Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study

Background

Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings.

Methods

We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, “fit” between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training.

Results

Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program offerings and other organizational characteristics were not statistically significant.

Conclusions

Findings suggest that many parishes do not offer cancer control programs, yet many may be ready to do so. However, the perceptions about existing organizational practices and policies may not be conducive to program initiation. A capacity enhancement intervention may hold promise as a means of increasing health programming. The efficacy of such an intervention will be tested in phase two of this study.

Does Successful Weight Loss in an Internet-Based Worksite Weight Loss Program Improve Employee Presenteeism and Absenteeism?

Certain risk factors associated with overweight and obesity may lead to reduced productivity in the workforce (i.e., increased absenteeism and presenteeism). Participants in a large, Internet-based worksite weight loss intervention, who were present at follow-up (N = 1,030), completed a self-reported productivity measure (World Health Organization's Health and Work Performance Questionnaire) at baseline and postintervention. Twenty-two percent of the participants lost a clinically meaningful amount of weight (≥5% weight loss). There were no statistically significant (p < .05) relationships between weight change from baseline to 12 months and change scores of absolute or relative absenteeism or for absolute or relative presenteeism. Within a modestly successful Internet-based, worksite weight loss intervention, weight loss did not improve self-reported absenteeism or presenteeism. Further studies are needed to explore the sensitivity of the World Health Organization's Health and Work Performance Questionnaire and the long-term effects of weight loss on productivity.

Effectiveness of a worksite-based weight loss randomized controlled trial: the worksite study

OBJECTIVE

To determine the effectiveness of an individually targeted Internet-based intervention with monetary incentives (INCENT) at reducing weight of overweight and obese employees when compared with a less-intensive intervention (Livin' My Weigh [LMW]) 6 months after program initiation.

METHODS

Twenty-eight worksites were randomly assigned to either INCENT or LMW conditions. Both programs used evidence-based strategies to support weight loss. INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and on-site educational sessions. Generalized linear mixed models were conducted for weight change from baseline to 6 months post-program and using an intention-to-treat analysis to include all participants with baseline weight measurements.

RESULTS

Across 28 worksites, 1,790 employees (M = 47 years of age; 79% Caucasian; 74% women) participated. Participants lost an average of 2.27 lbs (P < 0.001) with a BMI decrease of 0.36 kg/m(2) (P < 0.001) and 1.30 lbs (P < 0.01) with a BMI decrease of 0.20 kg/m(2) (P < 0.01) in INCENT and LMW, respectively. The differences between INCENT and LMW in weight loss and BMI reduction were not statistically significant.

CONCLUSIONS

This study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites.

A literature synthesis of health promotion research in salons and barbershops

CONTEXT

Barbershops and beauty salons are located in all communities and frequented by diverse groups of people, making them key settings for addressing health disparities. No studies have reviewed the growing body of literature describing studies promoting health in these settings. This review summarized the literature related to promoting health within barbershops and beauty salons to inform future approaches that target diverse populations in similar settings.

EVIDENCE ACQUISITION

We identified and reviewed published research articles describing formative research, recruitment, and health-related interventions set in beauty salons and barbershops. PubMed and other secondary search engines were searched in 2010 and again in 2013 for English-language papers indexed from 1990 through August 2013. The search yielded 113 articles, 71 of which were formerly reviewed, and 54 were eligible for inclusion.

EVIDENCE SYNTHESIS

Included articles were categorized as formative research (n=27); recruitment (n=7); or intervention (n=20). Formative research studies showed that owners, barbers/stylists, and their customers were willing participants, clarifying the feasibility of promoting health in these settings. Recruitment studies demonstrated that salon/shop owners will join research studies and can enroll customers. Among intervention studies, level of stylist/barber involvement was categorized. More than 73.3% of intervention studies demonstrated statistically significant results, targeted mostly racial/ethnic minority groups and focused on a variety of health topics.

CONCLUSIONS

Barbershops and beauty salons are promising settings for reaching populations most at risk for health disparities. Although these results are encouraging, more rigorous research and evaluation of future salon- and barbershop-based interventions are needed.

Health promotion in smaller workplaces in the United States

Most American workplaces are smaller, with fewer than 1,000 employees. Many of these employees are low-wage earners and at increased risk for chronic diseases. Owing to the challenges smaller workplaces face to offering health-promotion programs, their employees often lack access to health-promotion opportunities available at larger workplaces. Many smaller employers do not offer health insurance, which is currently the major funding vehicle for health-promotion services. They also have few health-promotion vendors to serve them and low internal capacity for, and commitment to, delivery of on-site programs. The programs they offer, whether aimed at health promotion alone or integrated with health protection, are rarely comprehensive and are understudied. Research priorities for health promotion in smaller workplaces include developing programs feasible for the smallest workplaces with fewer than 20 employees. Policy priorities include incentives for smaller workplaces to implement comprehensive programs and an ongoing system for monitoring and evaluation.

Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study

CONTEXT

Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.

OBJECTIVE

To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.

DESIGN

Cross-sectional study.

SETTING

Participants completed a validated survey instrument via mail.

PATIENTS OR OTHER PARTICIPANTS

A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading.

INTERVENTION(S)

Athlete knowledge and attitude scores served as separate predictor variables.

MAIN OUTCOME MEASURE(S)

We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.

RESULTS

Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions.

CONCLUSIONS

Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.

Motivation for participating in a weight loss program and financial incentives: an analysis from a randomized trial

This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.

Who participates in internet-based worksite weight loss programs?

BACKGROUND

The reach and representativeness are seldom examined in worksite weight loss studies. This paper describes and illustrates a method for directly assessing the reach and representativeness of a internet-based worksite weight loss program.

METHODS

A brief health survey (BHS) was administered, between January 2008 and November 2009, to employees at 19 worksites in Southwest Virginia. The BHS included demographic, behavioral, and health questions. All employees were blinded to the existence of a future weight loss program until the completion of the BHS.

RESULTS

The BHS has a participation rate of 66 percent and the subsequent weight loss program has a participation rate of 30 percent. Employees from higher income households, with higher education levels and health literacy proficiency were significantly more likely to participate in the program (p's < .01).

CONCLUSIONS

Worksite weight loss programs should include targeted marketing strategies to engage employees with lower income, education, and health literacy.

Cancer Screening Behaviors of African American Women Enrolled in a Community-Based Cancer Prevention Trial

Background: African American women have increased mortality rates for cervical, breast, and colorectal cancers, yet not all receive the recommended screening tests for these cancers. We characterized the cancer screening behaviors of African American women enrolled in a community-based cancer prevention trial. Methods: We examined cross-sectional data from 1123 African American customers aged ≥18 years from 37 beauty salons in North Carolina who completed the North Carolina BEAUTY and Health Project baseline survey. Mixed logistic regression models were used to identify correlates of receiving cervical, breast, and colorectal cancer screening tests within recommended screening guidelines. Results: Overall, 94% (1026 of 1089) of women aged ≥18 years reported receiving a Pap smear test within the last 3 years, 70% (298 of 425) of women aged ≥40 years reported receiving a mammography within the last year, and 64% (116 of 180) of women aged ≥50 years were considered to be within recommended screening guidelines for colorectal cancer. Age was correlated with recent Pap smear testing and mammography. Women who reported receiving a recent Pap smear test were more likely to report a mammogram in the last year, and women with a recent mammogram were more likely to be within recommended screening guidelines for colorectal cancer. Many women reported multiple barriers to getting recommended cancer screening tests. Conclusions: Almost all women reported receiving a Pap smear test within the last 3 years. Future interventions should focus on increasing breast and colorectal cancer screening among African American women.

Views about secondhand smoke and smoke-free policies among North Carolina restaurant owners before passage of a law to prohibit smoking

BACKGROUND

This study examined the knowledge, attitudes, and beliefs about secondhand smoke and smoke-free policies among North Carolina restaurant owners and managers before passage of House Bill 2, which prohibited smoking in most restaurants and bars.

METHODS

A random sample of North Carolina restaurants was selected to participate. A 15-minute telephone survey was completed by 523 restaurant owners and managers (one per participating restaurant) who spoke English and operated a restaurant that had seating for guests and was not a corporate headquarters for a restaurant chain (response rate, 36.7%). Bivariable analyses using chi2 tests of association were conducted. Multivariable modeling with logistic regression was used to examine relationships among several predictor variables and current smoking policies at participating restaurants, support among owners and managers for a statewide ban on smoking in restaurants, and beliefs among owners and managers about the economic impact of smoke-free policies.

RESULTS

Restaurant owners and managers were aware that secondhand smoke causes cancer and asthma (79% and 73% or respondents, respectively) but were less aware that it causes heart attacks (56%). Sixty-six percent of restaurants did not permit any smoking indoors. Sixty percent of owners and managers supported a statewide smoke-free law. Owners and managers who were current smokers, those who worked at a restaurant with an employee smoking prevalence of more than 25%, and those who worked in a restaurant without a 700% smoke-free policy were significantly less likely to support a statewide law requiring smoke-free public places. Only owner and manager smoking status and no current smoke-free indoor policy were significant independent predictors of the belief that instituting a smoke-free policy would have negative economic consequences for the restaurant.

LIMITATIONS

Although participating establishments were a representative sample of North Carolina restaurants, an overall survey response rate of 36.7% limits the generalizability of these findings.

CONCLUSIONS

Most North Carolina restaurant owners and managers in our sample had a smoke-free indoor policy and supported a law to make public places smoke-free. Results were used to strengthen interventions that create a safe and healthy environment for restaurant employees and customers, in anticipation of passage of House Bill 2.

Assessing and promoting physical activity in African American barbershops: results of the FITStop pilot study

This study assessed the feasibility of recruiting African American men in barbershops, assessing their physical activity, conducting physical measurements, and gauging their interest in barbershop-based health research. The authors recruited African American shop owners (n = 4), barbers (n = 6), and customers (n = 90) from four barbershops in Raleigh and Durham, North Carolina, during 2009. The participation levels were high among owners (100%), barbers (67%), and customers (81%). In addition to completing a self-administered survey, 57% (51/90) of the customers completed physical measurements. According to self-reported data, 34% (30/88) of the customers met national physical activity recommendations within the last week. Customers expressed moderately high interest in learning more about health at barbershops and joining a barbershop-based physical activity contest. The estimated recruiting cost per customer was $105.92. Barbershops offer an effective setting for recruiting African American men and conducting physical measurements as well as an interesting possible location for conducting future interventions.

Engaging key stakeholders to assess and improve the professional preparation of MPH health educators

OBJECTIVES

We described the process of engaging key stakeholders in a systematic review of requirements for a master of public health (MPH) degree within the Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, and summarized resulting changes.

METHODS

A benchmarking study of 11 peer institutions was completed. Key stakeholders (i.e., current students, alumni, faculty, staff, employers, and practicum preceptors) received online or print surveys. A faculty retreat was convened to process results and reach consensus on program revisions.

RESULTS

MPH program changes included (1) improved advising and mentoring program, (2) elimination of research and practice track options, (3) increased elective and decreased required credit hours, (4) replacement of master's paper requirement with "deliverables" (written products such as reports, documents, and forms) produced as part of the required "Capstone" course, (5) extended community field experience to 2 semesters and moved it to year 2 of the program, and (6) allowed practica of either 200, 300, or 400 hours.

CONCLUSIONS

Engaging key stakeholders in the program review process yielded important changes to the MPH degree program requirements. Others may consider this approach when undertaking curriculum reviews.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

A Pilot Study Testing the Effect of Different Levels of Financial Incentives on Weight Loss Among Overweight Employees

OBJECTIVE

To test the ability of two levels of modest financial incentives to encourage weight loss among overweight employees.

METHODS

This study used a randomized design with measurements at baseline, 3, and 6 months and two levels of financial incentives ($7 and $14 per percentage point of weight lost). Payments were structured so that all participants had equal ability to obtain the incentives during the study period.

RESULTS

At 3 months, participants with no financial incentive lost 2 pounds, those in the $7 group lost approximately 3 pounds, and those in the $14 group lost 4.7 pounds. Between baseline and 6 months, when the financial gains were equalized, weight losses were similar across groups.

CONCLUSION

This study revealed that modest financial incentives can be effective in motivating overweight employees to lose weight.

Beauty salons: a promising health promotion setting for reaching and promoting health among African American women

African American women suffer disproportionately from a wide range of health disparities. This article clarifies how beauty salons can be mobilized at all levels of the social-ecological framework to address disparities in health among African American women. The North Carolina BEAUTY and Health Project is a randomized, controlled intervention trial that takes into account the unique and multilevel features of the beauty salon setting with interventions that address owners, customers, stylists; interactions between customers and stylists; and the salon environment. The authors make explicit the role of the political economy of health theoretical perspective for understanding important factors (social, political, historical, and economic) that should be considered if the goal is to create successful, beauty-salon-based interventions. Despite some important challenges, the authors contend that beauty salons represent a promising setting for maximizing reach, reinforcement, and the impact of public health interventions aimed at addressing health disparities among African American women.

Using the PRECEDE model to plan men's health programs in a managed care setting

Managed care organizations represent an important venue for delivering health promotion programs. However, most health plans do not employ public health strategies that match peoples' needs and preferences to effective behavior change techniques. This article focuses on the planning efforts by Blue Cross and Blue Shield of North Carolina (BCBSNC) to address the problem of underutilization of preventive health care services among adult male members--an issue that has received comparatively little attention in the health behavior arena. BCBSNC planners used the PRECEDE planning process to define issues relevant to the target population and determine appropriate intervention strategies. Increasing perceived susceptibility and severity to disease, perceived benefits of screening, physician recommendation for screening, and health knowledge/awareness emerged as intervention priorities. The PRECEDE planning process yielded important evidence-based information and strategies to address men's underuse of preventive services and led BCBSNC to adopt new systems for planning interventions to promote the health of its members.

“Una Mujer Trabaja Doble Aquí”: Vignette-Based Focus Groups on Stress and Work for Latina Blue-Collar Women in Eastern North Carolina

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignettebased moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.