Differential response to targeted recruitment strategies to fitness promotion research by African-American women of varying body mass index.

OBJECTIVE: To assess patterns of recruitment into a community-based NCI-funded physical activity and dietary lifestyle change program targeting African-American women. DESIGN: Acquisition of a convenience sample to be screened for participation in a randomized, controlled prevention intervention. SETTING: African-American-owned and -operated health club located in an area of Los Angeles in which African Americans are concentrated. PARTICIPANTS: 893 African-American women. RECRUITMENT STRATEGIES: Social networking/word-of-mouth, staff presentations, mass and targeted media, and physician referral. MAIN OUTCOME MEASURE: Completion of screening questionnaire indicating a desire to enroll in the study. Screening questionnaire domains included self-reported height and weight, recent participation in organized weight loss programs, ability to walk one mile unassisted, current medication use, smoking status, personal medical history of cancer, sociodemographic variables, and recruitment source. RESULTS: Sociodemographic and anthropometric characteristics distinguished between respondents obtained through different recruitment strategies. In particular, women with a higher body mass index (BMI) were more likely than those with lower BMIs (P = .014) to be recruited through more personalized methods (eg, social networking). CONCLUSIONS: Culturally tailored recruitment strategies are critical in securing the participation of members of "hard-to-reach" populations, who are both under-represented in health promotion research and at high risk for chronic diseases.

Overweight and depressive symptoms among African-American women.

BACKGROUND: In a national survey, a correlation between overweight and depression was explained by dieting and poor health. This study examines overweight and depressive symptoms among urban African-American women, taking into account demographic factors, health status and practices, and psychosocial constructs. METHODS: Respondents are 429 participants in a pilot for a culturally tailored intervention promoting healthful eating and exercising. Anthropomorphic and self-administered questionnaire data were collected at a community health club site. RESULTS: Controlling for demographic factors, overweight is associated with symptoms of depression, a relationship that is partially explained by health status, but not by dietary restraint. Using multiple regression, poor health status, alcohol intake, hostility, and low levels of ethnic identity (connectedness with the African-American community) are independent predictors of depressed mood. In this study, dietary restraint reflects healthful eating and is inversely related to depression. The overweight/depression association is stronger among women with high levels of education and high levels of ethnic identity (statistical interactions). CONCLUSION: Poor health likely contributes over time to both overweight and depressed mood. Ethnic identity enhancement strategies should be studied for their effectiveness in strengthening identity and for their potential in attracting individuals especially likely to benefit from lifestyle change programs.

Body image, perceived pubertal timing, and adolescent mental health.

PURPOSE: To examine the impact of gender, racial-ethnic group, and perceived pubertal timing on body image and adolescent mental health. METHOD: A three-stage, area probability sample was selected which included 877 teens (13-18 years) with diverse social and demographic characteristics. Interviews in English or Spanish were conducted in person. The content emphasized emotional distress and problematic behavior, exposure to social stressors, coping resources and behaviors, and socioeconomic and demographic characteristics of the adolescent and his or her family. RESULTS: Girls were more depressed and had lower self-esteem than boys, but not after controlling for body image. Hispanics were more depressed and had lower self-esteem than other racial-ethnic groups, a difference that remained when controlling for body image. African-Americans had the most positive body image, a finding that could not be attributed to higher self-esteem or fewer depressive symptoms. The impact of perceived pubertal timing on body image varied considerably by gender and across racial-ethnic group. CONCLUSIONS: Negative feelings about their bodies contribute to the higher prevalence of depressive symptomatology and lower self-esteem among girls. African-Americans appear to take pride in their bodies in a manner that sets them apart from other teenagers, suggesting they hold a different ideal. Relative to teenagers of other racial-ethnic backgrounds, Hispanics may be at elevated risk for mental health problems.

Physical activity among African American and Latino middle school girls: consistent beliefs, expectations, and experiences across two sites.

Physical inactivity is a major public health concern. Low levels of physical activity are reported in many subgroups of women including adolescent girls. More data are needed to better understand factors related to physical activity participation in adolescent girls. Therefore, we explored adolescent girls' reasons for participating and not participating in physical activity. Two independent samples were taken in California and Texas; the total sample included thirty-four African American and Latino girls. Six focus groups were conducted by trained facilitators. Based on independent qualitative analyses, six replicated themes emerged from the focus groups. Fun, social support, and concern with body image facilitated participation in activity. In contrast, negative experiences in physical education classes, concerns about appearance after activity, and lack of opportunity impeded participation in activity. Overall, the girls showed an interest in physical activity and identified activity motivators and barriers. We discuss the implications of our findings for future research.

Building positive self-image in adolescents in foster care: the use of role models in an interactive group approach.

In a previous article (Yancey, 1992), the literature on identity development in individuals from socially devalued racial and ethnic groups was summarized. It was postulated that the social maladaptation of adolescents in residential group foster care is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial/ethnic socialization. The present article describes the development of a pilot preventive mental health intervention, the PRIDE (Personal and Racial/ethnic Identity Development and Enhancement) program, designed to provide components of parenting that are necessary for promoting positive self-image in ethnically marginalized adolescents and that are typically lacking in the group foster care milieu. PRIDE utilizes successful, ethnically relevant role models in interactive group sessions to create a significant cognitive and emotional experience for teens. While the utility of role modeling for at-risk youth is widely accepted, there is little research on the packaging, delivery, and influence of this intervention modality. This study demonstrates the feasibility of a "hybrid" role-modeling approach (intermediate in intensity of exposure and cost between one-to-one mentoring and career-day programs). Implications for further research on this type of intervention are discussed.

African-American physicians and smoking cessation counseling.

While African American physicians can play a key role in encouraging black patients who smoke to quit, little is known about the views and activities of these physicians with respect to antitobacco programming. In the process of developing a protocol for encouraging physicians' smoking cessation intervention, 96 African-American physicians completed a survey indicating their knowledge, attitudes, and practices relating to stop smoking counseling. Few physicians reported patient help-seeking behavior and 47.9% cited lack of patient motivation as a key barrier to intervention. Only 46.8% believed that it is possible to accomplish a lot of cessation help in a few minutes time, and 34.4% believed that setting up and maintaining an office protocol would require a great deal of effort. Explaining health risks (71.9%) and enrolling patients in programs (66.6%) were perceived as keys to patient cessation; fewer than half of the physicians surveyed discuss specific strategies for quitting with their patients. Physicians indicated a willingness to offer more counseling in the future and were open to a range of strategies for learning more about effective approaches. Our findings support the need for dissemination of such information, particularly among specialists, to support antitobacco efforts among African-American physicians.

Measurement of organochlorine levels in postprandial serum or in blood collected in serum separator tubes.

Whether organochlorine blood levels in fasting and postprandial specimens provide equivalent measures of exposure and the extent to which collecting blood in tubes containing material to separate serum and blood cells corrupts the specimen are unclear. In this paper, we present data from two studies that address both of these issues. In the first study, 27 women provided fasting blood in plain, silicone-coated Vacutainer tubes (red-topped) and in similar tubes containing serum separator gel (SSTs), as well as a postprandial specimen in a red-topped tube. The specimens collected in SSTs were left to stand overnight, with the gel in contact with the sample. In the second study, the blood of 12 industrial incinerator workers was collected in red-topped tubes and in SSTs. Blood in SSTs was left in contact with the gel for 5 days. Serum organochlorine residue levels ([1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] (DDE)) and polychlorinated biphenyls) in samples collected in red-topped tubes were highly correlated with levels measured in samples collected in SSTs (all Pearson r values were > or = 0.79). Postprandial and fasting organochlorine levels were also highly correlated (Pearson r values > or = 0.89). Our results indicate that timing of the collection of blood in relation to meals and use of SSTs to collect blood specimens did not greatly affect the relative classification of subjects with respect to serum level of DDE or polychlorinated biphenyls. The longer the specimen was in contact with the SST gel, however, the lower the level of organochlorine that was detected and, at least for DDE, the greater the misclassification caused.

Increased cancer screening behavior in women of color by culturally sensitive video exposure.

BACKGROUND: Electronic media have demonstrated efficacy in increasing knowledge and promoting health-protective behavior among individuals at high risk for chronic disease. In "Stimulating Cancer Screening among Women of Color through Video" (A. K. Yancey and L. Walden, 1994, J Cancer Educ 9:46-52) the development of a cost-effective documentary format for culturally sensitive health education videos was described. These videos could not be independently evaluated within the cancer control program for which they were developed. METHODS: A quasi-experimental study design tested the hypothesis that exposure to these videos increases cervical cancer screening behavior among samples of women from two clinic populations of predominantly low-income African-Americans and Latinos in New York City and Los Angeles. A 1-week-on-1-week-off design was utilized, in which the videos were continuously displayed in designated waiting rooms during on (intervention) weeks, with each facility serving as its own control during off weeks. RESULTS: The proportion of women seen as patients during the intervention weeks who subsequently obtained Pap smears was significantly higher than that of those seen during the control weeks at each site (P < 0.05). CONCLUSIONS: Culturally sensitive videos displayed in waiting rooms may be useful in health promotion efforts in communities of color. The similarity of results in both clinic sites suggests that Spanish-language tapes may be constructed to appeal to Latinos of different nationalities.

Stimulating cancer screening among Latinas and African-American women. A community case study.

Recent studies have attributed underutilization of early cancer detection programs among the disadvantaged to knowledge deficits and myths, lack of belief in cancer susceptibility (denial), and such attitudinal barriers as fear and embarrassment. Video modalities have been demonstrated to be effective in increasing knowledge and promoting health-protective behavior in low-income people of color. Waiting rooms of public health clinic facilities in large urban areas provide a captive audience of predominantly African Americans and Latinos with a preference for obtaining health information from audiovisual media. The development of a culturally sensitive, cost-effective documentary format is described. An experience of rapid acceleration in demand for Pap smears in an underserved Latino community of East Los Angeles following the showing of one of these videos is chronicled as a spontaneous and informal evaluation of this approach to health education/promotion video production.

Identity formation and social maladaptation in foster adolescents.

The literature on identity formation in individuals from socially devalued racial and ethnic groups in the United States is summarized. Implications are discussed for a particular segment of at-risk adolescents--those in foster care residential group homes--who have received little published attention. The majority, in large urban centers, are African-American or Latino. These young people bear a disproportionate burden of such societal problems as unintended pregnancy and childbearing, academic underachievement and early educational discontinuation, substance abuse, and, ultimately, homelessness and more individually and socially costly forms of dependency (criminal justice, welfare, or mental health systems). It is postulated that their social maladaptation is reflective of identity disturbances created by the negative images of African-Americans and Latinos perpetuated by the dominant society and unfiltered by optimal parental racial socialization.