Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence.

BACKGROUND: One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence. METHODS: We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry. RESULTS: African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively). CONCLUSION: Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals. IMPACT: More research is needed on how barriers can be overcome to improve LCS adherence.

A Pesquisa em Prevenção em Saúde Mental no Brasil: A Perspectiva de Especialistas / The Research on Mental Health Prevention in Brazil: The Expert's Perspective

Resumo: Este estudo investigou experiências e recomendações de pesquisadores em prevenção primária em saúde mental no Brasil, com vistas a subsidiar uma agenda de trabalho para o fortalecimento nacional da área. Utilizou-se a técnica Delphi e dez pesquisadores, especialistas em prevenção, foram entrevistados. Investimentos na aproximação entre pesquisa e extensão, incremento do ensino de prevenção, parceria com diversas áreas de conhecimento e estudos de validação de instrumentos para avaliação de programas foram citados como necessidades. Foram apresentados recursos pessoais, profissionais e ambientais, percebidos como apoiadores para a construção da carreira. Foram abordadas direções futuras para a área, tais como a construção de redes de pesquisa e a difusão de programas preventivos. São discutidas implicações dos dados para uma agenda de pesquisa.

Abstract: This study investigated experiences and recommendations of researchers in primary prevention in mental health in Brazil in order to support a working agenda to strengthen this national field. The Delphi technique was used and ten researchers, prevention specialists, were interviewed. Investments in rapprochement between research and extension, increase prevention education, partnership with various areas of expertise and studies on validation of instruments for program evaluation were cited as needs. Personal, professional and environmental resources were presented as being of support to career building. Future directions for the area were discussed, such as the strengthening of research networks and dissemination of preventive programs. Implications of the results for a research agenda are discussed.

Early Childhood Disadvantage for Sons of Mexican Immigrants: Body Mass Index Across Ages 2-5.

PURPOSE: To distinguish the origins of higher weight status and determine when and why intra- and interracial/ethnic disparities emerge. DESIGN: The study used a longitudinal analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). SETTING: The study was conducted in the United States. SUBJECTS: Participants were children of non-Hispanic white mothers and children of U.S.- and foreign-born mothers of Mexican origin from a nationally representative sample of children born in the year 2001 (N ≈ 3700). MEASURES: The Centers for Disease Control and Prevention growth charts determined sex- and age-specific weight status. Covariates were obtained from birth certificate records and parent interviews. ANALYSIS: Frequencies, growth curve trajectories, and ordinary least squares regression examined body mass index (BMI) and obesity across survey waves. RESULTS: Compared to their peers with non-Hispanic white mothers, children of Mexican-heritage mothers have higher average BMI and greater rates of obesity. The BMI of boys with Mexican-born mothers is higher relative to whites and children of U.S.-born Mexican mothers across early childhood, increasing sharply at about age 4.5 years. This divergence is driven by increases in the BMI of boys, as girls do not show the same growth. A number of measures, including descriptors of children's nutritional intake, lifestyle factors, and acculturation, do not explain the increased obesity rates among sons of Mexican mothers. CONCLUSION: Despite favorable perinatal health and weight, Mexican-American sons of foreign-born mothers show disadvantages in BMI that emerge close to the start of kindergarten.

The Role of Physical Activity and Sedentary Behaviors in Explaining the Association Between Acculturation and Obesity Among Mexican-American Adults.

PURPOSE: We investigated associations of acculturation with various types of activity (moderate-vigorous leisure-time physical activity [LTPA], moderate-vigorous work- and transportation-related physical activity, and sedentary activity), and whether these activities mediated the acculturation-obesity association among Mexican-Americans. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 2007-2010. SUBJECTS: Mexican-American NHANES participants aged ≥20 years (n = 1902). MEASURES: Demographic characteristics, physical activity, sedentary behavior, acculturation, and body mass index. ANALYSIS: Multinomial logistic regression was used to estimate associations of acculturation with categories of self-reported activity. Path analysis was used to test whether the activity measures mediated acculturation-obesity associations. RESULTS: In adjusted models, compared to U.S.-born Mexican-Americans, foreign-born Mexican-Americans living in the United States for less than 10 years were significantly less likely to be in the highest LTPA and sedentary activity categories, and more likely to be in the highest total and transportation activity categories. Foreign-born Mexican-Americans living in the United States for 10 years or more were significantly less likely to engage in high sedentary activity but more likely to engage in high transportation activity. Sedentary behavior was the strongest mediator of the acculturation-obesity association, accounting for 40.7% and 57.1% of the total effect of acculturation on obesity among foreign-born Mexican-Americans living in the United States for less than 10 years and for 10 years or more, respectively, compared to U.S.-born Mexican-Americans. CONCLUSION: Reducing sedentary behavior may lower the negative impact of acculturation on obesity.

A physical-cognitive intervention to enhance gait speed in older Mexican adults.

PURPOSE: To test the effects of a physical-cognitive exercise intervention on gait parameters under dual-task conditions in community-dwelling older adults. DESIGN: A repeated-measures quasi-experimental design, with control and exercise groups, was used. SETTING: Study participants consist of a convenience sample recruited from senior citizens' centers in Monterrey, Mexico. SUBJECTS: A total of 143 sedentary participants ages 65 to 92 years per group participated. INTERVENTION: A combined 45- to 60-minute program of physical and cognitive exercises was conducted in three weekly sessions during 12 weeks for the exercise group. Measures . The spatial gait parameters of speed (cm/s), step width, and stride length (cm); and the temporal parameters of single and double support time, cadence (steps per minute), and swing time(s) were measured using the GaitRite. Counting backwards or naming animals represented cognitive performance. ANALYSIS: Two (groups: exercise group vs. control group) by three (time: baseline, week 6, and week 12) repeated-measures multivariate analysis of variance (MANOVA) was applied. RESULTS: Repeated-measures multivariate analysis of variance revealed a significant group effect (Wilks lambda F4,279 = 6.78, p < .001); univariate analysis showed significant differences for gait speed (m/s), stride length, cadence, step width, and double support time. Time-by-group interaction showed significance in gait speed and stride length. CONCLUSION: The exercise group participants showed increased gait speed, cadence, and stride length, and reduced their step width and time spent with both feet on the ground. Walking while simultaneously performing a cognitive task might prepare older adults for competing/interfering demands from their environments. The protective health benefits of this intervention remain to be investigated.

The influence of gender stereotypes on eating habits among Costa Rican adolescents.

PURPOSE: To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents. DESIGN: Qualitative, descriptive research was used in this study. SETTING: Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica. SUBJECTS: Subjects were 92 adolescents (14 to 17 years old) and 48 parents. METHODS: Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory. RESULTS: Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior. CONCLUSION: Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Household food insecurity and dietary intake among Mexican-American women participating in federal food assistance programs.

PURPOSE: To explore the association between food insecurity and dietary intake among Mexican-American women after controlling for sociocultural and economic factors including participation in federal food assistance programs. DESIGN: Cross-sectional. SETTING: Three cities in Texas. SUBJECTS: Seven hundred seven Mexican-American women (26-44 years). MEASURES: Demographics, anthropometrics, acculturation, and food security status were obtained using validated measures. Dietary intake was assessed by a 24-hour dietary food record. ANALYSIS: Logistic regression was used to examine the association between individual and household characteristics on food security status. One-way analysis of covariance tested the association between food security status and dietary intake after adjusting for socio-demographic variables, acculturation, body mass index, participation in federal food assistance programs, and energy intake. RESULTS: About 77% of food-insecure women participated in at least one federal food assistance program. Each additional child in the household increased the odds of being food insecure by 25%. A higher proportion of obese women was found in the food-insecure group. No significant differences in dietary intake were found by food security status. CONCLUSION: Food insecurity did not negatively influence dietary intake independently of women's participation in federal food assistance programs. Food security did not ensure consumption of nutritionally adequate foods. Educational and food assistance programs need to be optimized to facilitate enrollment and improve the nutritional status of this ethnic group, food secure or not.