access increased significantly with age (p = .029). Compared to those with no cell phone, girls with a cell phone have greater odds of reporting more than 5 days of PA in the past week (odds ratio = 5.5, 95% confidence interval [CI] = 2.1, 14) and engaging in daily physical education classes (odds ratio = 2.6, 95% CI = 1.1, 5.9). Since girls with cell phones report greater PA, cell phones may be an effective strategy for communicating with girls about engaging in PA.

Neighborhood socio-economic disadvantage and race/ethnicity as predictors of breast cancer stage at diagnosis.

BACKGROUND: This study investigated the role of key individual- and community-level determinants to explore persisting racial/ethnic disparities in breast cancer stage at diagnosis in California during 1990 and 2000. METHODS: We examined socio-demographic determinants and changes in breast cancer stage at diagnosis in California during 1990 and 2000. In situ, local, regional, and distant diagnoses were examined by individual (age, race/ethnicity, and marital status) and community (income and education by zip code) characteristics. Community variables were constructed using the California Cancer Registry 1990-2000 and the 1990 and 2000 U.S. Census. RESULTS: From 1990 to 2000, there was an overall increase in the percent of in situ diagnoses and a significant decrease in regional and distant diagnoses. Among white and Asian/Pacific Islander women, a significant percent increase was observed for in situ diagnoses, and significant decreases in regional and distant diagnoses. Black women had a significant decrease in distant -stage diagnoses, and Hispanic women showed no significant changes in any diagnosis during this time period. The percent increase of in situ cases diagnosed between 1990 and 2000 was observed even among zip codes with low income and education levels. We also found a significant percent decrease in distant cases for the quartiles with the most poverty and least education. CONCLUSIONS: Hispanic women showed the least improvement in breast cancer stage at diagnosis from 1990 to 2000. Breast cancer screening and education programs that target under-served communities, such as the rapidly growing Hispanic population, are needed in California.

Prostate cancer screening among ethnically diverse first-degree relatives of prostate cancer cases.

OBJECTIVE: This study examined potential ethnic differences in prostate cancer screening behavior and correlates of screening in an ethnically diverse sample of first-degree relatives of prostate cancer cases. METHODS: The California Cancer Registry was used to identify a sample of prostate cancer cases who were contacted and invited to refer male first-degree relatives to the study. Telephone surveys with 1,029 first-degree relatives (354 non-Latino Whites, 228 Latinos, 272 African Americans, 175 Asians) assessed prostate cancer screening behavior and correlates of screening. RESULTS: Less than half of the participants had received a prostate specific antigen (PSA) test in the past year, with lowest rates observed among Latinos. Factors independently associated with an increased likelihood of the PSA test receipt in the total sample included: prior PSA testing, having a physician recommendation to be screened, and reporting fewer barriers to screening. Being the brother versus the son of the case predicted a higher likelihood of screening for all ethnic groups except for African Americans. In addition, the negative influence of barriers on screening was significantly greater for Latinos compared with Asians. CONCLUSIONS: Although ethnicity was not an independent predictor of screening, ethnic variations were observed in the relationship between some predictors and screening and in the modifiable correlates of screening. Findings may inform future intervention research that aims to enhance informed decision-making regarding prostate cancer screening and ultimately reduce prostate cancer health disparities.